Dental Health - British Society of Dental Hygiene & Therapy

clinicalDCP practice in theInternational contextSue BagnellIn the United Kingdom, the termdental care professionals (DCPs)collectively refers to dentalhygienists, dental therapists, dentalnurses, dental technicians, clinicaldental technicians, and orthodontictherapists 1 . All members of thedental team are accountable formeeting the needs of each patient,and each member has a clearlydefined role as outlined in the Scopeof Practice (2009) document 2 . Thispaper explores whether internationalcomparisons between DCP practicein the UK and in Canada couldcontribute to the evolution of DCPpractice within the UK. To lookinto this topic in depth, the paperwill focus on dental hygienists anddental therapists.Dental hygienists andtherapistsTo gain an understanding of therespective roles of the dental hygienistand dental therapist it is necessary toprovide definitions for each discipline.The International Federation ofDental Hygienists (2008) provides acomprehensive definition of a dentalhygienist:A dental hygienist is a healthprofessional and is graduated from arecognised school of dental hygiene,who, through clinical services,education, consultative planning andevaluation endeavours, seeks to preventoral disease, provides treatment forexisting disease and assists people inmaintaining an optimum level of oralhealth. Dental hygienists are healthprofessionals whose primary concern isthe promotion of total health throughthe prevention of disease. 3The Department of Health, SocialServices and Public Safety defines adental therapist as:A dental therapist works as part of adental team that provides clinical andeducational care for adults and childrenin the community, including thosewith special needs. Dental therapistscarry out a range of straightforwardtreatments, including simple fillingsor extractions. They also undertakea range of preventive procedures andprovide oral health advice 4 .Scope of practiceDental hygienists and dental therapistscould be considered to contribute to theprovision of oral healthcare. There area limited number of dental therapistspractising in Canada; the only trainingprogramme for dental therapy is inPrince Albert, Saskatchewan 5 . Thistraining programme is currently injeopardy as federal funding for theprogramme has been withdrawn 6 .to improve access todental care, dentalhygienists treatpatients without aprescription from adentistThe scope of practice of dentaltherapists in Canada includes:examining, diagnosing, developing,or modifying treatment plans;carrying out some restorations; andproviding urgent care for patientsin a dental emergency 5 . The scopeof practice for dental therapists inthe UK is comparable to that forCanada; however, dental therapy isnow offered in the UK as a combineddental hygiene/therapy curriculum inuniversities 5 .As opposed to the similarity injob scope for dental therapists in theUK and Canada, dental hygienists inCanada practise a broader scope ofduties than their UK counterparts 7 .In both countries, dental hygienistsassess patients, practise planning andpreventive care, and offer a variety oftherapeutic services. However, themajority of the UK training is nowfocussed on offering the combineddental hygiene/therapy curriculum 8 .Currently, 16 of the 20 dental hygieneprogrammes have moved to providingthe dual qualification 9 .Both countries have dedicatedassociations that act as a collectivevoice for the profession 8,10 Hygienistsand hygienist/therapists in Canadaand in the UK demonstrate theirprofessional commitment bycompleting continuing professionaldevelopment (CPD) to maintain theirskills and knowledge and stay up todate; this is regulated by the respectiveregulatory bodies in each country 10,11 .Both countries have specific criteriafor completion of CPD which could beconsidered comparable. In Canadacommitment to CPD fluctuatesbetween provinces but generally entailscompletion of between 45 and 75 hoursof CPD every three years 10 . In the UKcommitment to CPD entails completionof 150 hours of CPD every five years 11 .Completion of CPD and regulation ofprofessionals is essential to protectpatients’ safety and health 12 .Dental hygienists in the UK canbroaden their scope of practice bycarrying out extended duty courses fora variety of skills 9 . The additional skillsinclude; tooth whitening, prescribingradiographs, administering inhalation6 Dental Health Volume 51 No 6 of 6 November 2012

clinicalCanada, the ratio of dentists to dentalhygienists is 0.86 19 . Increasing thenumber of dental hygienists/therapistsin the UK could be considerednecessary to meet the oral health needsof the population.One other point of comparisonbetween dental practice in the UKand in Canada is the difference intraining and regulation between thetwo countries. In general, there areglobal disparities in training within thedental hygiene/therapy profession 12 .For Canada, dental hygiene is a selfregulatedprofession in most provinces,and each province and territory has itsown regulatory body 28 . Conversely, inthe UK dental hygienists are regulatedby the GDC 11 . Both Canada and theUK offer a variety of educationalprogrammes; training is completedto either diploma or degree level as adental hygienist or (in the UK) as adental hygienist/therapist 7 . In Canadahygienists are restricted to practising inthe province they are registered to workin 28 . In an effort to increase mobility ofpractice between the provinces, thereis a need to standardise educationalqualifications. Similarly in the UK,freedom to work in any of the countriesof the European Union would beenhanced by standardised education ofdental hygienists/therapists, ensuringan equivalent level of education onthe practitioner side, and a correlatingequivalent level of oral care forpatients 9 .EducationThere has been a gradual shift towardsthe baccalaureate as the entry-levelrequirement to practice in Canadaand in the UK. Currently, countriesthat have exclusively baccalaureateentry to dental hygiene are Finland,the Netherlands, Italy, Portugal,and Slovakia 12 . In the UK, eightuniversities offer baccalaureate entry todental hygiene/therapy programmes 8 .In Canada, there are currently threebaccalaureate entries to dental hygieneprogrammes 20 . In addition to this,dental hygienists who have obtained aDiploma in Dental Hygiene and havemet the requirements to be licensedin Nova Scotia can now study for anacademic year to attain a Bachelor ofDental Hygiene at the University ofDalhousie 29 .Completing education to a higherlevel has been shown to improve astudent’s ability to carry out researchand develop critical thinking skills; thishas been shown to improve standardsof patient care and also allows studentsto develop to their full capacity 28,30,31 .Therefore, a move towards astandardised level of educationthat develops such skills could beconsidered essential to the evolution ofdental hygiene and dental therapy as aprofession.dental hygienists/therapists could beutilized in providingcare to the increasingnumber of people whohave maintained afunctional but heavilyrestored dentitionIn the UK, opportunities to studyto the masters or doctorate level inpostgraduate education level forrelated health sciences are available todental hygienists who have attaineda bachelor degree, but there are nospecific dental hygiene programmes 9 .The situation is similar in Canada,and there are no graduate level dentalhygiene programmes; however,there are several general Master ofScience programmes open to dentalhygienists 28 .ResearchGiven that one of the inherent barriersto challenging dentistry’s dominanceover the independent practice of dentalhygiene is the underdeveloped formalknowledge base of dental hygiene,the profession needs to focus ondeveloping the baccalaureate entry topractice, which would ultimately openpathways to graduate education 28 . Theopportunity to become educated to thislevel could be considered essential ifdental hygienists and dental hygiene/therapists want to expand theirprofessional authority and status.Dental hygienists/therapists in theUK could take a cue from Cobban 32who has suggested for Canadiandental hygienists that their careeradvancement is tied into the ability toadapt a culture of creating evidencebasedknowledge that enhancesclinical practice, improves oralhealth outcomes, and augments tothe existing knowledge base of thedental profession. In Canada, dentalhygienists have access to the CanadianFoundation for Dental Hygiene, whichexists to provide a fund to enabledental hygienists to carry out dentalhygiene research to improve the oralhealth of the nation 10 . The creation ofsuch a foundation, specifically for thedental hygiene and dental hygiene/therapy community in the UK, could beconsidered beneficial to the profession.A move has been made within the UKto promote DCP research through theFaculty of General Dental Practitionersand the BSDHT 8,33 the creation of anadditional foundation either throughthe auspices of BSDHT, or somethingcompletely new, would strengthen thismove.As the number of dental hygienistsin Canada is much greater than in theUK, and Canada has more hygieniststhan dentists 19 , it is possible thatCanadian dental hygienists have morepotential for promoting their professionthan UK dental hygiene/therapists.The availability of information throughthe website of the CDHA is extensive.Continuing development of the BSDHTwebsite could assist with promotion ofthe profession in the UK.ConclusionCareful workforce planning of theprofession is required to meet thechanging age demographics and socioeconomicrequirements of the nation.To ensure the continued progressionof dental hygiene/therapy in the UK,continued efforts will need to bemade by the profession to promoteoral health. The profession will needto continue to strive for standardisedlevels of entry to practice education,8 Dental Health Volume 51 No 6 of 6 November 2012

newsWorld Oral Health DayThe findings of a major report onthe State of Oral Health in Europewere debated on World Oral HealthDay (12th September) in the UKParliament.MPs and members of the professionand press, including representatives ofBSDHT, President Sally Simpson andEditor Heather Lewis, gathered at theSmiling Britain roundtable convenedby Wrigley and GlaxoSmithKline(GSK) Consumer Healthcare to discussthe report, issued by The Platform forBetter Oral Health in Europe.The State of Oral Health reporttakes a comprehensive look at Europe’sdental health. Its findings show that,although there has been significantimprovement over the last decade,more needs to be done to improveoral health and encourage good oralhygiene habits. Oral disease remainsa significant public health burden,particularly in economically challengedareas. It is also an increasing economicburden; public spending on thetreatment of oral disease across the EUis soon likely to exceed that of cancer,heart disease and stroke.Professor Ken Eaton, President ofthe European Association of DentalPublic Health and Chair of EuropeanPlatform for Better Oral Health ledthe discussion on the report. He wasjoined by experts including Dr NigelCarter, Chief Executive at BritishDental Health Foundation and dentalhygienist, Juliette Reeves, for a widerangingdiscussion aimed at identifyinghow the priorities the report sets outcan be applied by dental professionalsin the UK.To address the burden of oral disease,the report recommends that thefollowing actions be considered bydecision-makers across Europe:t Making a commitment to improvingoral health as part of EU policies by2020;t Addressing increasing oral healthinequalities;t Encouraging good practice sharing;t Improving the data and knowledgebase, bridging the research gapin oral health promotion anddeveloping common methodologiesin data collection processes;t Supporting the development of thedental workforce in Europe.Professor Ken Eaton, President of theEuropean Association of Dental PublicHealth and Chair of European Platformfor Better Oral Health said:“Much needs to be done to improve oralhealth in Europe. I hope that the Platformfor Better Oral Health in Europe’s reportwill provide a catalyst for change. Apartfrom oral cancer, poor oral health rarelykills people directly. However, it causes avery significant deterioration in quality oflife for millions of people, which is tragicas prevention of oral diseases is relativelysimple.”From left to right: Juliette Reeves, Dr Nigel Carter and Professor Ken Eaton.10 Dental Health Volume 51 No 6 of 6 November 2012

CLINICALSetting the stage for implantsSusan S WingroveImplant dentistry needs a solidfoundation to build on for optimalimplant dentistry results. Dentalclinicians can now regrow bone andenhance soft tissue to set the stagefor aesthetic implant dentistry. Alldental professionals need to beeducated on the key adjunctiveregenerative procedures that areavailable today.This article will focus onproviding an overview for dentalhygienists to discuss with patientsany necessary or aestheticadjunctive treatment procedureoptions, socket preservation,alveolar ridge and sinusaugmentation, prior to implantplacement.combination based on the osteogenic,osteoconductive and osteoinductiveprinciples (figure 2).Figure 1a: Example of mineralised/demineralised bone particulate(OSSIF-i sem)differentiation of the particular typesof cells for the true regeneration. Toregenerate the bone and tissue back toits original state.Setting the stageThis new regenerative dentistry hasrevolutionised how dental professionalstreatment plan for tooth replacement.Traditionally tooth replacementwas completed with either a bridge,partial or full denture. The patientwould proceed to lose bone until theypossibly became an edentulous cripple.The knowledge, technology, andregenerative products now availablereplace missing teeth and preservebone. Dental hygienists need to havean understanding of soft tissue andbone regenerative procedures to haveconversations with their patientson the optimal treatments for toothreplacement, which include adjunctiveregenerative procedures.To place implants the bone qualityand quantity need to be adequate,otherwise a placement of an implant isnot possible. To achieve this dentistsuse regenerative products whichinclude mineralised or demineralisedcadaver bone particulates, membranes,and/ or growth factors (figure1). They can be used alone or inFigure 1b: Example of barriermembrane~ sponge strip (OSSIF-isem)An understanding of these principlesis important to fully grasp how boneremodels and how regeneration andosseointegration of implants occur.Osteogenesis is the living bone cellsattached to a graft or added in a defectto contribute to bone remodeling.Osteoconduction, or the scaffold,guides the reparative growth of thenatural bone. An artificial membrane(e.g. autografts, allografts, xenograftsand alloplasts assures the bone cellshave time to regenerate in the defectwithout interference of tissue. Finally,osteoinduction, the signals or growthfactors, stimulate the division andFigure 2: The principles ofregenerationDentists use a procedure called guidedbone regeneration (GBR) that involvesusing one of the four types of bonegrafts available; autografts, allograft,xenografts, or alloplasts (figure 3).A GBR is a bone regenerationprocedure that uses a graft barriermembrane to seal off the area, to allowbone to regenerate while keepingthe connective tissue out so thatosteogenesis is achieved.Growth factors, osteoinductivesignals, are also emerging on themarket to speed up the regenerationprocess. These growth factors aresometimes referred to as growthenhancers such as bone morphogenicprotein (BMP), platelet derived (PRP,PRF, or PRGF) and are popular foradjunctive procedures. Also availableare embroyonic stem cells that arederived from early stage embryos,amniotic cells from donated placentas,12 Dental Health Volume 51 No 6 of 6 November 2012

