Sunday, 22 May 2016

My Top 5 Dental Blogs

Keeping up to date with the issues in dentistry is easier than ever with blogs, news sites and dental groups on social media, but with so much information around which sites are the best ones to read regularly? (apart from this blog obviously!)

1. GDP UK -

This site has mountains of information for all dental professionals (only dental professionals can register) and the area of the site I visit most is the blog section.

The site has various different bloggers who focus on different aspects of dentistry, from GDC watch to the likes of the Tony Jacobs (founder of the site) and Simon Thackeray. The blogs are entertaining, insightful and informative. 

There are also different forums on the site, the Young Dentist forum I find particularly useful at the moment, different resources and general updates about events and news in the dental world. 

2. Colin Campbell -

Colin inspired empathy and respect from the dental world last year with his series of blogs about his experience of a Fitness to Practice hearing with the GDC and since then I follow updates with his blogs. 

Colin blogs very regularly and his posts are concise and easy to read and topics can vary from events coming up, his experience of practice to his favourite book or album of the week! His insight into life as a dentist and the importance of keeping a good work-life balance definitely struck a chord a few months ago when I found myself overwhelmed with the amount of dental-related activities I threw myself into!

3. Dental Spotlight -

Of course I have to mention Dental Spotlight, especially since I have an article featured on the site (see here)!

Akta's blogging is very readable and her interviews with various members of the profession are enlightening and give a fantastic overview of what opportunities and paths are out there; from launching a dental app to life as an editor of a dental magazine. 

4. Waseem Riaz -

Waseem's portfolio of impressive cases show his talent with composite and his site has some really fantastic clinical tips to help out both the younger generation of dentists as well as the more experienced!

His site's format is very well designed and the photography and graphics to display the tips he has learnt are useful and easy to follow - I would recommend following him on Instagram to get updates of his tips and clinical cases!

5. Reena Wadia -

Reena, a figurehead for women in dentistry and popular young dentist writes regularly on her own site and if you're looking for tips for early on in career or anything regarding perio, her site is the place to go!

As well as blogs, Reena has created several helpful short videos which could be particularly useful if you're thinking about specialising.

What's your favourite dental blog? Do you read any of the above? Let me know!

Sunday, 15 May 2016

Hypodontia at Kings College Hospital

As part of our Dental Core Training, one of our most recent study days was held at KCH about Hypodontia. What did I learn from the day?

Missing lateral incisors. Photo credit: Braces4Oxford

What is hypodontia?

Hypodontia is a condition of missing teeth (usually 1-6 teeth). If more than 6 teeth are missing this is classed as Oligodontia whereas if all teeth are missing, this is Anodontia (this is extremely rare). 

80% of hypodontia patients have 1-2 teeth missing and hypodontia in the primary dentition almost always leads to hypodontia in the permanent dentition. 

Incidence of hypodontia: 5-10% (depending on which study/population you look at)
Incidence of oligodontia: 0.25%
There is no recorded incidence of anodontia. 

Which teeth are most commonly affected?

In order of highest prevalence (excluding third molars):
  1. Upper 2nd pemolars
  2. Upper lateral incisors
  3. Lower second premolars
  4. Lower central incisors

Associated features:

  • Delayed eruption and formation
  • Microdontia
  • Ectopic canines
  • Infraocclusion
  • Taurodontism
  • Enamel hypoplasia


The exact causation of hypodontia is not fully explained; however it is thought to be influenced by 3 factors:
  1. Genetics (autosomal dominant)
  2. Epigenetics
  3. Environmental factors e.g. irradiation, chemotherapeutics, trauma
If environmental factors are implicated, then the timing of the incident indicates which tooth will be affected i.e. what stage in tooth development is affected (a good resource for this information is the American Academy of Paediatric Dentists).

Genes that have been implicated include MSX1 (which leads to absence of 5s and 8s), PAX9 (associated with microdontia) and AXIN2 (which leads to the absence of 8-27 teeth and also implicated in colo-rectal cancers). 

Associated syndromes:

  • Ectodermal dysplasia
  • Witkop's syndrome
  • Down syndrome
  • Reiger's syndrome
  • Incontinentia Pigmentia 
  • Cleft lip and palate
  • Ehler's Dahnlos

So a patient has missing 5s; they are very likely to have retained Es which can actually have a good prognosis sometimes (I've seen patients in their 40s with a retained E or so!). But what risks are associated with infraocclusion?
  • Ankylosis - this can lead to a complicated extraction if it is indicated
  • The E holds a greater space than 5. This may lead to prosthetic planning problems when it is lost
  • Hard and soft tissue deficit when the E is lost
  • Sinking contact points which increases the caries risk
Infraocclusion is associated more with Es than Ds and is more likely to happen on the lower arch. 

This is just a snippet from the day. The overriding message I got was that whenever you see hypodontia patients, it is important to approach their management with a multi-disciplinary team including paediatrics, orthodontics, restorative dentists, oral surgeons and sometimes even psychologists and geneticists. 

Certainly in both my restorative and oral surgery rotations I have been involved in the management of these patients. On the restorative side I have provided resin-retained bridges, composite augmentation and the onlaying of infraoccluded Es. Now on my oral surgery rotation, I have been involved in the planning and placement of implants for these patients and sometimes even autotransplanting or parking canines which have been ectopic. It's been really interesting to manage these patients from different approaches!

A patient I provided direct Gradia onlays for infraoccluded Es.

