Monday, 27 February 2017

Make A Dentist Conference 2017

Last weekend, the annual Make A Dentist Conference took place at Barts and The London School of Medicine and Dentistry. 

Dr Mukesh Soni speaking at the conference

This year I am part of the Make A Dentist Committee and the committee was very excited about this year's line up. The event was sold out and a surprising number of dental students turned up considering it was a Saturday (I don't recall arising before 11am on a Saturday when I was a student!). 

This year's line up crossed all realms of the dental world and featured some of the leading names in the profession:

Dr Sundeep Rooprai - Buying a Dental Practice. Where do I start?
Dr Hatem Algraffee - Surgical Periodontics. Is it neccessary and needed?
Dr Mukesh Soni - Practical Implantology and  Social Media
Dr Andrew Wallace - How every dentist can carry out sage and predictable aesthetic Orthodontics
Dr Rikin Parekh - Getting started in Facial Aesthetics
Dr Nilesh Parmar - Titanium is the answer
Dr Mahul Patel - Treatment techniques and approaches in the posterior dentition
Dr Richard Porter - The relentless pursuit of beauty and the dentists' role

Dr Richard Porter delivering his talk on the pursuit of beauty

Top Tips from Speakers

1. Dr Sundeep Rooprai - When considering buying a practice, consider doing so with a business partner. This will split costs; however, be careful who you chose as your business partner... you don't want to ruin any of your friendships!

2. Dr Hatem Algraffee - Emdogain can be used to regenerate lost periodontal support but only in vertical or walled defects, not in horizontal bone loss

3. Dr Mukesh Soni - In order to preserve alveolar bone during extractions (specifically the buccal bone), make sure you learn to use luxators correctly! Apply down the long axis of teeth: this may mean you need to decoronate a tooth. Ultimately this ridge preservation will be useful if an implant is considered in the future

4. Dr Andrew Wallace - When you give your patients good aesthetic results, they are your most important marketing tool and will refer you their friends and family for treatment.  

5. Dr Rikin Parekh - When considering a career in facial aesthetics, shop around for your insurance as conventional dental indemnity providers are often not the most cost effective. For example, companies such as Hamilton Fraser.

6. Dr Nilesh Parmer - According to surveys on social media, the most common dental course undergraduates want to enrol on during their first 3 years post qualification are orthodontics. Focus on your basic skills first e.g. endodontics, oral surgery, coronal restorations, before considering these extra skills

7. Dr Richard Porter - Provided a refreshing talk on our obsession with beauty and the media's perception of what is beautiful e.g. celebrities who post photos of themselves with no make-up on are 'brave', not beautiful

8. Dr Mahul Patel - When cementing multiple extra-coronal restorations, ensure you cement individually in order to aid interproximal clean-up of cement and resin residue

After a long day of learning from the best, my brain was buzzing and ready for rest!

The day was jammed-packed full of tips and personal experiences from the speakers and each speaker was very entertaining. The audience of the conference was mainly students and young dentists and each speaker had tailored their talks to these early stages and their own tips from what they have learnt through their careers. I'd like to thank all the speakers for dedicating their time and expertise to speak in aid of the charity's cause and the entire committee for their hard work on the day!

To read my post about last year's conference click here

Did you go the conference? What did you think of it? Let me know in the comments below!

Saturday, 25 February 2017

Special Care Dentistry..... Who do we see?

My current post is within the Community Dental Services in East London. The Community services have changed even since I had outreach clinics during my undergraduate years; so who exactly am I seeing?

Our Community Dental Service serves the special care patients of City and Hackney and Tower Hamlets. Patients can be self-referred in some cases or are referred from other health professionals. These are commonly General Dental Practitioners, GPs, Speech and Language Therapists, School Nurses etc. 

We are now more commonly sharing the care of these patients with their other professionals. These include the following sets of patients:

1. Patients with Blood-born Viruses

Patients who have HIV, AIDS or who are/have been infected with Hepatitis B or C have traditionally been a subset of patients we see in the community dental setting; however, this group is not really seen as a special care group any longer unless there are other complicating factors or they fall into one of the other groups below.

I have been discharging some of these patients to the general dental services and many of them feel apprehensive about the way they may be treated in a high street dentist. It is discrimination to treat these patients any differently (we should be using universal precautions for all patients) and I am having to reassure patients it is illegal for practices to refuse to see them due to their medical status.

2. Patients with learning difficulties

We see adults and children with moderate to severe learning difficulties such as autism (see my post about ASD here), ADHD, patients with syndromes who have associated learning difficulties e.g. Down's.
With these sort of children you often have to think outside the box about how to manage them or even attempt to look in their mouths. You also need to put yourself into the parent's shoes - is brushing their teeth twice a day actually achievable or will you have to compromise?
With adults you may have the same issues as trying to treat children but also the added challenge of obtaining valid consent. In these cases you may need to act in a patient's best interest and if there are complications, involve the help of an IMCA.  

3. Patients with physical or sensory disabilities

Physical disabilities may make access to a regular dentist challenging; this could be because the dental surgery is up some stairs or the doors are too narrow. GDPs are obliged to make reasonable adjustments to facilitate the access for these patients, but in some cases this just isn't possible.
As a service we also can provide transport to assist those who are less able to come to their appointments and we also can use a hoist to transfer patients to the dental chair in those who are not able. As well as physical disabilities, we also see patients who are deaf or blind. Treating these patients can make you really think about how you usually communicate with patients and again you need to think outside the box when communicating with these patients. Sometimes we have to book in BSL interpreters to help communicate with those who are deaf. 