CLINICALFigure 3: Bone grafting optionsType of GraftDescriptionAutograft Patient’s own bone harvested from a donor site to be(Autogenous) used in regeneration and preservation procedures.Allograft Bone harvested from the same species, human bone –(Allogenic) cadaveric bone and human tissue usually obtained froma tissue bank used in regeneration and preservationprocedures.Xenograft(Xenogenic)Alloplast(Alloplastic)Bone or tissue transplant from another species- animalused in regeneration and preservation procedures.Synthetic bone, hydroxyapatite and biocompatiblesubstances, with similar properties to bone used inregeneration and preservation procedures.and some synthetic derived productsthat are able to differentiate intobone and tissue with very promisingstudy results. 1,2 They all can be usedalone or in combination based onthe osteogenic, osteoconductive, andosteoinductive principles (figure 2)It’s all about the bone!Dental hygienists are in the idealposition to talk to their patients aboutthis exciting time of regenerationdentistry. The average hygienist spends30 minutes with patients on a one toone basis. It is imperative that youattain the verbal skills to talk withpatients about the tooth replacementsand the key adjunctive procedures tohelp them retain the bone and obtainthe ideal implant treatment. If teethare lost and not replaced atrophy of thebone is apparent in facial aesthetics.Having a conversation with yourpatients on the regenerative proceduresavailable today will help patients makea more informed decision about toothreplacement and bone preservation.The key adjunctive regenerativeprocedures to talk about with yourpatients and set the stage for implantsare; socket preservation, alveolar ridgeand sinus augmentation. Anotheradjunctive regenerative procedureused to correct or regenerate lostbone around an existing implant(s)is referred to as implant dehiscenceor fenestration defect. A dehiscenceis a break in the covering epitheliumleaving an isolated buccal or lingualarea of the implant exposed and afenestration is an apical defect. A GBRprocedure is used to retain the implant,therefore adjunctive procedures canalso be used after implants have beenplaced.Socket preservation involves placingbone graft particulate and / or a barriermembrane to the socket of an extractedtooth at the time of extraction topreserve the alveolar ridge. If a toothsocket is allowed to heal on its own,new bone will form, but with a 25%decrease in width and a 4mm decreasein height in the first year after theextraction. 3,4 Socket preservation isdone to prepare an optimal foundationto place an implant, but should be doneafter each and every extraction.The first step for regeneration startswith the ‘Blood Clot’. Placing boneparticulates in an extraction site willprotect the blood clot which is essentialto the healing process and can alleviatethe post-surgical complication referredto as ‘dry socket’. (figure 4)This can be used alone as socketpreservation especially in cases whereimplants are not treatment planned.Step two involves adding a membranebarrier to prevent the fast movingtissue cells from taking over and allowthe bone cells time to form in thesocket. Both can be used to ‘set thestage’ for implants and provide morepredictable healing, bone preservation,and fewer complications.Figure 4: Step one – place boneparticulates into the socketIt is critical to remove the extractiontooth with minimal damage tothe alveolar bone or soft tissue.Extraction site preservation startswith the surgeon using a periotomeinstrument to manually cut throughthe periodontal ligament (PDL) thatholds the non-ankylosed tooth in place.(figure 5)Figure 5: Example of how aperiotome is usedWhat happens if the tooth isextracted and not replaced with animplant?Bone loss continues and the patientmay eventually become edentulousand need a partial or traditionaldenture. In the past we were not ableVolume 51 No 6 of 6 November 2012 Dental Health 13

newsPast President retiresPatricia MacphersonJacqui Smith was President ofthe British Dental HygienistsAssociation (BDHA) (now theBritish Society of Dental Hygieneand Therapy - BSDHT) from1992-1994 and, as she reachesher retirement, colleagues andfriends wish to pay a tribute to hercontribution to the profession ofdental hygiene.Jacqui has always displayed atremendous passion for our profession,alongside bringing up two childrensingle-handedly whilst working indental practice. She has been a longstanding and committed memberof the North East Regional Group ofBSDHT, always willing to step intothe breach and voluntarily help herregion. Jacqui was the first Presidentto come from that Group and, duringher Presidential term of office, sheinstigated the production of guidancesheets for BDHA/BSDHT Members.Her Regional Group colleagues, RoyAnthony and Sharon Parr, describe heras “supportive and knowledgeable” and“an inspirational woman, her enthusiasmis contagious”. Jacqui has always beenvery approachable and numerouspeople comment that she was always afriendly face if you attended a meetingor a course where you knew no one.Her common-sense approach and herability to teach you to ‘look outside thebox’ and recognise your own strengthsand weaknesses, has influenced many.Primley Park Dentistry, Leeds, whereJacqui has worked for the last tenyears, describe her as “an exceptionaldental hygienist and colleague” who was“able to convert even the most reluctantpatients to looking after their mouths andwe have all greatly enjoyed working with herto get the best results for our patients”. Shehas been passionate about providingexcellent oral hygiene care for herpatients and instrumental in settingup many educational initiatives.As part of Jacqui’s retirement giftthe practice are arranging a localwalk inviting all members of theteam, and loyal patients, and will beraising money for her chosen charityDiabetes UK - another example of herconsideration for others. To support,please go to www.justgiving.com/JacquiSmithRetirement.Jean Bowden signed up withJacqui to join the Queen AlexanderRoyal Army Nursing Corps in 1964.Attached to the Royal Army DentalCorp, they became lifelong friendsduring their training as dental nurses,dental radiographers and finally dentalhygienists. Jean has admired bothher professionalism and ability as apractising dental hygienist over theyears. She relates the tale of whenthey were training and she had triedto rescue a grey squirrel which had gotJacqui Smithinto one of the dormitory’s bathrooms.The little critter had been so spookedby a gaggle of near hysterical girls thatit shot up her sleeve and bit her on thearm before leaping out of the windowto freedom. Jacqui immediatelydragged Jean’s top off and started tosuck out what she saw as the ‘poisonousand deadly venom’ left by this poorcreature! The result was that theyboth ended up having tetanus jabs atCambridge Military Hospital. No doubtJacqui’s knowledge of first aid hasimproved over the years!Julia Brewin applauded Jacqui’sunfaltering dedication and professionaldrive during her 40 year career and alsoher enthusiasm, devotion and skill,and the fact that she has maintained acontinued interest and willingness tolearn throughout.I served on BDHA Council andbecame Honorary Secretary duringthe final year of Jacqui’s Presidencyand have had direct experience of herprofessionalism and enthusiasm andwould like to add my very best wishes,along with those of many other friendsand colleagues, for a long and veryHappy Retirement. Jacqui will bemuch missed.Jacqui’s Retirement Walk Group.16 Dental Health Volume 51 No 6 of 6 November 2012

clinicalComparisons andmanagement of tooth wearCarolyn RentonDiet, lifestyle, habits and nutrition can play a major role on the detrimentalhealth of the dentition, with different sources causing different types ofpermanent destruction to enamel and dentine. The purpose of this paperis to explore the different types of tooth wear, the aetiology, risk factors,clinical features, and the suitable management of different lesions.Non-carious tooth surface loss(NCTSL) of dental tissue is a normalphysiological process that takes placethroughout life, and is increasing inits prevalence. 1 Improvements in oralhealth care and an aging populationhave resulted in the longevity ofdentition. When lesions occur theypromote plaque accumulation,sensitivity, caries incidence, structuralintegrity and pulp vitality. For thesereasons it is essential to diagnose issuesearly to enforce methods to preventfurther occurrences. The aetiologyis complex and multifactorial. Untilit can be identified and addressedtreatment is likely to fail and furtherprogression will ensue.Aetiology andassociationAbrasion is an abnormal mechanicalprocess that results in tooth tissuebeing worn away. It is usually causedby overly forceful tooth brushing,abrasive tooth pastes or too frequenttooth brushing. Other habits cancontribute (eg pipe, hair-pin, pentopchewing), however studies show94% of dentists report it to be causedby tooth brushing. 2 It has a highersusceptibility in the presence erosion.Attrition in comparison is a slowphysiological process where ‘tooth totooth’ contact wears away enamel, andthen dentine. It is often caused bybruxism: a parafunctional activity thatcan occur during sleep or whilst awake,which in turn is thought to be broughtabout by stress or malocclusion. Ifleft untreated it may cause TMJdysfunction and fractured teeth. Itoften occurs with abfraction.Abfraction is a physical processassociated with tooth flexure fromocclusal loads. It is caused whenthere is a large amount of tensilestress concentrated in the cervicalarea. Small cracks developand expand into largerlesions by continuedforce in that area. 4 It canoccur independently, or inassociation with abrasion,attrition and/or erosion.RiskfactorsAbrasiont Tooth brushing,tooth pasteAttritiont Stress, malocclusionAbfractiont Occlusal loadErosion in complete contrast is achemical process that results in enamelbeing etched away by acid. It is theresult of exposure to non-bacterialacid from intrinsic or extrinsic origin.The chemical process is the same ascaries (dissolution of hydroxyapatitecrystals), but the clinical manifestationand management is fundamentallydifferent as the erosive process doesnot involve bacteria 5 . It is oftenassociated with abrasion and attrition.Erosiont Diet - fruit juice, carbonated drinks, fruit, sports drinks, wine, ciderst Lifestyle - drugs; ecstasyt Occupation - metal sheet workers, industrial battery workerst Environmental - swimmerst Illness - GORD, bulimia, ruminationt Medications - anti: psychotics, depressants, hypertensivest Other factors - xerostomia, salivary hypofunctionAbrasionAttrition18 Dental Health Volume 51 No 6 of 6 November 2012

Clinical featuresclinicalErosionAbrasiont Angular-shaped defectst Hard glassy sclerotic dentinet Shallow grooves, that deepent Well circumscribedt Dished out wedge shapedt Not related to caries, but canbecome carioust Affects buccal surfacesAbfractiont Angular-shaped defectst Hard glassy sclerotic dentinet Shallow grooves, that deepent Well circumscribedt Dished out wedge shapedt Affects cervical regionst Incisor, canine, premolarst Narrower and more V shapedthan abrasionPassive managementAll types of NCTSL:t Considerations – wear relative toage, symptoms, aetiology, patientwishest Monitoring tools – photographs,study models, indices, splintcomparisons, measurementsAbrasion: tooth brushing instruction/direction, correct technique, soft toothbrush, interdental aids. If sensitivitypresent:t Homecare: tooth paste withpotassium nitrate, potassiumchloridet In surgery: fluoride varnish, resins,and bonds: hema, oxalatesAttrition: stress counselling,malocclusion analysis - splint therapy– soft bite guard, localised interferencesplint, stabilisation splintAbfraction: force analysis –redistribution of stress, splint therapyAttritiont Flattened cuspst Worn incisorst Palatal and occlusal facetst Localised/generalisedt Affects palatal and occlusal surfacesErosiont Poorly demarcatedt Polished appearancet Larger enamel surfacet Enamel thint Affects palatal and occlusal surfacesakin to attrition whenparafunctional activitypresent.Erosion: ascertainunderlying causes: disease,medicines, reduce abrasivetoothpastes, dietarycounselling, plaque control,adjuncts: xylitol, fluoride.When sensitivity an issue,same as abrasion.Active treatmentAbrasion: glass ionomer cement isan option, but will quickly wear ifaetiology is not addressed. Compositeresin is an alternative option.Attrition: composite resins toimprove aesthetics or full restorativerehabilitation with indirect methods.Abfraction: glass ionomer cement orresin-modified glass ionomer cementsare the preferred material as it bendsand flexes with the tooth structure.Recent studies have shown a highsuccess with flowable composite, 6however success may be due to theskill of the operator, and the depth ofthe lesion.Erosion: same as attrition – in severecases, Dahl appliances can be used toalter the intercuspal position and clearthe freeway space, prior to restorativerehabilitation.ConclusionNCSTL is cumulative and appearsand increases with age. The aetiologyis multifactorial with most patientspresenting with different contributoryfactors. Specific causes need tobe addressed otherwise treatmentwill fail and the condition willinevitably worsen. Health, nutrition,occupation, lifestyle and oral healthshould be analysed and educationprogrammes developed with methodsand techniques for the fundamentallong term provision and prevention offurther damage.References1. Ho, C. Non-carious tooth surface loss, alook at the causes, diagnosis and preventionof wear. Australasian Dental Practice, 2007;33(6): 184-90.2. Conway, B. (2008) Abrasion andimplications for oral health. Academyof Dental Therapeutics and Stomatology[Internet], May, pp.1-8. Available from:http://www.ineedce.com/coursereview.aspx?url=2046%2fPDF%2f1103cei_abrasion.pdf&scid=14494 (Accessed on 02 July 2012).3. Strassler, HE. (2008) Prevention interventionfor bruxism. Academy of Dental Therapeuticsand Stomatology [Internet], Available from:http://www.ineedce.com/coursereview.aspx?url=2051%2fPDF%2f1103cei_preventive_inter.pdf&scid=14503 (Accessedon 01 July 2012).4. Rees, JS. The biomechanics of abfraction.Proc Inst Mech Eng H. 2006; 220(1): 69-80.5. Ren YF. (2011) Dental erosion: etiology,diagnosis and prevention. Academyof Dental Therapeutics and Stomatology[Internet], April, pp.1-6. Available from:http://www.ineedce.com/coursereview.aspx?url=2033%2fPDF%2f1104cei_erosion_web1.pdf&scid=14483 (Accessed on 02 July2012).6. Maurus, R. Esthethic and predictabletreatment of abfraction lesions. InsideDentistry. 2011; 33(1): 106-10.About the author:Carolyn Renton qualified as dental therapistand hygienist in 2006 and has nearly 20years’ experience in the dental industry. Sheworks in two dental practices in Leicester andNottingham and is currently studying for a BScin Dental Studies at the University of CentralLancashire.Address for correspondence:carolynrenton@live.comVolume 51 No 6 of 6 November 2012 Dental Health 19