To read more about hypodontia, the team at KCH have started a blog page with lots of information - see here

Please leave any thoughts or comments in the comments section. 

Sunday, 8 May 2016

Top Tips for Case Presentations

Is it coming up to case presentation time? Whether it be for a finals case at uni or during your DFT or DCT year, what things should you include?
A case I presented during my DFT year

What type of patient should I use for a case presentation?

When I was at university, it's tempting to pick your most complicated patient to use as a case presentation, but is this the best option? 

Sometimes it may be more useful to pick a patient who only has a few elements to their treatment plan but this elements could be particularly interesting e.g. a class V composite where you've used a wax-up then mock up in the mouth and how you built it up. 

At university, we had to prepare a portfolio of cases, so using less complicated cases for each in this case is definitely more beneficial. ALSO bare in mind that there are other factors that can make a case interesting e.g. a patient who doesn't have capacity, a patient with a complicated medical history. 

What information should I include in my presentation?

Whether you are presenting your case via a power point, a written article or with the patient in the chair, make sure you include all the following information:
  • Introduction i.e.. age, F/M, history 
  • Presenting complaint and history of complaint
  • Medical, dental and social history
  • Examination: extra and intra oral, occlusion, BPE, chart, TSL
  • Investigations e.g. radiographs, sensibility testing, biopsies, study models
  • Photographs (these can be of study models, lab work or peri-operatively as well as just pre and post-op)
  • Prognoses and Diagnoses
  • Risk assessment i.e.. traffic lighting of 4 domains of oral health (oral cancer, perio, caries, TSL)
  • Treatment options and objectives of treatment
  • Patient attitude and mutually agreed treatment plan (can include copy of FP17 form if this is an NHS patient)
  • Stages of treatment: acute, prevention, stabilisation, definitive
  • Reflection and feedback
  • Guidelines and evidence used

Top presentation tips 

Presenting a patient in front of a couple of examiners to a whole room full of colleagues can be intimidating! It's really important to keep your cool and be prepared. Here are some of my top tips!

1. Practise the day before and time yourself

This will help you assess whether your presentation may be too long or short so you can adjust. If you can get someone to listen to you too this is a bonus! Be aware of speaking too quickly and rushing through slides

2. Keep information on slides to a minimum

Use them as prompts, not as an overload of information. People will be caught up trying to read everything and not listening to you, or they just won't bother. The more pictures, diagrams and tables you use the better! Tables can also be a handy way of including information if you have a word limit. 

3. Think of questions they may ask and prepare accordingly

This could be why you provided one treatment over another or how you prepared a tooth for a crown or restoration. Showing someone else your presentation beforehand is a good way of predicting what may be asked. Also be aware of any evidence to help back up any of the treatment you've provided

4. Be logical

Structure your presentation logically e.g. introduce patient, C/O, HPC, MH/DH/SH, EO etc etc. Address the patient's issues and concerns and present them as you prioritise any patient care you provide i.e. pain relief, disease stabilisation, rehabilitation, review. Present clearly and logically!

5. Know your guidelines!

Know all of the common ones you use in all your patients e.g. NICE recall, FGDP radiographs, Delivering better Oral Health (DoH). Also use society guidelines to assess complexity of treatment if there is some element of possible referral e.g. American Association of Endodontics guidelines for case difficulty (see here). 

If you need some more guidances, take a look at my presentation of the above case for DFT year (note that I presented the case before I had completed the entire treatment plan), click here

Please leave any comments or questions in the comments section below!

Monday, 2 May 2016

Top 5 Skills to Develop during Dental Foundation Training

This article can be found in the BDJ Student Magazine.

When I started my foundation year (seems like forever ago!), I was overwhelmed by how there was to learn out in practice and it's amazing how clueless I was back then! Looking back there were definitely some areas where I needed to make use of the support that is out there for DFTs. It's best to identify these areas sooner rather than later to give you a head start in improving your skills so here are my top five areas you should aim to develop in your DFT year!

1. Composite

Depending on where you graduate, you will have varied experiences working with composite. It's best to start practising your skills in this area, especially since proposed phase down of amalgam in the Minimata Convention and it's likely to be used more and more in years to come. 

To read more about composite skills check out some of my posts here

2. Endodontics

A source of fear for many young dentists (myself included sometimes), get practising while you have the time! Get working on your hand-filing skills, not just rotary as many NHS practices do not have this facility! 

To read more about endodontics, check out my guide here

3. Extra-coronal restorations

Especially working on partial coverage restorations and how to design them to a gold standard. Developing a good relationship with your technician is also key in providing both good quality work for the patient and receiving feedback on your clinical skills. 

Read more about extra-coronal restorations here

4. Communication

The more patients you see, the better you will become at communicating. Reflect on cases where things haven't gone to plan and work out areas for improvement. Patients in practice can have completely different attitudes from those in hospitals so don't be surprised if they are more demanding.

Read about my top tips for communicating published in the BDJ student magazine here

5. Photography

I try to take pictures of every patient and at first I didn't have access to a practice camera so I invested in my own. This gives me a medico-legal record and allows me to develop both my photography and my clinical skills by being able to look back through my photos and critique them. 

To read more about photography, see my guide here

You will learn so much during your DFT year both in terms of clinical skills and also what life is like out in practice. Keep the above learning points in mind, but most importantly, make the most of out of professional support while you can!

Please leave your thoughts and comments in the box below!

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