Tuesday, 29 September 2015

10 Things I've Learnt from Dental Foundation Training - Dental Spotlight Article

It's a honour to be featured on DENTAL SPOTLIGHT this week!

Dental Spotlight is a blog aimed at moving the light away from the patient and onto the dentist.'

The website is a collection of interviews and articles about individuals in the world of dentistry to show how dynamic a career in dentistry can be!

In the article posted on this fantastic site, I talk about the top 10 things I've learnt from my first year out from hospital as a qualified dentist! Hopefully it will give those who have just started a heads up from what they can expect from their year and how to make the most of things!

To read my full article, see here.

What have you learnt so far from your foundation year? Please leave any comments in the section below. 

Sunday, 27 September 2015

#TubulesLive Event with Trevor Burke: Is there life after Amalgam?

Last week saw the return of #TubulesLive and a fantastic presentation by Trevor Burke. This event was exclusively live on Dentinal Tubules online or in the studio! One of the perks of Tubules Premium members!

For all of you that missed this entertaining and educational presentation by Professor Burke, here is a summary of the main points of his lecture. 
  • We all learn at dental school that amalgam has a longer lifespan than any other direct material, with 42% still in place after 15 years! However, some of the short term data is surprising, with 10% failure rate after 1 year and 20% after 2 years. 
  • Overall, the evidence shows that there is around 7 years difference in survival between small occlusal amalgams and large MODs.
  • The Minamata Convention is 2013 aimed to phase down the use of mercury containing products globally by setting national objectives for caries prevention, promoting cost effective and clinically effective mercury-free alternatives and promoting research and development
  • This phase down is not limited to just dental amalgam, but to also other products such as thermometers and fluorescent lighting tubes
  • There have been some Randomised Controlled Trials (RCTs) to shown there are no problems caused in children after having dental amalgams placed
  • BUT if you remove an amalgam, high levels of mercury can be released into a patient's blood so you should use rubber dam and high volume suction
  • Advantages of amalgam include: cheap and easy to use, technique tolerant, good life span and less moisture sensitive BUT it is not adhesive and is not tooth-coloured
  • Indirect alternatives such as gold, cast alloys and porcelain are expensive
  • GIC needs more development in order for it to be a good amalgam-alternative as it can be dissolved but it could be considered as a long term provisional which can be resurfaced with composite when it wears
  • Due to composite being an adhesive, a study has shown that an occlusal cavity removed only 5% of the tooth surface in comparison to 25% in amalgam
  • Studies have shown that failure rate per annum for composite is around 2%
  • A main concern in composites is its polymerisation shrinkage although ways around this have been explored such as increasing the filler load, bulk fills and high molecular weight resins
  • On average, a posterior composite does take 2.5X longer to place than an amalgam, so perhaps bulk-flow materials should be considered as alternatives
  • Some concerns with bulk flow materials include C factors leading to increased sensitivity and stress, poor shade selection and costs. 
  • There needs to be more development in finding an ideal alternative to amalgam which is self-adhesive, low shrinkage, with good physical properties, is wear resistant, is quick and easy to place and non-toxic

Make sure you tune in for the next #TubulesLive event on the 15th October! Let me know your thoughts on the phase down of amalgam in the section below!

To see my posts about previous #TubulesLive events see here

Tuesday, 22 September 2015

Coffees, Lakes and Game of Thrones: Croatia Chronicles

This summer my travels took me to the beautiful land of Croatia.

Beautiful blue lakes at Plitvice National Park

What language is spoken there?
Croatian but almost everyone can speak English to a remarkably good standard and signs and menus are usually in both languages.

What is the currency?
Kuna. At the moment, it's around 10 Kuna to the Pound

How do I get around?

Getting around is pretty easy whether it be by bus, tram or boat. Driving around Croatia is definitely something that I would recommend - the roads are are pleasant and easy to navigate and along the coast there are some fantastic views of across the Mediterranean.

We spent 12 days in total in Croatia moving from one end of the country to another. Here's how our adventure unravelled:


Zagreb Cathedral
The capital of Croatia and a great hub to connect to both international and regional cities. We chose Zagreb to connect us easily to Plitvice Lakes.

During the summer, the city is relatively quiet with everyone flocking to the coast, but there is still plenty to do and is the perfect place to chill on the cafe-lined streets with a coffee.

The street of Tkalciceva is lined with cafes, bars and restaurants that bustle on late into the night. We stayed at the top of this street at Taban Hostel - a pleasant enough hostel at a decent price but no air con (and it was hot!). We stayed at a different hotel later on in the visit the other side of town, The Garden Hotel which was much more pleasant. Strolls through the upper town to view the different churches, cathedral and funicular show the varied architecture of the city.

There are so many museums to explore - the Museum of Broken Relationships is a unique experience that is a very different museum to what you usually visit.