newsNo increasein ARFThe GDC has agreed there will beno increase in either the dentistor dental care professional (DCP)Annual Retention Fee for the nextyear.This means that dental careprofessionals ARF will remain at £120,due by 31 July 2013.GDC budget plansThe decision was made at the Councilmeeting on 27 September 2012, whenthe GDC’s 2013 budget was approved.Further investment is planned toimprove and enhance the GDC’sperformance including:t Fitness to Practise reforms;t A move to introduce onlineregistration service which will leadto a cut in administration costs from2014;t Policy projects, notably theStandards Review, DirectAccess, Scope of Practice, reviewof continuing professionaldevelopment and Revalidation willbe progressed;t The new process for inspectingeducation in the UK;t The continued implementation ofelectronic document and recordsmanagement;t The redevelopment of 37 WimpoleStreet offices.Cost-effective regulationDuring 2012, progress made on costeffectiveness initiatives has continued.It is currently estimated that efficiencysavings of the order of £2.8m willbe achieved in 2012 resulting incumulative savings over two years ofsome £3.6m. The decision to redevelop37 Wimpole Street takes advantage ofthe existing lease. It does not expireuntil 2057 and is held on a peppercornrent. The redevelopment meansthe GDC reduces the need to rentadditional premises to accommodatestaff. Compared to other optionsconsidered by Council, it was deemedto provide the best value for money.Countdown to CPDdeadlineOn 31 July 2013 more than40-thousand DCPs will reach theend of their first CPD cycle. Thismeans you must complete 150hours of CPD by 31 July 2013 orrisk losing your registration withthe GDC.Full details of the types of CPD theGDC expects registrants to completecan be found online at www.gdc-uk.orgWho’s logged what?t 12,700 (32%) DCPs have logged allof their hours (including 50 hours ofverifiable CPD);t 4,600 (12%) DCPs have logged nohours;t Dental Technicians are the leastlikely to have logged any hours - 23%having not yet declared any.The deadline affects you!A CPD cycle for DCPs starts on 1August after they register. Cycle datescan be worked out using the tablebelow:A quick and easy way for DCPs to log theirCPD hours is to use eGDC. Details of how toset up an account can be found atwww.egdc.-uk.orgWhen did you register? Your 1st CPD cycle start date Your cycle endsOn or after 1 August 2011 01 August 2012 31 July 2017Between 1 August 2010 01 August 2011 31 July 2016and 31-Jul-11Between 1 August 2009 01 August 2010 31 July 2015and 31-Jul-10Between 1 August 2008 01 August 2009 31 July 2014and 31-Jul-09On or before 31 July 2008 01 August 2008 31 July 2013Invitation to becomeBSDHT Council ObserversBSDHT Council would like to invite any interested BSDHT members toapply for the role of Council Observer.Council agreed that it would make the work of the BSDHT Councilmore transparent to members if Council meetings were to be openedto invited observers.A number of members of the Society may attend full Council meetingspurely as observers, although numbers will be limited due to space.Applicants will be accepted on a first come basis and no expenses willbe paid. Meetings are held four times a year in Birmingham.The next meeting will be held on Friday 25 January 2013.To register your interest please contact the PresidentSally Simpsonon 01452 886365 or email enquiries@bsdht.org.uk20 Dental Health Volume 51 No 6 of 6 November 2012

society newsFrom the PresidentAs this is my last piece for thejournal before I step down at theOral Health Conference in Liverpool,I’d like to take this opportunity tosay what a huge honour it’s beenfor me to have served the SocietyI’ve admired for so many years. Itspassion and commitment to itsmembers and to the wider dentalprofession continues undiminished.Over the past eight years I have servedon Council, then the Executive Team,and finally as President-Elect andPresident. And now, having chairedboth my last Council and ExecutiveMeetings, I really can’t believe howquickly the past two years have passed- time really does fly when you’rehaving fun!I wouldn’t have missed it for theworld - it’s going to leave a huge holein my life!A summary of the BSDHT activityover my term of office this year…During my term of office one of themost important issues I wanted toaddress was to improve communicationwith members. I also wanted to ensurethat we were able to offer members agreater transparency and insight intothe work undertaken by the ExecutiveTeam, Council and our OperationalTeam.Moving with the times…I hope the work done in updating,redesigning and refreshing the BSDHTwebsite has allowed you to view andaccess much more information thanbefore.Also that the inclusion of regular“blogs” by me and our PublicationsEditor, Heather Lewis, and accessto our Constitution and CouncilMeeting Minutes has meant that as anorganisation we are much more ‘open’.As a consequence I believe ourmembers are now much more aware ofthe work undertaken by the Society –largely for the benefit of our membersbut also for the wider dental profession– that vital element of translucencyis precisely what members within theorganisation were looking for!As you know, this year we’ve strivedto reach out to members and thewider profession using social media,and regular updates now appear onFacebook and Twitter. In this way wekeep members up to date with Societynews, events and about developmentsin the wider dental arena. EmmaFisher also continues to feed relevantinformation, new research andprofession updates of interest tomembers into the “resource centre” onthe website.We continue to develop ourmembership services and to respond toenquiries from members, particularlyon work related issues.Changes to our publications…Last year you will also have receivedthe newest addition to our PublicationsPortfolio - “The Annual ClinicalJournal of Dental Health”. The nextissue is being prepared as we speak andwill be published to coincide with theAnnual Conference. Again its aim isto showcase the research undertakenprimarily by Dental Hygienists andTherapists – so look out for your copyarriving soon!Promoting participation inresearch…We’ve continued to provide supportto members wishing to participate inresearch and collaborated with FGDPand a sponsor to provide members withevents to involve, educate and inspirethose with an interest in the researchfield.We will again give members anopportunity to exhibit posters at thisyear’s conference.Sally SimpsonPenny Hardaker…Our new Business DevelopmentManager, Penny Hardaker has been asuperb addition to our team and hasenthusiastically set about her task ofimproving the quality and range ofservices we provide to our membersand develop future business strategyfor the Society’s activities.Penny’s first few monthswith us have been spent puttingtogether a framework for ourfuture organisational planning andformulating a new strategic plan.She has also begun to outline anoperational plan which will set out ourprimary goals and target timescales.We also recognise the importance ofgood relationships with our sponsorsin the dental trade and Penny has beendiscussing with them how we mightmaximise these relationships to ourmutual benefit.Oral Health Conference 9/10November Liverpool…I hope to meet with many of you at theOral Health Conference in Liverpoolnext month. In response to yourfeedback we’ve offered more choiceand variety in the subject matter forthe presentations with many moreparallel sessions and workshops. Therewill be a huge exhibition where youcan meet with the dental trade andlearn about new products, equipmentand innovations.We’ve looked carefully at cateringtoo, and have planned a variety oftasty, healthy and delicious meals andrefreshments - all included within yourdelegate rate.This year your newly inauguratedPresident, Julie Rosse, will also host aPresident’s Reception. This will allow22 Dental Health Volume 51 No 6 of 6 November 2012

society newsdelegates to mingle with all thoseattending - our sponsors, exhibitors,guests, speakers, and VIP’s, withrefreshments and Beatles- themedbackground entertainment.I do hope you like the changes we’vemade – all requested by you on thedelegate feedback forms.The International Federation ofDental Hygiene…BSDHT will continue its membershipof the International Federation ofDental Hygiene (IFDH) where JulieRosse and I have represented theSociety at the IFDH House of Delegates(HoD), inputting into decision makingprocesses within the Federation.We have provided reports anddata to IFDH on behalf of the UnitedKingdom and next year Julie Rosseas President and the newly electedPresident –Elect will representBSDHT at the HoD Meeting at theInternational Symposium of DentalHygiene in Cape Town, South Africa.If you’re interested in going to theSymposium then go to our website -you can find information there abouthow to book.I’ve also begun to investigatewhether membership to the EuropeanFederation of Dental Hygiene (EFDH)might benefit BSDHT and UKprofessionals, and have opened up adialogue with EFDH. The ExecutiveTeam feel that it’s crucial that we are intouch with the profession on a globallevel - so much can be learned from ourinternational colleagues. I’m convincedthat sharing of information, education,research and news is crucial to ourgrowth.Professional representation…As always the Society has continued torepresent members within the dentalprofession and in the wider arena,and has communicated the viewsof members to many organisationsincluding the Office of Fair Trading,Department of Health, General DentalCouncil, Professional Indemnifiers andthe Stakeholder Group of the All PartyParliamentary Group for Dentistry.Those of you that have followed myreports over the last year will be awareof our work with the OFT and GDCover Direct Access. You will by now beaware that the GDC has agreed thatthe Task and Finish Group’s proposalshould go to full public consultation.The proposal is that registered dentalcare professionals should have theoption to provide direct to patientsany care, assessment, treatment orprocedure that is within their scope ofpractice and for which they are trainedand competent.This consultation is now live atwww.gdc-uk.org and will run untilthe end of December. The BSDHThas received an invitation to respondbut I cannot stress how important itis that, as a registrant, you respondpersonally - this is potentially one ofthe biggest changes to the way we willbe permitted to work, and could signala new way in which our patients canchoose to access dental care. I urge youall to contribute your views.We also continue to contributeour views to the GDC on a varietyof topics and most recently I haveattended meetings with them to reviewthe proposals on CPD and also toexpress our views on the proposals forrevalidation.I have also attended Parliamentaryevents on many occasions to ensurethat our views on oral health, dentalcare and the profession are heard byParliamentarians and that we arerepresented in debates around theoral health and delivery of care to ourpopulation.Supporting education, and theDental Hygienists and Therapistsof the future…Improving our visibility to dentalhygiene and therapy students and theirTraining Schools has been a primaryobjective this year. Julie Rosse, in herrole as Regional Group Co-ordinator,has visited many Training Schools tomeet with students.In addition I’ve had meetings withboth the Schools’ Directors and TutorsGroup to look at ways in which we canbetter support both the Schools andtheir students.We now offer a graduation prizeof a complimentary one year BSDHTmembership at every school to astudent of the school’s choice. Thisprize has been very kindly supportedby one of our member benefit partners,Lloyd and Whyte.My thanks…Finally I would like to thank everyonewho has assisted me in leading theSociety over the past two years, themajority of whom are hard-workingvolunteers who have either freelyoffered their assistance or beennominated by other members. Theircommitment and dedication - throughtheir work as members of our Regional,Publications, Council and ExecutiveGroups - is truly inspirational.My very sincere thanks also go tothe Adams Partnership, in particularSue Adams for the quality services andinput she provides in the day to dayrunning of the Society.I must mention the Executive Teamof Julie Rosse, Carole Brennan, HeatherLewis, Jill Rushforth, Diane Hunter,Michaela ONeill and Deborah Sheatherall of whom have worked so hard andcontributed so much over the last twoyears which has been invaluable inhelping to spread the workload of theExecutive. Another huge ‘thank you’goes to BSDHT Company Secretary,Mike Wheeler who has not only offeredhis free time to fulfil his role but also,when required, has acted as a trustedmentor and advisor to many of theExecutive Team. I am humbled to haveworked with such an amazing team -so incredibly motivated, passionate andprofessional.I look forward to watching BSDHTgrow further under the Presidencyof Julie Rosse and to the excitingpossibilities we are ready to embrace inthe profession. Julie and I have workedtogether very closely over the past fewyears and I’m sure she will bring somuch to our organisation as your nextPresident.Finally my thanks go to you allfor inspiring me to represent you – Iwas compelled to speak out for sucha dedicated group of health careprofessionals.Sally SimpsonPresidentVolume 51 No 6 of 6 November 2012 Dental Health 23