4. Adults who are substance abusers

Whether this be alcohol or recreational drugs, substance abusers can be quite a challenge. They are often sporadic attenders, have rampant dental disease and other complicating social factors such as homelessness or mental health problems. You also need to consider the effect of the substance on their systemic health e.g. liver damage in alcoholics where clotting may be impaired.
When I see these patients, I try to get as much done in one appointment as possible and the focus is to stabilise the disease so I usually use Glass Ionomer to stabilise their caries.


5. Patients with severe mental health problems

We see a lot of patients who are living in forensic mental health units as well as visiting these patients in their wards. Diagnoses can vary, but common mental health problems I see are schizophrenia, anxiety and depression, Bipolar Disorder and Personality Disorders. Just because these patients have a mental health problem doesn't mean they lack capacity so you need to take things on a case by case and appointment by appointment basis.
In these cases you need to ensure your communication is very clear and also be aware of your own safety: escorts are essential with some patients!

6. Patients were severe dental phobias

Out of all the special care groups, patients or family members can self-refer themselves to the service apart from dental phobias. In these cases we need a referral from a health professional, usually a dentist.
For these patients we can either use acclimatisation techniques but also the use of conscious sedation (oral, inhalation, intranasal or intravenous), but we can also use other anxiolytic measures such as the use of the wand for delivering local anaesthetic. We also are the gateway for patients to be referred for general anaesthetic in extreme cases. 


7. Children with behavioural issues

I get referred a lot of children with caries from GDPs with behavioural issues. It takes a lot of practice working with children to learn ways of management to get their compliance. In some cases it is not always possible and they require a referral for general anaesthetic or the use of inhalation sedation. But you'd be surprised how many children you can treat with acclimatisation appointments and lots of patience!
To read tips about taking radiographs in children, read my previous post here.


8. Patients who are homeless or temporary housed

These patients are often black-listed in general practices due to their high failure to attend their appointments or late cancellations. In community, they often do the same; however, we have the capacity to be more lenient and we try to understand how their lives can be nomadic and sporadic and their priorities change.
They often have other issues as I have mentioned above e.g. substance abuse, mental health problems and you also need to be realistic about how achieving good oral hygiene may not be possible as they may not be able to access running water.
Over Christmas, I volunteered for Crisis, a homeless charity. To read about my experience, see my post here.


9. Vulnerable adults

These can be those with social problems, learning difficulties, mental health problems or those who are elderly.
Most of the time, I like to see these patients and involve their carer or key worker in their treatment as sometimes involving them is the only way to get a valid history.


10. Patients with complex medical histories

Community is the intermediate setting before referring a patient onto secondary care so we often see lots of patients with complex medical histories. This may not mean treating them any differently to how a GDP would, but we have closer links with other services e.g. their GP or doctor. We are also more experienced in the management of certain patients for example, patients who are about to undergo heart valve surgery or those at risk of infective endocarditis, patients who are at risk of MRONJ and oncology patients.


11. Children or adults with complex social problems

These patients may be looked after children, those who are under care or have guardians who are not their biological parents. In some cases, we need to liaise closely with their social workers (once we have consent to do so), especially if we are concerned about a child's welfare e.g. repeated missed appointments, dental neglect.
To read about safeguarding, see my post here.


12. Patients who are housebound

Our service delivers domiciliary care to those who are housebound; whether that be to their own home, to care homes or to hospital wards. I am learning to drive at the moment (about time!) so I do not do this visits myself but I do have exposure to these patients on clinics. If these patients need extractions or more extensive treatment that cannot be done on a domiciliary visit, then we arrange transport to bring them to clinics to have their treatment done.
When I have treated these patients, I have learnt to ask questions that you wouldn't necessarily think obvious. For example, to manage post-op pain after an extraction, if this patient is in a ward or care home you may need to write a prescription for them as their carers may not be able to give them pain relief otherwise.
Overall, managing these patients can be challenging but I really enjoy the lateral thinking that comes with their treatment and management. As you can see, a lot of the time a patient may belong to more than one special care group. With community dental services being re-commissioned and evolving we are seeing more and more complex patients within the service. For me this means I need a good night's sleep after a day packed full of challenging, but stimulating clinical situations!
Do you work in special care dentistry or community? Let me know your thoughts on special care groups in the comment section below!

Friday, 17 February 2017

Tubules Relaunch Party: The Genius 2 has arrived!

So back at the beginning of February Dentinal Tubules hosted their most anticipated Relaunch party...

Tubules Family: Study Club Directors

You may have read one of my previous posts explaining What's the Deal with Tubules..? and why you should join; this relaunch will give you so many more reasons to join!

The evening was held at The Fable in London; drinks were flowing (including 2 specially made cocktails for Tubules), there were yummy snacks as well as the usual wonderful Tubules company. The party-goers were exclusively invited as premium members, study club members and supporters of the Tubules ethos and were there to cheer on Dhru as he announced the upcoming overhauled Tubules website. 

So What's New?

Many of you may be familiar with the current website and what it has to offer, but from April 1st, the Genius 2 (the current site is called the Genius) will be launched!

Those you who were at the event will have seen a sneak preview of the new site which includes an improved and easy to navigate interface, private platforms for each study group, new playlists where you can save your favourite videos and a comprehensive CPD record. 

For the past year, Tubules Study Clubs have grown from strength to strength and now the clubs have spread internationally! Make sure you sign up to premium membership before April (as the price is going up!) and Tubules will honour this price for a lifetime. 

The evening itself was a huge success (including an impressive magic trick from Rishi) and it was a pleasure as always to see so many familiar faces from some inspirational people in the profession! Check out the highlights video from the evening...

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

Were you at the event? Did you enjoy your evening? Leave your comments in the box below!

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