Plitvice Lakes

We booked our bus from Zagreb to Plitvice online - make sure you do this a day or so before you want to go because the buses fill up quickly and print out our tickets too!

The lakes are in a national park and is a UNESCO World Heritage site. The lakes are a brilliant turquoise and are very pretty. We spent 2 days in the park which was a good amount of time to explore most of the lakes and we stayed in one of the hotels in the park which meant we didn't have to pay for 2 day entrances.

There are 4 hotels in the park and we stayed at Hotel Bellevue which wasn't a particularly charming institution but functional and we got a decent breakfast in the morning. By staying in the park we could also explore the lakes during the quieter times of day early in the morning and later into the evening.

You can visit the parks en-route to other parts of Croatia such as Split or Zadar.


The busy cruise hub made famous by Game of Thrones - this bustling city has it's hub in old walled town can see thousands of visitors a day.

Staying within the Old town can be hectic and be prepared to walk up lots of stairs in this quaint historic city. Highlights have to be walking along the city walls (do this early or late to avoid the hot sun) and going up the cable car to get some fantastic views over the city as well as the small island of Lokrum.

We also went on a Game of Thrones tour which was a fun walking tour for fans exploring lots of sites in the city as well as the Fort.

View from the cable car over Dubrovnik

Sites around Dubrovnik

Elaphiti Islands - a small group of islands with a regular boat surface connecting the port of Dubrovnik to Sipan, Lopud and Kolocep. You can also arrange a day trip to all 3 islands. The islands are an escape from the hustle and bustle of the city - we were supposed to spend 6 days on Sipan but on arriving there we changed our minds as things seemed just a bit too quiet for us and the beaches weren't that great!

Slano - a 30 minute drive north of Dubrovnik, a bay where we stayed for 6 nights at the 5 star Grand Admiral Hotel. With both an indoor and outdoor pool, private beach and gym we spent our days relaxing for the last stretch of our trip.

Mostar - a city in southern Bosnia. From Dubrovnik it takes around 2 hours to drive there if the border crossing is not that busy (it did take us over an hour to cross on the way there). Make sure you have the correct insurance if you are hiring a car and the car can be taken across the borders. The famous bridge in Mostar which was destroyed in the Balkan war has been restored and there are people who jump from the bridge into the river below.

You can also do day trips to Montenegro from Dubrovnik.

The famous Old Bridge in Mostar, Bosnia.

This was a fantastic trip that made me realise that there is so much to explore in Europe! I used to look far afield for great places to visit, but this trip together with my short Amsterdam break has fuelled a thirst to explore places closer to home!

Have you been to Croatia? Been to any of the above places? Let me know what you think in the comments below!

Sunday, 20 September 2015

Effective Communication - Young Dentist FMC Article

It's within the first few weeks of your foundation year - communicating well with your patients is something you may or may not feel that comfortable with yet. In my latest publication, I talk about an experience I had with a patient which taught the importance of good communication!

There is so much to learn during your BDS from microbiology to how to cut a crown prep to how to manage a medical emergency - communicating effectively can sometimes be glossed over. 

It is easy to assume that patients understand what we are saying when we tell them about their gum disease or decayed tooth, but sometimes this can trip you up.

Almost a year ago now, I learnt this in a experience with one particularly tricky patient and how I managed her complaint. As clinicians we can't always please everyone, but learning how manage these patients is an important skill. 

To read the full article click here

To read some of my other articles for the Young Dentist FMC, see here

Monday, 14 September 2015

Sterling Dental Charity Ball

Over the past couple of months, I've got involved with a fantastic dental charity: Sterling  Dental Foundation. Their annual charity ball is coming up soon which will be an event not to miss!

The cause that Sterling will be supporting this year is Bobby's Walk.

In 2004 at the age of 70 Bobby Grewel, Chairman of the India Association, embarked on a colossal task to raise money for a number of charities. He trekked 2,556 miles from Amritsar in the north-western tip of India to Kanyakumari in the extreme south. 

Bobby walked 30-35 miles a day for over 5 months across 10 states and in the end raised over £100,000 which was donated to Northwick Park Hospital for cancer and AIDS research. 

Now in his 80th year, Bobby has decided to return to India to embark once more on a journey that will see him go 'full circle'. Setting off in Kanyakumari where he finished his last journey, his will make his way up the east coast of India via Chennai and Calcutta to Delhi covering a massive 2,600 miles. 

Bobby has set a target of raising £1,500,000 for Great Ormond Street Hospital, HRH the Prince of Wales Trust and the India Association who will distribute funds to charities both here in the UK and abroad. 

Sterling Foundation will provide practices and clinicians across the profession and we are committed to supporting the dental industry through working closely with charities and other professional associations. 