society newsExclusive Membership BenefitOne Year’s Free BSDHT Membership,with specialist financial adviceThe BSDHT has teamed up with BDA appointedfinancial services provider, Lloyd & Whyte, to providespecialist Independent Financial Advice and InsuranceServices to members. In addition, those members whoarrange Income Protection policies or Pension Plansthrough Lloyd & Whyte before 30th September 2013will receive a year’s free BSDHT membership.It’s long been recognised by most dental hygienistsand therapists that whilst there are many benefits frombeing self-employed there can also be an increased level offinancial uncertainty.So it’s important to consider how you will provide foryourself not only if you’re unable to work through illnessor injury but also later in retirement. Financial Planningcan help bring some security to what, otherwise, can be anuncertain future.Lloyd & Whyte have been appointed by the BDA for thepast 15 years and draw on a wealth of experience in servingthe dental profession.The firm holds Chartered Financial Planners, CharteredInsurance Brokers status and is independent of any productprovider. A combination of which means you benefitfrom professional, independent and impartial advicewhich is relevant to your unique requirements as a dentalprofessional.For an informal discussion on how Independent FinancialAdvice can help you achieve better financial stability, or todiscuss individual products such as Income Protection andPension Planning and for more information regarding thefree BSDHT Membership offer, call 01823 250750or visit www.bsdht.org.uk/lloyd_whyte.24 Dental Health Volume 51 No 6 of 6 November 2012

obituaryKirsty SandomRDT RDH (U. Cardiff) 1972-2012Amanda GallieIt is with great sadness that I sharewith you the news that our friendand colleague, Kirsty Sandom,tragically lost her fight against arare lymphoma on August 12th2012.All those who knew her will agreethat Kirsty had a passion for excellencein dentistry and was a dedicated dentaltherapist and dental hygienist, and anaccomplished artist.She trained as a dental therapist in1997 through a grant from the NorthWales Community Dental Service andqualified in 1998. Two years later in2000, Kirsty successfully graduated asa dental hygienist at Cardiff UniversityDental School.Kirsty then worked in thecommunity service in North Walesbefore love led her to Nottingham in2002. Here she worked at JonathanZif’s implant practice in OadbyLeicestershire right up until her illnessmade it impossible to do so. Togetherwe then job shared at the Oasis DentalHygiene Unit in West Bridgford inNottingham for nearly a decade.Kirsty was hugely responsible forthe first conversion to private hygieneprovision in the Oasis corporate,and worked tirelessly to bring theproject to fruition. She workedhard to change the politics and thesystem, campaigning hard for nursingassistance to achieve excellence.Without her tireless enthusiasmthis big sea change would not havehappened.Kirsty won an accolade forprofessionalism and note taking andwas an excellent clinician.Her biggest achievement andlegacy is her son Harry. Together withher partner, Nick, Kirsty nurturedand raised Harry in Nottingham: anamazing mother she never tired ofproviding her beautiful son with everyounce of positivity and energy she had,right up until the later stages of herillness.Our hearts go out to Nick andHarry and KirstyHarry, her sister Fiona and the rest ofher family at this time. They workedtirelessly over the last two years tosupport Kirsty through her illness.I dedicate these words to thememory of an amazing women and adear, dear friend who will be misseddreadfully.There is a “Just Giving page” fordonations to Lymphoma research. Lastyear £3850.00 was raised on Kirsty’sbehalf. Please donate if you wish todo so.Mouth Cancer Action MonthThe British Dental Health Foundation has announceddetails of the UK’s largest mouth cancer actioncampaign, dedicated to raising awareness of the killerdisease.Mouth Cancer Action Month takes place in Novemberand is sponsored by Denplan. The campaign will becalling on dental professionals, doctors and pharmacists tohelp educate members of the public about a disease thatkills more people in the UK than testicular and cervicalcancer combined under the tagline ‘If In Doubt, GetChecked Out’.Latest figures show that more than 6,000 new casesa year are diagnosed in the UK, and one person diesevery five hours from the disease. Chief Executive of theBritish Dental Health Foundation, Dr Nigel Carter OBE,highlighted the importance of early detection in the battleagainst the disease.Dr Carter said: “Performing a mouth cancer check shouldbe part of every routine dental examination. If the professioncan inform and urge patients that regularly attending checkupsincreases the chances of mouth cancer being detected at an earlystage, together we can help to raise awareness of this killer disease”.If you are planning on holding an event to raiseawareness of mouth cancer to your local community,please visit www.mouthcancer.org and share your details.If you know anyone who has suffered from mouthcancer, or you diagnose a cancerous or suspicious lesionduring the campaign, the Foundation would love to hearfrom you.Please contact a member of the PR team onpr@dentalhealth.org or 01788 539792 to share yourdetails.26 Dental Health Volume 51 No 6 of 6 November 2012

CLINICAL QUIZClinical QuizA 39 year old male patient attendedcomplaining of bleeding gums and loose teeth.A diagnosis of generalised severe chronicperiodontitis was made, initial periodontaltherapy was performed and the periodontaldisease was stabilised.The patient attended on the reassessmentappointment and had noticed smallyellow spots on his gums. These wereasymptomatic. On examination it was notedthat these lesions were on the mucosal area ofthe UR4 and the UL4.What could be the possible diagnosis?This quiz was kindly produced by Mr Amit Patel, Specialist inPeriodontics and member of the Editorial BoardAnswers to September’s quizQ1. What clinical term is used to describe the lesion?A: LeukoplakiaQ2. What social habits may be contributing?A: Smoking, betel chewing, alcoholQ3. What micro-organism may be present inthe lesion?A: CandidaQ4. What percentage of this type of lesion will undergomalignant change in 5 years?A: 1-3%The winner of the September quiz was Gemma Davies.Send your answers to the Editor by 31st December. The first correct answer out of the bagwins a top of the range Triumph Oral B toothbrush (retailing at £150) courtesy of Braun Oral B.28 Dental Health Volume 51 No 6 of 6 November 2012

ETHICAL DILEMMASAsk Dental Protection…With a team of more than fifty dento-legal advisersavailable to support the profession, Dental Health hasselected recent enquiries they have received to see what the experts at DentalProtection could add to the advice from BSDHT in this fictionalised case.QFor more than a year I have been employed ata relatively new private practice. A few monthsago, I was told the practice had lost money and wasasked if I would change from an hourly rate (£30 perhour) to a percentage (35% of treatment completed,which translates as an average £2 an hour loss ifthe books are full). My dentist colleague was alsochanged to a percentage contract.This salary decrease was acceptable to me as Ienjoy working at the practice and I love the patients:I have a strong work ethic and will always ensurepatients are up to date with the exams and ensureappointments are made for outstanding treatment.However, I have noticed that my appointmentshave dramatically reduced and I now have, on average,six patients a day, whereas previously I had a full clinictreating 15 patients, and my diary was fully bookedtwo weeks in advance.On speaking to the nursing staff, I have discoveredthat the dentist is now carrying out routine hygienetreatment in shorter appointment times but at thesame cost to the patient.I have expressed my dislike of the situation to thepractice manager, but after speaking to the associatedentist, he reports that the principal dentist is tryingnot to refer patients on the grounds that they do notneed a hygiene appointment.As you can understand, it is a very difficultsituation. I like the practice very much and I am goingto ride out the next few months to see if it is just aslow period. However, I would be grateful for anyadvice you can give me so that we can come to someagreement that benefits me, the dentist and, moreimportantly, our patients.ADental Health spoke first to the BSDHT whocommented that such enquiries were not uncommonin the current economic climate, as many dentists, like otherbusinesses are trying to make economies where they can.One dental hygienist recalled something very similarhappening a couple of years ago, when the practice, whichwas completely private, noticed that the patient numberswere dropping and so to save money, the dentist would carryout the scale and polish at the same time as the check up, tosave the patient from coming back for a second visit.This hygienist found that she was quite busy for the firstpart of the morning, and then probably had a gap between11:30 – 3:00pm which of course, was not at all productivefor a self-employed person working on a percentage basis.Although the end of the day from 3-5pm was busy, this wasnot compatible with her financial expectations.Like any other employment situation, if the financialreward falls below your needs and expectations you needto have a conversation with your employer. The BSDHTsuggested that in such a situation the hygienist shouldexplain to the practice owner that for most of the day theyare sitting around unpaid, and that such a situation isnot acceptable on a regular basis. In situations where thehygienist is working several days in the practice, it might besensible to consider consolidating all the appointments intoa single day.The BSDHT also recognised that the dentist could beexperiencing a reduction in patient numbers, and so wouldnot want to pay somebody else to provide the hygieneservices if s/he has an empty chair. Equally the patientsmay not want to take additional time off work for a secondappointment if they have any concerns about losing theirown job.Although Dental Protection would not normally provideadvice on the business aspects of dentistry they were happyto provide some general observations on the issues raised bythe question.It is true that many practices, even those which areexclusively NHS, are seeing a reduction in the number ofpatients accessing their services. Unfortunately the fixedcosts of running a dental practice (for example staff wages,rent, equipment lease etc) still remain the same and areinvariably high. There can then be a fine margin betweenrunning a profitable business and one which is sinkinginto the red. The practice owner must remain alert to thefinancial viability of the practice and this will no doubt becolouring his/her actions.One of the major disadvantages of being a self-employeddental hygienist is that you are not afforded many of theemployment rights that true employees enjoy. You wouldnot, for example, be entitled to redundancy pay should theworst case scenario come to pass and your services wereno longer required. Your contract with the practice wouldsimply come to an end.Similarly the practice could point out that as you are self-30 Dental Health Volume 51 No 6 of 6 November 2012

employed, it cannot guarantee your income or promise to fill allyour appointments on a daily basis. Indeed most self-employedhygienist contracts simply state that the practice will do its bestto “introduce” patients requiring treatment. If you were anemployee however the situation is reversed and there is in effect,a financial incentive for the practice to make sure you are busy.In terms of the appointment book becoming rather thin, youdo need to be careful before jumping to any conclusions. Youmay of course be correct in your assumptions but if this wasthe case the principal could simply terminate your contract. Itis of course always the case that appointment books have sometime slots that fill well in advance of the others; usually closeto the times when people are travelling to and from work. As aresult the early and late appointments are usually booked well inadvance whilst leaving gaps in the middle of the day to fill moreslowly.Similarly, for a variety of reasons, patients may not find itconvenient to attend appointments when there are spaces inthe appointment book. It is worth remembering that patients,like everyone else, do have other commitments and demandson their time. Most will have jobs to go to, children’s needs toaccommodate and many will have their own financial worries.All of these elements are of course outside the control of thepractice, and yet can have a significant effect on the way anappointment book looks.Just to complicate matters further practices always have busyand slack periods throughout the year and these can vary fromone year to another. The effect you are seeing then may havelittle to do with the principal’s actions and more to do with thelocal situation.There is also the argument that, if properly managed,work expands to fill the available space. Many clinicianswho move away from the NHS do so to allow them to spendmore time with patients. That extra time is not always usedin providing additional treatment, but is more usually spentwith the individual patient in providing a more bespoke orindividual service. Whilst not suggesting that you string out theappointment, or over treat the patient, spending 30 minutes witha patient rather than 20 will be noticed (as the patient will notfeel as rushed) and if nothing else allows you to build a betterprofessional relationship with them. Happy patients come backand will often refer their friends and family to the practice. Evenif you are paid a fixed fee for an appointment, by spending moretime now you create an opportunity to improve the appointmentbook in the long term and your income.Alternatively some of this unallocated time can be usedto catch up on CPD (online possibly) or reading professionaljournals such as Dental Health. Even if CPD doesn’t directlygenerate fees, by shifting the activity into some of these episodesof down time, you are freeing up more of your time outsidework.As the questioner obviously likes working in this particularpractice it may be that s/he is prepared to ride out the stormin the hope that an economic upturn will bring with it a fullerappointment book. The alternative is to be more proactive asdiscussed above. S/he needs to be careful however as the grass isnot always greener on the other side and it is quite possible thatany other practice that you might consider moving to, is alsoexperiencing similar difficulties in trying to balance their books,in these most challenging of times.Volume 51 No 6 of 6 November 2012 Dental Health 31

