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!



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