We invite you, whether you be a dentist or hygienist, to walk alongside Bobby for this worthwhile cause and to join us in fund raising and celebrating this inspiring individual in his latest adventure!

The ball will be held on the 28th of November, 6.30pm til late! Join us for entertainment, canap├ęs, a 4 course meal, dancing and most importantly: an OPEN BAR!

Only £75 a head with group discount available - grab your ticket before they all go! 

Buy your tickets here

Hope to see you all there!

Thursday, 10 September 2015

Colgate Oral Health Network: Managing Periodontal Disease by Controlling the Plaque Biofilm

This week I attended an education evening hosted by Colgate at Bart's Dental Institute with Francis Hughes and Mike Curtis about periodontal disease. Here I will talk about their main points from the evening. 

The main debate from the evening was whether or not periodontal disease is an infectious disease. This was an interesting approach to the management of this disease where as clinicians we get caught up in the nitty gritty of scraping root surfaces. 

The issue is when we think of other infectious diseases is that they are normally caused by one species of micro-organisms, whereas periodontal disease has multiple implicated species. In the mouth there is over 1000 different species of organisms - but which one is the key organism in causing periodontal disease?

The idea that disease is caused by Bacterial Dysbiosis has been thought of before such as in Salmonella infections of the gut. This means that unhealthy organisms have a different population and distribution of organisms to healthy ones. 

What is a normal population of organisms?

Our individual make up of organisms is like a unique fingerprint for each of us. It also varies for each site in your body e.g. mouth, skin, intestines. 

The make up in your mouth tends to be the most stable in comparison to other sites, but in some individuals their micro-biomes will be more susceptible to change and therefore to disease. Dysbiotic states are also more easily colonised by other pathogenic organisms. 

So can Periodontitis be transmitted?

There are some studies in mice that have suggested that are germ free can be infected and develop periodontitis if they are in contact with other mice who are inoculated with 'normal' bacteria. 

What are the implications of this?

  • We inherit out oral micro-biomes either by resistant or susceptible dysbiosis
  • This may be preventable
  • Can we use this to reverse the process and introduce a healthy micro-biome?

As clinicians, we are obsessed with the plaque paradigm: that improving plaque control will improve disease severity. 

If you look at the statistics such as the Adult Dental Health Survey, plaque control and mild periodontal disease prevalence have decreased over the years, but the prevalence of severe periodontitis has either stayed the same or even increased according to some data! 
This suggests that in some individuals, disease will develop no matter how a patient's plaque control is like. 

Most of the treatments we provide address removing the biofilm (either mechanically or chemically), and if treatment is effective, teeth of poor prognosis can last for years. 

Limitations of conventional periodontal treatment

Adequate plaque control can be difficult for many patients and for some people, improvement may not be seen if they have severe disease. 

Barriers to effective oral hygiene:
  • Motivation
  • Dexterity
  • Social circumstances
  • Peer pressure
The bacteria in peoples' mouths can also induce a host response which is unique for each person, but also the host response can modulate the bacteria. Smoking is also a massive factor in periodontal disease - you are 4-5 times more likely to develop periodontal disease if you smoke. 

Other factors in periodontal disease:

  1. Smoking
  2. Genetic factors
  3. Systemic factors e.g. diabetes, pregnancy, calcium channel blockers
Up to 25% of diabetics are undiagnosed - this is a huge factor that we need to consider as dentists. There has been some evidence to suggest that good periodontal health can positively affect diabetic control. Together with the 2 million people who are taking calcium channel blockers which can cause gingival overgrowth and inflammation, we need to be aware of factors that can be a cause of severe disease in some individuals. 

Possible future treatments for periodontitis:
  • Anti-inflammatories
  • Anti-cytokines
  • Anti-microbial peptides
  • Probiotics
  • And many more!

We have been treating periodontal disease the same for many years - hopefully with new approaches such as how to modulate the host response or alter the oral micro-biome can help us approach treatment differently. This may help us to treat those with severe disease who may be resistant to conventional treatments. 

Thanks to Colgate and Barts for holding the event and Mike Curtis and Francis Hughes for giving us such an engaging and thought-provoking talk. 

To see a summary of another talk by Francis Hughes, click here

Leave your comments and thoughts in the comments section below.

Sunday, 6 September 2015

It's all about the money: Finances for Young Dentists

For those of you who are entering your first job as a dentist, finances can be a tricky thing to manage. Luckily last year I had a talk with Humphrey and Co. chartered accountants to help us manage our money! Here I shall summarise some of the key points you need to know.

This Article can also be found at the Dentspace.co.uk.

Foundation Dentists

For many of you, this may be your first ever job, so payslips and tax are probably a bit alien!

The key thing to remember as a DF1 is that you are salaried i.e. you have an employer who pays you every month. This means that tax will be deducted automatically from your payslip via Pay As You Earn (PAYE). 