interviewWomen on TopParadise Dental Technologies (PDT) is a company born of ethics and integrity, but mostof all it oozes love and passion for dental hygiene. In a recent trip to the beautifultown of Missoula, in the stunning state of Montana in the shadows of the RockyMountains, Paul Harrison co-owner of Swallow Dental Supplies in the UK, spent sometime with Linda Miller, owner of the uniquely vibrant PDT, discussing the company’shistory, ethos and plans for the future.Paul: Linda, tell me a bit about your background.Linda: Well, the dental industry certainly isn’t new to me.I have worked in the industry for over 30 years. From 1980to 1991 I was the quality manager for the American DentalCompany and then, in 1992, I was one of the founders ofAmerican Eagle Instruments here in Missoula. This is whenI really knew that I enjoyed hygiene instruments the most.It was at American Eagle that I presented the idea, and wasinstrumental in the design of the first large-diameter, lighthygiene instruments. The larger, lighter handle designsmade a huge difference.Paul: So what made you decide to start your own company?Linda: I was “venting” to a friend about my job oneevening after work and said, “If we had our own businessbased around our ethics and integrity, it would be paradisecompared to where I am now”. So with our focus on mypersonal ethics, values and a commitment to all the peopleinvolved – customers, patients and an ideal environment forour employees – Paradise Dental Technologies (PDT) wasborn. The paradise theme can still be seen with our ads andthe Hawaiian shirts that we often wear at shows and thecolours developed for our instrument handles. And, youknow, it really is paradise.around Missoula; we are part of the bigger community afterall. I think that what we do here is reflected in our customerretention rates which show a 98% re-order ratio.Paul: You mentioned your employees and I have certainlyexperienced their dedication, belief and hospitality. As your businessgrows how do you keep the same philosophy?Linda: It has been very exciting seeing the development ofthe business. In 2000 there were three of us manufacturingin my two-car garage at home. There were some very longdays. Our early success meant that we had to move to anew factory in 2005 but quickly outgrew it. We now have49 close-knit employees in a new 23,000 sq ft state-of-theartfactory as well as our sales team of 29. It’s a very bigextended family that work and play together. We do not “jobthings out”. We keep all of our testing and production inhouse here in Missoula. It really is all down to caring aboutthe profession and producing a very high quality instrumentthat enables the hygienist to do their job better. We have atruly amazing team. We keep them involved in the businessand their enthusiasm and commitment rubs off on any newpeople that join us.Paul: Most people will relate to wanting to create a more ideal workenvironment, but your vision seems to go beyond this. You mentionedethics, values and a commitment to all the people involved. Tell me,what do these mean to you?Linda: Well, I think that companies have an obligationway beyond the “bottom line”. My personal and PDT’sbusiness ethics extend to our customers that buy and useour instruments; they must be the best that can be made.We must also consider the patient who will have a betterexperience because our instruments are used and, last butnot least, our employees in Missoula who work hard tomake the instruments the best that can be used. By keepingour company in Missoula we are able to employ excellent,skilled and dedicated people all of whom have the samegoal – to make the best instruments available. We also havea programme of dental hygiene education for schools in andLinda in the factory.32 Dental Health Volume 51 No 6 of 6 November 2012

interviewPaul: What do dental hygienists like the most about yourinstruments?Linda: The first reaction is always how light the instrumentsare. Our customers know that a light and thick handlemeans less hand strain. They also like the grip becauseit gives great tactile sensitivity and does not have to besqueezed hard to stop it slipping. When they start to usethe instruments they see how long the edge lasts comparedto other manufacturers and nobody really likes sharpeningso this is a great benefit. Lastly, the small things like theadaptation of the blade become apparent when they arebeing used.Paul: Your ethos is obviously giving great benefits, but what sets youapart from other instrument manufacturers?Linda: We really believe that subtle differences make sucha difference to the patient and hygienist experience. Itis these subtle differences that define us. For exampleour Gracey curettes are not “just” curved, but they have asweeping curve that ensures that more of the blade adapts tothe tooth so less strokes are needed. Because our steel is sostrong, we can make our blades just a little bit thinner andyou’d be amazed what a difference such a small change canmake. Making a handle that looks sexy is easy, but we alsowanted a grip that means a light touch can be used and thatwill give the highest tactile sensitivity and excellent control.Our instruments have been designed to adapt better so theyare more patient friendly. All of these simple but subtledifferences have made a big impact.We like to innovate. For example, back in 2000, thecreator of our new steel told me that we could not get thehardness that we wanted. Fortunately, they were wrongand we came up with a cryogenic and heat treatment thatstill sets the standard for the performance of a qualityinstrument. We are constantly improving our productiontechniques to make sure that we stay ahead so that we canuphold our claims that our instruments are the finest youwill ever use.Paul: You make several new and unique instruments which havebecome very popular. Probably the best known are the MontanaJack® and the O’Hehir curettes.Linda: (laughs) Yes, the Montana Jack ® is very unique. Itis named after Jack Clark one of our sales guys in NorthCarolina. He does not live in Montana though. Jack cameto me with an idea for a very thin bladed scaler for use onboth anterior and posterior teeth. I told him that, if he couldpromise sales of 1500 instruments in a year, we would makeit for him. He told me he could sell 15,000 so we made themand he kept his promise. We now sell thousands of MontanaJacks worldwide every month.Our O’Hehir New Millennium curettes were developedwith Trisha O’Hehir. Trisha is a dental hygienist and educatorin the USA, and a member of the Editorial Board of DentalHealtht and a great woman. I believe that she has done somelecturing for BSDHT. The O’Hehir’s are angled like Gracey’sbut are much easier to use and are hugely successful.Paul: What are your plans for the future?Linda: Well, as you know, we now sell PDT into 40 countriesworldwide. We are very fortunate to have distributors withthe same business ethic and determination to satisfy theircustomers and hence patients and all while having some fundoing it. Our growth has been exponential and we want tokeep it that way by staying true to our ethics and principles,introducing exciting new instrument designs and enteringmore countries. There has and always will be a need for highquality, well made instruments and we want to continue tolead the market and keep the respect that we have gainedsince 2000.Lastly, we are very much a family oriented company and itwould be great to see my two daughters, Laura and Melodyjoin me in our growth and success. The future looks verybright and it’s still paradise.Paul: Thank you Linda; both for your time, your friendship andyour profound contribution to dental hygiene.Dental HealthAre we meeting your needs?The Editor, with the support of the Publications’ Committee and Editorial Board,strives to provide you with a quality publication.Are we succeeding?Your opinions are vitally important to us.Please let us know what you thinkEmail editorofdh@ntlworld.com with your thoughts or suggestions.Volume 51 No 6 of 6 November 2012 Dental Health 33

eviewsReviewsIn this issue of Dental Health AlisonLowe provides a short summary of someinteresting items from other sources.This is your brain onsugar – study showshow high fructose dietsabotages learning andmemory.The Peer Reviewed Journalof Physiology.15th May 2012The results of a recent UCLA studyhave shown that a diet high in fructosealters the brain’s ability to learn andretain information. However, theaddition of Omega-3 fatty acids to thediet can counteract this disruption.Whilst earlier research has revealedhow fructose harms the body throughits role in diabetes and obesity, thisstudy is the first to uncover howsweeteners influence the brain.Sources of fructose in the western dietinclude cane sugar (sucrose) and highfructose corn syrup, an inexpensiveliquid sweetener (the researcherswere less concerned about naturallyoccurring fructose in fruits as they alsocontain important antioxidants). Theaverage American consumes 35lbs ofhigh fructose corn syrup per year.Researchers studied two groups ofrats that each consumed a fructosesolution as drinking water for sixweeks. The second group also receivedomega-3 fatty acids in the form offlaxseed oil and docoahexaenoicacid (DHA), which protects againstdamage to the synapses (the chemicalconnection between brain cells thatenable memory and learning). DHA isessential for synaptic function i.e. braincells’ ability to transmit signals to oneanother and since our bodies can notproduce DHA it must be supplementedthrough our diet.The animals were fed standard ratchow and trained in a maze twice dailybefore starting the experimental diet.The UCLA team tested how well therats were able to navigate the maze,which contained numerous holes butonly one exit (visual landmarks wereplaced in the maze to help the ratslearn and remember the way).Six weeks later, the researcherstested the rats’ ability to recall theroute and escape the maze. The secondgroup of rats navigated the maze muchfaster than the rats that did not receivethe omega 3 fatty acids.The DHA deprived rats were slower,their brains showed a delay in synapticactivity; disrupting their ability tothink clearly and recall the route theyhad learnt 6 weeks earlier. They hadalso developed a resistance to insulin(the hormone that controls bloodglucose and regulates synaptic functionin the brain). A closer look at therats’ brain tissue suggested that theinsulin had lost much of its power toinfluence the brain cells. Insulin hasan important role to play but because itcan penetrate the blood-brain barrier itmay signal neurons to trigger reactionsthat disrupt learning and causememory loss.It is thought that eating too muchfructose could block insulin’s ability toregulate how cells use and store sugarfor the energy required for processingthoughts and emotions. These findingsillustrate that what you eat affects howyou think – food for thought indeed.The association of dentalplaque with cancermortality in Sweden.A longitudinal study.BMJ Open 2012:2published 11th June 2012Dental plaque biofilm may beassociated with premature deathdue to cancer according to a studyof 1390 randomly selected youngSwedes followed up from 1985 to 2009.Research suggests that there may be alink between plaque levels and cancerand death due to cancer. Althoughthe cause and development of thedisease was not taken into account, thepresence of high bacterial load on toothsurfaces and gingival margins wasassociated with poor outcome.Of the 1390 participants, 4.2%(58) had died prematurely during thefollow up, 35 as a result of cancer.Causes of death were recorded fromnational statistics and classifiedaccording to the WHO classification ofdisease. The amount of dental plaquebetween those who had died versussurvived was statistically significantmaking it a strong independentpredictor. All subjects underwent oralclinical examination and answered aquestionnaire assessing backgroundvariables such as socioeconomic status,frequency of dental visits and smoking.Age increased the risk of death as didmale gender. The malignancies weremost widely scattered in men whilstbreast cancer was the most frequentcause of death in women.The study hypothesis was confirmedby showing that poor oral hygiene,as reflected in the amount of dentalplaque, was associated with increasedcancer mortality. Oral health incancer patients has been cited as aconcern during and following therapy.Although, the conclusions of the studydo not demonstrate cause and effect,they raise concerns about potentialsystemic consequences of poor oralhealth and more specifically death dueto cancer.34 Dental Health Volume 51 No 6 of 6 November 2012

eviewsLeaving the tap runningwhilst tooth brushingis in action Off and Onagain; The Last Bite.The Dentist. Vol 28 No. 7July/August 2012As Stephen Hancocks wiselycommented recently in ‘The Dentist’:‘The paradox of the British weather reallyshould not surprise us after all these years,but it does just the same as it flip flopsfrom too hot to too wet’. Hence, theannouncement of the drought, actingas a prompt for torrential downpoursmeant that the hosepipe ban andrequests for water restraint werequickly reversed.Part of the plea for water restraintincluded not only a ban on hosepipeuse but also making sure the tapwas not left running whilst toothbrushing was in action, which set offan overabundance of media conjecture–apparently 64% of seven to ten yearolds let the water run into the basin,calculated to be wasting over 12 litresper person.In the 1970s it was suggested thatat night teeth should be brushed inthe dark to save electricity duringthe three day weeks of power cuts,however it was quickly pointed outby oral health experts that it wasessential to be able to see what youare doing! Whilst the pleas for waterrestraint are reminiscent of this it isclear that removing plaque is resourceintensive; a running tap uses aroundsix litres of water a minute, if youare brushing twice daily then abouttwenty four litres of water are wastedevery day, that is 168 litres a week.For a family of four, turning the tapoff whilst brushing would save about35,000 litres of water a year. 35,000litres is equivalent to 35m 3 , an Olympicswimming pool holds 2500m 3 of waterso if 70 families of four turned off thetap whilst brushing is in action theywould save enough water to fill anOlympic pool!The amount of water we use inthe UK is not sustainable; we haveto use less on a daily basis to ensureour supply does not run out. Wateruse is also linked to climate changebecause treating, pumping and heatingwater to make it safe for consumptionproduces carbon dioxide which is ofcourse a greenhouse gas. With this inmind, perhaps eco-awareness shouldbe incorporated into oral hygieneinstruction.Volume 51 No 6 of 6 November 2012 Dental Health 35