On your payslip there will be a tax code which tells HMRC how much tax needs to be deducted. Usually during your DF1, your tax code will be 1000L, but this may vary depending if you've had previous jobs and how much tax you've paid in the past. 

You can also increase your code number i.e. allow you pay less taxes, by claiming back money on professional expenses. You claim these back either by filling in a tax return or writing to HMRC directly.

Professional expenses include:
  • Subscriptions e.g. to journals or magazines
  • GDC ARF 
  • Cleaning and laundry 
  • Indemnity fees
  • Trade union membership (BDA)
  • DBS checks
  • Health checks/Vaccinations
These are wholly allowable as long as they are completely necessary for your job. If you are self-employed, you can claim for that may not be completely necessary for your job i.e. things that are not in your work contract, but are still used for job e.g. Loupes, camera etc. I will talk about these later. 

Make sure your employer gives you a P60 at the end of the tax year on the 5th April each year (the latest they have to give it to you is the 31st May). This is a record of your pay and the tax you've paid that tax year. You will also receive a P45 at the end of your employment. Keep these safe as you may need to reproduce them in the future. 

You will also pay class I National Insurance contributions which will be linked to how much you earn - this will be automatically deducted under PAYE. 


If you decide to become an associate (which a lot of dentists do), your employment will change as you will be self-employed as you are effectively renting your chair from your principal. Therefore tax and national insurance will not automatically be deducted from your pay. 

You will need to notify HMRC that you are self-employed (unless you already have an accountant who will do this for you), you can do this by phone or by filling in a CWF1 form. 

As a result, you will need to keep some money aside every month in order to pay your tax and national insurance at the end of the year - you will need to pay income tax and class 2 and 4 National Insurance contributions. National Insurance gives you the benefits of state pensions, incapacity benefit and maternity allowance.

On top of the necessary expenses you can claim for when you are employed, you can also claim for other expenses, for example:
  • Dental materials 
  • Laboratory fees
  • Accountancy fees
  • Loupes, camera and other equipment
  • Use of home as office
  • Course fees (in some cases)
  • Telephone (for business purposes)
  • Motor running costs (for example if you locum)

You will receive a tax return form just after the 5th April each year, but the first payment can be paid up to 18 months after you declare yourself self-employed.


All dentists who carry out NHS treatments are eligible for superannuation i.e. contribution to NHS pension scheme. When you are a DF1 or work in a hospital, these deductions will come out automatically unless you actively opt out.

There has been recent changes to the NHS pension scheme so it is no longer final salary based but contribution based. The benefits of the scheme however still are really good and it is widely considered to be one of the best pensions you can have.

During your DF1 you will probably be a member of Dentist Provident or Wesleyan (or both), so if you have any questions please speak to your independent financial advisor.

Student Loans

This will depend on when you started university and how much tuition fees you paid. 

Plan 1

This will apply to you if you started university before 1st September 2012.

You student loan repayments will start the April following your graduation and will be automatically deducted from your salary each month. 

Currently, repayments are based on 9% of your earnings over £17,335, so on the current DF1 salary this will be around £100 a month taken off your pay cheque.

If you are an associate, repayments cannot be collected through PAYE system so you have to calculate the amount you pay each tax year to the Student Loans Company. So every January, you have to be able to pay off your tax, your National Insurance and your Student Loan repayments - this can be a bit of shock if you haven't planned financially for it throughout the year!

Plan 2

This will apply to you if you started university after 1st September 2012

This works similarly to above, but the earning threshold is higher for repayments at £21,000.

Should I get an accountant?

This depends on how much self-employed work you plan to do. As a DF1, there is no need to fork out for an accountant, but if you become an associate for more than a couple of days a week or for more than one practice I think investing in an accountant will save you the massive headache of sorting out your tax returns on top of all the other stuff you have to deal with!

What you need to do no matter if you get an accountant or not if to keep records of all business related receipts as well as important tax documents e.g. P45, P60. 

Accountants also have the experience of knowing what is an allowable expense and what is not. This is important as if your records are flagged up by HMRC and they find you have claimed fraudulently, there is a massive fine you will need to pay!

When looking for an accountant you can get recommendations from other dentists or look up the specialist dental accountants. Here are some things to look for if you want an accountant:
  • Do they act for other associates?
  • Are they on the BDA approved list of accountants?
  • Are they a member of the Nation Association of Specialist Dental Accountants and Lawyers (NASDAL)?
  • Are they aware of superannuation and VAT allowances for dentists?
  • Will they give you a realistic indication of their fee?
  • Are they easy to get a hold of and make appointments with?

A massive thank you to Greg and Karen from Humphrey and Co for helping explain the complexities of finance! To see more or if you want to register for their services see their website here

If you're still a bit confused about tax, superannuation or student loans please leave any questions in the comment section below and I'll do my best to help!

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