ook reviewBook ReviewTitle: BrushAuthor: James GoolnikPublisher: Bow LaneLimited; 1st Edition(2011)Pages: 201 (Paperback)ISBN: 978-0-9568332-0-4Price: £12.99 (100% profitsgoing to DENTAID)Reviewed by:Patricia MacphersonThis is a self-help book composed oftwelve chapters:1. Be a business owner and avoid aheart attack2. Time, money and karma3. This is a relationship business4. It’s a journey – what are thesignposts?5. Providing what your patientswant6. Use the global market to youradvantage7. Build a team you can be proud of8. You need to be one step ahead ofyour patient9. Know and drive your market10. Develop a support network11. Clinical trends12. What does the future hold?13. Don’t forget to flossI found this to be an inspiring bookwritten by a dentist who has builtup a successful practice which heis constantly evolving. It is a booksuitable for dentists, dental students,dental hygienists/therapists, studentdental hygienists/therapists andpractice managers and indeed anyteam member who strives to providethe best for their patients.James’ enthusiasm for theprofession shines through thispublication. Even if you do notwish to set up your own practice, Iam sure there are many things inthis book that you can personallylearn, or suggest to your employerthat will improve the service youprovide for your patients. IndeedI am letting my dentist readthis book! Not everything thatJames has done has worked, and he isnot afraid to admit this. He is a greatbeliever that you can learn from yourown mistakes (and from the mistakesof others).What comes across is theimportance of developing an excellentteam and a good network of colleaguesto support you. His philosophy isto believe in what you are doingand provide to patients: “good qualitydentistry focusing on their needs, using goodtechnology to their benefit, backed up byoutstanding customer service.” His aimis to create a happy patient who willspread the word to others. He suggestsletting go of the patients that causeyou grief. “The key to a great business is tofocus on your core strengths and delegate therest.” There may be other people in yourteam who are more skilled than you tocarry out a particular task.He gives pointers on how to set upyour own practice and pitfalls to lookout for. He stresses the importanceof a business plan and doing a SWOTanalysis (Strengths, Weaknesses,Opportunities and Threats) whichshould be frequently revisited. Hisview is that a role model or mentor isvital to focus upon what is possible butat the same time reviewing how faryou have come in your development.There is also a helpful bullet pointlist at the end of each chapter whichsummarises the learning points.Overall, his recommendations are toshare ideas and goals with your teamand have regular (quarterly) PersonalPerformance Interviews with them.Encourage all the clinical members tohelp you build your patient base – getthem to ask the patients you really liketo recommend family members, friendsor colleagues who need treatment.This is one example of a cost effectiveway to grow a practice and like muchof the advice, is plain common sense.He also emphasises that any form ofbusiness development is a journey andnot a one-off exercise. The learningcurve may be steep at times but in thechanging economic and technologicalenvironment in which we operate wecannot afford to rest on our laurelsand must constantly look for newand innovative ways to advance ourbusiness.This is a well written book in aneasy, sometimes humorous, stylewhich should not be mistaken for alightweight publication – the messagescontained within are vital and relevantin today’s world. If you neededanother reason to part with yourmoney, 100% of the profits from thesale of this book are being donated toDENTAID.36 Dental Health Volume 51 No 6 of 6 November 2012

diary datesDiary datesSpring 2013 BSDHT Regional Group Meeting DatesRegional Date Venue Contact Contact DetailsGroupthe SecretaryEastern 16th March 2013 Carly Dibden carly.dibden@gmail.comLondon Annette Quamina londonbsdht@gmail.comMidlands 9th March 2013 Moat House Hotel Joanna Ericson Joanna.ericson@ hotmail.co.ukStaffs. ST17 0RJNorth East 16th March 2013 Holiday Inn, Sharon Parr sands.parr@ntlworld.comGarforth, LeedsNorthern Ireland 9th March 2013 Radisson Hotel, Deidre Flynn dee_flynn@yahoo.co.ukOrmeau Road, BelfastNorth West Kate Reading ksr@moorlands.netScottish Jane MacConnell bsdhtscottishsecretary@gmail.comSouth East David Salomons Centre, Janet Scott janet.scott@sky.comtunbridge WellsSouthern 9th march 2013 Salisbury District Hospital, Gloria Anne Perrett secsouthern@gmail.comwiltshireS West & S Wales 23rd March 2013 Village Hotel, Cardiff Joanne Wilkinson wilkinson@joanne669@gmail.comSouth West 16th March 2013 Joanna West jowest60@gmail.comPeninsulaThames Valley 9th March 2013 Barcelo Oxford Hotel, Karrie Archer karrie.archer@btopenworld.comGodstow Road, OX2 8ALBSDHT Council MeetingDate: Friday 25th JanuaryVenue: Hilton Metropole, BirminghamNECRegional Group TrainingDayDate: Saturday 26 January 2013Venue: Hilton Metropole, BirminghamNECUpdate on LocalAnaesthetic - 2 DayCourseDate: December 13th, 2012Venue: Chase Postgraduate Centre,LondonTime: 9:30 - 4:30Speakers: Dr. Ambika Chadha andMrs. Hayley LawrenceAim: To establish confidence inadministering dental local anaestheticthrough sound theoretical and practicalknowledge.Objectives:1. Introduction to pain and localanaesthetics2. Anatomy of anaesthesia3. Demonstration of injectiontechniques4. Complications of anaesthesia5. Causes of LA failure and how toovercome them.Register: https://www.ewisdomlondon.nhs.uk/coursesandbookingFurther info: email: hayley.lawrence@londondeanery.ac.ukNew London DeaneryCourses 2013t Update on local anaesthetict CQC come quickly Commissionert Return to practice for Hygienist/Therapistt Effective techniques for subgingivalscalingt DCP study clubt Core CPD Updatet Advanced management ofperiodontal disease: 6 day hands oncourse by Dr. Peter Galgutt Oral cancer screeningt Impression takingt Whiteningt Temporary dressing andrecementing crownst Return to work Dental Hygienist/Therapistt Nonsurgical periodontal therapyTo register and book your place go tohttps://www.ewisdom-london.nhs.uk/login or contact: hayley.lawrence@londondeanery.ac.uk38 Dental Health Volume 51 No 6 of 6 November 2012

Advanced Managementof Periodontal Disease(six day course)Dates: 14th November; 19th December2012; 23rd January; 20th February;27th March 2013Time: 09:30 – 16:30Venue: LonDECSpeakers: Dr. Peter Galgut and HayleyLawrenceCost: £250.00 for all six daysLearning objectives:To review current concepts in thepathogenesis and clinical managementof periodontal diseases, and givepractical advice in the management ofclinical periodontics. The course willconsider strategies for management ofsevere dental and periodontal problemsfaced by hygienists and therapist.Topics include:1. Mechanical non-surgicalperiodontal therapy andpharmacological adjuncts tomechanical cleansing2. Probing techniques and forces3. Effective treatment planning &time management4. Reading & interpreting radiographs5. Topical and local anaesthetic review6. Hand vs ultrasonic instrumentation7. Correct operator positioning toavoid back and neck problems8. Patient management: dealing withproblem patients9. Knowing your limitations: avoidingmedico-legal issues10. An overview of moderninstruments for more effective nonsurgicaltherapyContact: hayley.lawrence@londondeanery.ac.ukImplant MaintenanceCourseDate: Saturday November 3rd 2012Venue: The Ivoclar VivadentInternational Centre for DentalEducation, (ICDE) Leicester.Speaker: Juliette ReevesThe course inassociation withStraumann and IvoclarVivadent is supportedby American EagleInstruments, EMS, Kerr,Optident and PhilipsOral Healthcare. It willfocus on the essentialsof implant care, implanttherapy and the maintenance of thesurrounding soft tissues.This Master Class will provide 6hours verifiable CPD and is targetedtowards Dental Hygienists andTherapists in general practice involvedin the after care of implant patients.This hands on course willinclude lectures, videos, protocols,demonstrations and hands on sessionsusing some of the latest materials plusprobing and instrument techniquesin implant maintenance. The coursewill focus on the practical applicationof implant therapy techniques andthe chance to evaluate a range of newinstruments and materials for tissuediary datesmanagement. Participants have theopportunity to experience and practisedifferent techniques on models.Places on this full day course heldat the ICDE are limited and the cost of£95 includes all course materials, goodybag, lunch and refreshments.Contact: www.perio-nutrition.com/Courses.htmlDate: 1-3 May 2013Venue: Manchester CentralConvention ComplexThe increasingly popular event,which is entitled “How long do implantslast?” will focus on the complications,risk management and prognosis ofimplant treatment and will appeal to allmembers of the dental implant team.If you would like to attend theevent, the easiest way to book foryourself and your team is online at:www.adi.org.uk/congress2013Core CPD for DentalCare ProfessionalsSubjects covered: Legal and EthicalConsiderations for the DCP, ComplaintsHandling and Communication,Disinfection and Decontamination,Radiography and Medical Emergencies.Please email for details.Dates: Saturday 1st December 2012Venue: Aylesbury.Cost: £49.00 (including tea/coffee anda light lunch)Speakers: Sue Bagnall and Nicky GoughCPD: 5 hours core verifiable CPDBooking:enquiries@cpd4dentalhygienists.co.ukFIRST ANNOUNCEMENTThe Oral Hygienists’ Association of South Africa (OHASA),under the auspices of the International Federation of DentalHygienists (IFDH), wishes to extend a warm invitation toour Dental and Medical colleagues across the globe toattend the first ever International Symposium on DentalHygiene in South Africa and the continent of Africa.Come explore our beautiful host city of Cape Town andparticipate in a world-class event.Volume 51 No 6 of 6 November 2012 Dental Health 39

Continuing ProfessionalDevelopment ProgrammeCPDDental Health is pleased to include a Continuing ProfessionalDevelopment (CPD) Programme for its members who arerequired to show evidence of CPD hours spent.The Programme is formulated in accordance with theguidance of the UK General Dental Council’s regulationswhich now require all registered UK hygienists andtherapists to undertake CPD and provide evidence of theequivalent of 10 hours per annum of verifiable CPD. Thequestions in this issue will provide 1 verifiable hour forthose entering the CPD programme.Members wishing to enter the Programme need tolog on to www.bsdht.org.uk and select CPD. Register ifyou have not yet done so, or Login if you have alreadyRegistered, and go to the Take CPD section. Certificates canbe printed for the Programme in each issue, or stored in apersonal ‘Global’ account and printed at any time. There isno charge for this service.Alternatively, members may complete the answer sheetoverleaf (or a photocopy). Return it with a cheque for£11.75 (£10 +VAT) made payable to BSDHT, to: BSDHT, 3Kestral Court, Waterwells Business Park, Waterwells Drive,Gloucester GL2 2AT. Responses must be received before31st December 2012 as the answers will be given in theJanuary 2013 issue (Volume 52 No 1).Members from whom fully completed forms andappropriate cheques are received will receive a certificatefor 1 hour of verifiable CPD with the answers to thequestions.Aims and outcomesIn accordance with the General Dental Council’s guidance on providing verifiable CPD for hygienists and therapists:• The aim of the Dental Health CPD Programme is to provide papers of relevance to hygienists and therapists and totest their understanding of the contents.• The anticipated outcomes are that hygienists and therapists will be better informed about recent scientific, clinical andmanagement research and advances that they might apply their learning to their practices and the care of their patients.Please use the space on the answer sheet to provide any feedback that you would like us to considerDental Health Online CPDFollow eight simple steps and create your free record of verifiableCPD and certificates.1. Go to www.bsdht.org.uk and select CPD and follow link.2. Click on ‘Register’ at the top right of the page.3. Enter your GDC number.4. Complete your contact details and create your password.5. Once you have created your account and logged in, click into the ‘CPD area’ – the last bullet under‘Your Account’ and then click on ‘View all available CPD’.6. Scroll down the page through the choice of CPD available until you see Dental Health. Click on ‘Take’ to the rightof the page.7. Under ‘Article name’ click on ‘Dental Health’ to answer the CPD questions.8. To complete the CPD, click on the appropriate answer to each question. We welcome any comments you may like toadd at the end and then click on ‘submit’ to complete the exercise. Once you have submitted your answers, return toCPD Area and click: CPD results – click here to check your score and print certificate for these activities. Also inthe CPD area you can click on My Global CPD summary to date – print summary and add other CPD to checkcumulative hours taken through the site. You can also add any other CPD taken elsewhere to your Globalaccount to create your total account of hours taken.We hope you have found this guide useful. If you have any problems, please contact us on 01452 886365or email enquiries@bsdht.org.ukAnswers to the CPD questions in Dental Health Volume 51 No 5 of 6September 2012CPD Paper1: Essential lipid mediators in theresolution of chronic inflammation:implications for supportive therapy pp 6-8Question 1: C: PUFA’sQuestion 2. B: Omega 3 fatty acidsQuestion 3. D: Cellular membranesQuestion 4. D: Both PGE2 and metabolites of AAQuestion 5. A: DHAQuestion 6. D: combination of B and CCPD Paper 2: Significant implications of mouthbreathing pp 10-12Question 1: A: The body needs 2% oxygenQuestion 2. D: CO2 has no impact on blood pHQuestion 3. C: 10-12 breaths per minuteQuestion 4. A: Carbon dioxideQuestion 5. A: Nitric oxide has no role to play in respirationQuestion 6. A: Deep mouth breathing can lower CO2 levelsin the lungsVolume 51 No 6 of 6 November 2012 Dental Health 41

cpdSelf Assessment for CPD Select one correct answer in each questionCPD questions November 2012Worth1 hour ofverifiableCPDCPD paper 1: Setting the stage for implants, pages 12-15Q1. A tooth is extracted, and socket preservationhas not been carried out. In such a case, which ofthe following statements is false?A. The bone resorbsB. There may be a detrimental affect on facial structureC. The alveolar ridge does not retain its shapeD. A denture is the only option to replace the missingteethQ2. Which of the following statements is true ofadjunctive procedures?A. Can be used after implant placement to regeneratebone lost around implantsB. Cannot regenerate bone height and width to placeimplant(s) in the optimal locationC. Are only performed prior to placing implantsD. Are carried out by a dental hygienistQ3. What is a GBR?A. Generalised bone reductionB. Generalised bone regenerationC. A bone regeneration procedure that allows bone toregenerate while keeping the connective tissue outD. A bone regeneration procedure that allows bone toregenerate while keeping the connective tissue inQ4. What are the principles of regenerativeproducts?A. Osteogenesis, osteoreductive, osteoinductiveB. Osteoclastic, osteoconductive, osteoinductiveC. Living cells; scaffold to allow bone to regenerate;signals to isolate and accelerate regenerationD. Eliminate the need for surgical proceduresQ5. How long does it normally take for granulationtissue to fill the socket?A. 6 days B. 6 weeksC. 6 months D. 12 monthsQ6. What is a xenograft?A. A bone graft typically derived from a different species,typically bovine or porcine graftsB. A bone graft which is always osteoreductiveC. A synthetic bone graft used in regeneration andpreservation proceduresD. A synthetic bone graft manufactured entirely inthe UKCPD paper 2: Comparisons and management of tooth wear page 18-19Q1. Which of the following is not considered to bean aetiological factor in the process of abrasion?A. Over zealous toothbrushing habitsB. Abnormal oral habitsC. Acidic beveragesD Abrasive toothpasteQ2. Which of the following statements is true ofattrition?A. Often caused by parafunctional activityB. Always causes pain and discomfortC. Requires no dental interventionD. Only ever noted in the permanent dentitionQ3. Abfraction may best be described by which ofthe following statements?A. It is a physical processB. It is a chemical processC. It is a physiological processD. It is a biological processQ4. Erosion is the result of…?A. Bacterial infection B. Bacterial inflammationC. Bacterial acid D. Non-bacterial acidsQ5. Which of the following statements is false?A. Abrasion characteristically affects the buccal surfacesB. Attrition characteristically affects the palatal andocclusal surfacesC. Abfraction characteristically affects the cervicalregionsD. Erosion characteristically affects cervical regionsQ6. Dental erosion is caused by sustained directcontact between tooth surfaces and acidicsubstances. It has long been recognized thatdemineralization of dental enamel will occur oncethe oral environmental pH reaches the criticalthreshold. What is considered to be the criticalthreshold?A. 2.5 B. 3.5C. 4.5 D. 5.542 Dental Health Volume 51 No 6 of 6 November 2012

cpdDental Health Volume 51 Number 6 November 20121. Please print your details below:First Name* Last Name* TitleAddress*Postcode*Tel: Fax: BSDHT Membership no*E-mail:GDC no**Essential information. Certificates cannot be issued without all this information being complete.2. TICK the answer to each question for each article you select. You may complete one or two articles.6 CPD article 1 6 CPD article 2a b c d a b c dQ1 6 6 6 6 Q1 6 6 6 6Q2 6 6 6 6 Q2 6 6 6 6Q3 6 6 6 6 Q3 6 6 6 6Q4 6 6 6 6 Q4 6 6 6 6Q5 6 6 6 6 Q5 6 6 6 6Q6 6 6 6 6 Q6 6 6 6 63. Please either remove this page, or send a photocopy to:BSDHT CPD Programme, BSDHT, 3 Kestrel Court, Waterwells Business park, Waterwells Drive, Gloucester GL2 2ATtogether with a cheque for £11.75 (£10 + VAT)Or complete online FOR FREE at www.bsdht.org.ukAnswer sheets must be received no later than 31st December 2012. Answer sheets received after this datewill be discarded as the answers will be published in the January issue of Dental Health.FeedbackWe wish to monitor the quality and value to readers of the BSDHT CPD Programme so as to be able to continuallyimprove it. Please use this space to provide any feedback that you would like us to consider.Volume 51 No 6 of 6 November 2012 Dental Health 43

administrationBSDHTAdministrationPresident: Sally SimpsonPresident Elect: Julie RosseHonorary Treasurer: Jill RushforthHonorary Secretary:Carole Brenan, 3 Kestrel Court,Waterwells Business Park, WaterwellsDrive, Gloucester GL2 2ATTel: 01452 886365Email: enquiries@bsdht.org.ukRegional Group Co-ordinator:Julie Rosse, Tel (direct) 07968 349460or email: julierosse@bsdht.org.ukWebsite Resource Centre Feeder:Emma Fisher Email: emmafisher@bsdht.org.uk or call 01452 886365Hon. Vice Presidents: Mr Peter Ward,Dr Nigel CarterServices Representative: Lyne Aldridge,Email: lynneyaldridge@hotmail.comTutor Rep: Elizabeth Bannister,Senior Tutor, Birmingham School ofDental Hygiene and Therapy, St Chads,Queensway, Birmingham B4 6NNEmail: elizabeth.bannister@sbpct.nhs.ukPublications Editor Representative:Alastair LomaxEmail: alastair_lomax@hotmail.comElected Council Members:Deborah SheatherEmail: deb.sheather@yahoo.comMhari CoxonEmail: mharifaye@hotmail.comJudy MarstonEmail: judymarston@btopenworld.comElected Council Members toExecutive Committee:Michaela O’NeillEmail: conormichaela@googlemail.comand Diane HunterEmail: mrsdianeehunter@aol.co.ukCo-opted Council member toExecutive Committee.Deborah SheatherEmail: deb.sheather@yahoo.comDirectors of the InternationalFederation of Dental Hygienists:Sally Simpson and Julie RosseJobline & Services Co-ordinator:Tel: 01452 886365Email: enquiries@bsdht.org.ukBSDHT Representatives:Institute of Health Promotion and Education:Elaine Tilling, British Dental HealthFoundation: Alison GarrettPublic Pay Sector Advisor (UNISON):Michael WheelerBSDHT reps on joint BDA/BSDHTcommittee: Sally Simpson and Julie RosseRegional GroupRepresentatives on CouncilEastern: Sarah LawsonEmail: lawson170@btinternet.comLondon: Nina FrateEmail: ninas32@hotmail.comMidlands: Judie HenfreyEmail: judie.henfrey@tiscali.co.ukNorth East: Cheryl McBroomEmail: Cheryl.mcb@btopenworld.comNorth West: Helen MinneryEmail: helenminnery@live.co.ukNorthern Ireland: D FlynnEmail: repbsdhtni@gmail.comScottish: Sandra Leaney.Email: scottishrgrep@hotmail.co.ukSouth East: Rimy O’FarrellEmail: mikemkfrrll@aol.comSouthern: Niamh EganEmail: councilrepsouthern@gmail.comSouth West and South Wales:Judy CaesleyEmail: judy.caesley@bristol.ac.ukSouth West Peninsula: Janet BaxendaleEmail: thebaxendales@blueyonder.co.ukThames Valley: Suzanne EllisEmail: ellis@newportpagnell3.fsnet.netRegional Group TeamEasternChair: Hannah ShawEmail: Hannah.shaw88@yahoo.co.ukSecretary: Juliette ReevesEmail: reeves@waterville.freeserve.co.ukTreasurer: Nichola BartleyEmail: nickishewan@hotmail.comTrade Liaison: Tricia VodaEmail: p.voda@btinternet.comLondonChair: Sarah MurrayEmail: s.m.murray@qmul.ac.ukSecretary: Donna-Marie CooperEmail: londonbsdht@gmail.com ordonna.m.cooper@btinternet.comTreasurer: Vaida BuksnaityteEmail: acc.londonbsdht@gmail.comTrade Liaison: Suzanne DymantEmail: londonbsdhttrade@gmail.conMidlandsChair: Veronica ScattergoodEmail: veronicascatt@hotmail.co.ukSecretary: Joanna Ericson email:Email: Joanna.ericson@hotmail.co.ukTreasurer: Helen WestleyEmail: helen_westley@hotmail.comTrade Liaison: Emma DukeEmail: emmajd@me.comNorth EastChair: Jacqui SmithEmail: nergchair@btinternet.comSecretary: Sharon ParrEmail: nergsecretary@gmail.comTreasurer: Roy AnthonyEmail: roy.anthony@ntlworld.comTrade Liaison Kerry RobinsonEmail: nergtraderep@hotmail.co.ukNorth WestChair: Yvonne DerbyshireEmail: yderbyshirebsdht@aol.comSecretary: Kate ReadingEmail: ksr@moorlands.netTreasurer: Catherine ClarkeEmail: catherine.clarke1@btopenworld.comTrade Liaison: Natalie GouldenNorthern IrelandChair: Janine BurnsEmail: chairbsdhtni@gmail.comSecretary: Trudi FawcettEmail: secretarybsdhtni@gmail.comTreasurer: Tracey DooleEmaiI: treasurerbsdhtni@gmail.comTrade Liaison: Jane SinclairEmail: tradebsdhtni@gmail.comScottishChair: Sarah WalkerEmail: bsdhtscottishchair@gmail.comSecretary: Jane MacConnellEmail: bsdhtscottishsecretary@gmail.comTreasurer: Lisa BanksEmail: bsdhtscottishtreasurer@gmailTrade Liaison: Trisha SteeleEmail: bsdhtscottishtrade@gmail.comSouth EastChair: Sarah CoxEmail: ssjcox@mac.comSecretary: Janet ScottEmail: janet.scott@sky.comTreasurer: Ellie StilesEmail: elliestiles@hotmail.co.ukTrade Liaison: Laura BerryEmail: Laurajane21@hotmail.co.ukSouth West and South WalesChair: Elaine TillingEmail: Elaine@molarltd.co.ukSecretary: Joanne WilkinsonEmail: Wilkinson.joanne669@gmail.comTreasurer: Jill QuigleyEmail: Karl.quigley@btinternet.comTrade Liaison: Joanne WilkinsonEmail: wilkinson.joanne669@gmail.comSouth West PeninsulaChair: Penny WilliamsEmail: williamspenny.s@gmail.comSecretary: Joanna WestEmail: jowest60@hotmail.comTreasurer: Maureen GingellEmail: mohyg@gmail.comTrade Liaison: Jill HetheringtonEmail: mouthmotivation@hotmail.comSouthernChair: Jane PetersonEmail: chairsouthern@gmail.comSecretary: Gloria PerretEmail: secsouthern@gmail.comTreasurer: Alice StubbsEmail: treasurersouthern@gmail.comTrade Liaison: Teena EatonEmail: tlosouthern@gmail.comThames ValleyChair: Carole BrennanEmail: carole264@btinternet.comSecretary: Karrie ArcherEmail: karrie.archer@btopenworld.comTreasurer: Suzanne EllisEmail: ellis@neportpagnell3.fsnet.ukTrade Liaison Officer: Sheila FoxEmail: sheilabarbaraf123@gmail.com44 Dental Health Volume 51 No 6 of 6 November 2012

Market Newsmarket newsMy TePeTePe havelaunched anew initiativeto help youhelp yourpatients – aTePe Scriptpad. Anillustratedmouth mapto show yourpatientswhere andwhat colour/size of TePe Interdentalsbrushes they need, plus informationon which shops stock TePe. On thereverse are featured the specialistproducts such as TePe Compact Tuft,Implant care brush and TePe Select,so that your patients can see what youare recommending for them. Simplyfill out both sides of the sheet withyour product recommendations andhand to the patient – it’s as simple asthat! TePe Script Pads are availablefrom your wholesaler or contactinfoUK@tepe.com.Strength & protection where itmattersTePe’s renown and popular InterdentalBrushes are the answer to removingplaque and impacted food frombetween the teeth – and easier to usethan floss. TePe have now launchedGingival Gel, specially formulated to usewith Interdental Brushes. It contains0.2% Chlorhexidine (effective protectionagainstplaque) and1500 ppmFluoride(helpsprotect toothenamel),deliveredjust whereit is needed,close to thegums. Thegel has a refreshing mint flavour andcontains no alcohol or abrasives. TePeGingival Gel comes in a smart bottle,specially designed for easy applicationonto the brush.For further information contactinfoUK@tepe.com, www.tepe.comGrahame Gardner enhanceUrbane rangeGrahame Gardner have enhancedtheir popular Urbane scrubwear rangewith the addition of 9534, a newlonger length tunic. This flatteringstyle boasts the same high qualitydesign features as the rest of theUrbane range, and is available in awide selection of bold colourways.The Urbane Scrub range has becomea firm favourite of dental surgeriessince it was launched in the UK 6years ago. Therange presentsall the comfortassociated withscrubwear, butthe uniquedesigns alsoinclude sidedarts, contrasttrims andother desirabledesign featuresmaking Urbanea collection ofdistinction. Please call 0116 255 6326or visit www.grahamegardner.co.uk.The importance of RSI - Protectyour most valuable assets withDENTSPLY Hand InstrumentsOver time, the repetition of similarprocedures can leave you at riskof developing RSI. The ergonomicexcellence at the heart of every DENTSPLYscalinginstrumentcombats this,whilst actingas a true andfaithful workingextensionof your ownbody. Workinghygienists and ergonomic experts haveplayed a vital role in the design ofDENTSPLY’s Silicone Handled and ResinHandled Instrument ranges, ensuringthey provide excellent grip and handlingcharacteristics while minimising the riskof repetitive strain injuries.Contact us at dentsply.co.uk or 0800 0723313. Earn rewards against purchases atdentsplyrewards.co.ukAccess webinars and productsdemonstrations and earn CPD atdentsplyacademy.co.ukWorking in partnership to provideexpert careJohnson and Johnson has introducedthe first in a new expert rangefrom LISTERINE® – a twice-dailymouthwash built on potassium oxalatecrystal technology that blocks dentinetubules deeply forlasting protectionfrom sensitivity.Advanced DefenceSensitive blocks 92%of dentine tubulesin just 6 rinses invitro; over twice asmany as Sensodyne ®Rapid Relief andColgate ® SensitivePro-Relief TMp˂0.05. It can beused alone forlasting protection, or in combinationwith the most recommended pastefrom the leading sensitivity brand,to significantly increase the numberof tubules the paste blocks in vitro.Contact Johnson & Johnson on0800 328 0750.DentalHealthAre we meetingyour needs?The Editor, with the support ofthe Publications’ Committeeand Editorial Board, strivesto provide you with aquality publication.Are we succeeding?Your opinions are vitally importantto us.Please let us know what you thinkEmail editorofdh@ntlworld.comwith your thoughts or suggestions.Volume 51 No 6 of 6 November 2012 Dental Health 45

oracleWaterpik International, Inc.Sponsors Research PosterPresentationsat the BSDHT Conference 2012Waterpik International, Inc. is partnering with the BSDHT tobring the latest research to dental hygienists and therapistsin the UK. In addition to hosting a stand at the BSDHT OralHealth Conference and Exhibition, Waterpik International,Inc. is once again sponsoring the event’s poster presentationsarea.Delegates who have been involved in research projectshave the opportunity to share their results with colleaguesand win a prize by displaying a poster of their work at theConference. The winner will be selected by the BSDHTScientific Committee and awarded at the President’sreception.Waterpik International, Inc. is proud to support anactivity that encourages scientific investigation andknowledge sharing amongst the profession to improveclinical treatment for patients.The BSDHT Oral Health Conference and Exhibition isbeing held at the ACC Conference Centre in Liverpool on 9th-10th November 2012.For more information please speak to your wholesaleror visit www.waterpik.co.uk. Waterpik ® products are widelyavailable in Boots stores and selected Lloyds Pharmacies.BDTA Dental Showcase benefitsdental charitiesFollowing the launch of the BDTA Dental Showcase CharityPoll in which the British Dental Trade Association (BDTA)announced it would make a donation to three dentalcharities if 20,000 registrations were reached, the associationis delighted to reveal that this was successfully achieved anda donation of £5,000 has been made, benefiting the industry.The donation has been shared amongst three dentalcharities: Bridge2Aid, the British Dental Health Foundationand Dentaid based on the number of votes each charityreceived.Tony Reed, Executive Director of the BDTA commented:“I would like to thank all members of the dental teamwho registered for BDTA Dental Showcase and took theopportunity to vote for their favourite dental charity. TheBDTA is a non-profit making organisation supportingdentistry in a wide variety of ways. I am delighted that somany members of the team took the time to participate inthe poll, it will make a difference to many people’s lives.”Liverly debateAs part of its educationplan, Philips will besupporting ProfessorDamien Walmsley onFriday 9 November2012 at the BSDHT OralHealth Conference inLiverpool on the subjectof the ultrasonic scalerand recent advances inunderstanding how it works and Maria Perno Goldie, a notedUS Dental Hygienist on auto immune disease in relation topatient care.Visit the Philips stand 38 from 8.30am on the firstmorning of the Conference and the first 300 Members ofthe Philips Transitional Support Programme will receive aFREE AirFloss providing they agree to try the product andcomplete the evaluator programme. For more informationvisit the Phillips stand if you can’t attend the show, visitwww.sonicare.com or www.philipsoralhealthcare.com or call0800 032 3005 or 0800 0567 222Volume 51 No 6 of 6 November 2012 Dental Health 47

oracleBDTA Dental ShowcaseAnother highly successful BDTA Dental Showcase took placefrom 4-6th October!On each of the three days 10,500 dental professionalsconverged on London’s ExCeL to experience all that’s newin dentistry at the UK’s largest dental exhibition. Delegatestook full advantage of the opportunity to interact with andgain advice from over 330 leading dental companies eachwith its own on-stand experts ready to help and share theirknowledge. The very latest in dental equipment, servicesand techniques were showcased at the event, creating aprofessional atmosphere for everyone to engage with thefuture of dentistry.Tony Reed, Executive Director of the BDTA commented:“Once again we have enjoyed another successful year ofBDTA Dental Showcase, offering delegates a ‘voyage ofdiscovery’. The exhibition provided a positive atmospherefor business sales to thrive and business relationships toflourish, enhanced by a variety of new initiatives that provedto be of immense appeal to the dental team. We look forwardto launching plans for BDTA Dental Showcase 2013.”BDTA Dental Showcase will take place on 17-19 October2013 at NEC, Birmingham.48 Dental Health Volume 51 No 6 of 6 November 2012

ecruitmentRecruitmentBERKSHIRENewbury.Hygienist required at a prestigiousmulti-discipline private Newbury practice.Initially Wednesdays. 30-60 minuteappointments with nurse support.To arrange an informal chatplease contactnickfrench@briarsdentalcentre.comattaching your CV.DEVONNewton Abbot.We are looking for a hygienist to join ourbusy, friendly, forward thinking practice,for two days a week. Predominantly NHS,some private work (dental implants).Please telephone 07775 896966or emailstephtomes@stpaulsdentalpractice.co.ukfor further information.KENTAshford.Dental therapist required two days aweek (with the possibility of more) for aprivate and Denplan patient base.Please email your CV toerdds@hotmail.comLONDONBarnet, Cockfosters.Experience dental hygienist required forbusy dental practice. Saturdays only09.00 – 18.00hrs. Salary negotiable.Please telephone 020 8449 7461or emailMargaret.sander@googlemail.comfor further information.SOMERSETWellington.Part time hygienist required for a busyfour surgery established independentmodern mixed practice in WellingtonHigh Street. Dedicated hygienistsurgery with KaVo chair and handpieces.Hygiene appointments and patientsare predominantly private. Excellentremuneration. BDA Good Practice,friendly and qualified team of staff andappreciative patients. Long standinghygienist of six years emigrating withfamily.Please telephone 01823 661555 oremailwellingtondentalpractice@hotmail.comfor further information.WEST MIDLANDSWolverhampton.Willows Dental, Wombourne are lookingfor a friendly, enthusiastic qualifieddental hygienist to work part time at ouraward winning practice.Email Neel atmail@willowsdental.co.ukWILTSHIRESwindon.Hygienist required for three days perweek, Tuesdays, Thursdays and Fridays.Busy, friendly, private practice, fullycomputerised. Immediate start.Please send CV to: Tracy RobinsonVictoria Road dental practice,75 Victoria Road, Swindon SN1 3BB.For further information please telephone01793 534627.Volume 51 No 6 of 6 November 2012 Dental Health 49

guideline for authorsGuidelines for AuthorsDental Health has producedthese guidelines to assistprospective authors towardspublication. The journal willconsider for publication fulllengthresearch papers, clinicalcase reports, review articles, shortcommunications, letters to theeditor and professional issues.Please submit manuscripts to:Heather Lewis, Editor, DentalHealth, 19 Cwrt-y-Vil Road,Penarth, South Glamorgan, WalesCF64 3HN. Tel: 02920 710042or Fax: 02920 710042 or Email:editorofdh@ntlworld.com.Manuscripts A copy of eachmanuscript, including tables andhigh-quality figures, should besent electronically via email as anattachment.Copyright A mandatorysubmission and copyright formmust be signed by all authorsstating that they agree to thesubmission and that the materialsubmitted has not been publishedand is not under editorialconsideration in any otherjournal. The submission of themanuscript by the authors meansthat the authors automaticallyagree to assign exclusive copyrightto Dental Health if and whenthe manuscript is accepted forpublication.Peer review Upon receipt,manuscripts are sent to twoindependent referees approved bythe Editor. Manuscripts will not bereturned to authors.Length of contributions Forresearch papers and case reportsauthors should ideally limit theirwork to 2,500 words. Tables andfigures must be allowed for in thefinal count. (Approx. 100-500words, depending on size.)Titles Titles must be descriptiveand succinct.Abstracts A structured abstractis required of research papers andcase reports and should includeobjectives, methods, results andconclusions stating the purpose ofthe study, basic procedures, mainfindings and principal conclusions.It may be up to 200 words andshould be able to stand-alone.Tables Tables should be numberedconsecutively and accompanied bya caption.Illustrations Illustrations mustbe submitted in a format suitablefor direct reproduction in thejournal. The Editor reserves theright to reject illustrations orfigures based upon poor quality ofsubmitted materials.Legends They should be brief andspecific.AcknowledgementsAcknowledge persons who havemade substantive contributions tothe study. Authors are expected todisclose any commercial or otherrelationships that could constitutea conflict of interest.References The author isresponsible for the accuracy ofthe reference list at the end of thearticle. All references must bein the Vancouver style. Numberreferences consecutively in theorder in which they appear in thetext and these numbers shouldappear as superscripts each timethe author is cited. All referencescited, and only these, must belisted at the end of the paper.This should include the namesand initials of all authors unlessthey are more than six when onlythe first three should be givenfollowed by et al. The authors’names are followed by the title ofthe article; the title of the journalabbreviated according to the styleof Index Medicus or the Indexto Dental Literature; the year ofpublication; the volume number;first and last page numbers in full.Titles of books should be followedby the place of publication, thepublisher and the year.Examples:Reference to a journal article:Lewis MAO, Lee SM, Potts AJCand Nutes SJ. Mucous membranepemphigoid in childhood. DentalHealth 2000; 39 (3): 10-11.Reference to a book: CawsonRA and Odell EN. Essentials ofOral Pathology and Oral Medicine.London: Churchill Livingston, 1998.Reference to a chapter ina book: Bergenholtz G andHasselgren G. Endodontics andPeriodontics. In: Lindhe J, KarringT and Lang NP (eds.) ClinicalPeriodontology and ImplantDentistry, pp 296-326.Copenhagen: Munksgaard, 1997.The Editor reserves the right to editmaterial for clarity of style and tosuit the space available.Volume 51 No 6 of 6 November 2012 Dental Health 51