Many years ago, while I was working at Kirk Hallam Dental Practice in Ilkeston providing oral surgery, a dentist and specialist in oral surgery named Karen Patterson came to visit me there. She wanted to check out the new NSK oral surgery handpiece I was using because she was providing oral surgery in Nottingham and the practice were thinking of purchasing one.

It was a pleasure to meet Karen and I got to know her from that time onwards but most notably at that meeting she was explaining to me about her involvement in Bridge2Aid, which was a very young charity at that time providing training for Clinical Support Officers (CSOs) in Tanzania. She explained that she had travelled to Tanzania for a fortnight to provide training to local CSOs to allow them to provide emergency dental care in their communities.

This training basically consisted of teaching the CSOs to safely extract teeth and this really appealed me too. At that stage, extracting teeth was the thing that I did the most. I had always felt that Bridge2Aid was an ideal charity to be involved with because it suited my skill set, and at some point I would be really keen to go to Tanzania and help out.

At that stage I had two young children and since then I have had another child, and at the moment it seems quite a difficult task to get two weeks to go to Tanzania to help out. I was therefore delighted to see that they have introduced the concept of the Unity Partnership.

The Unity Partnership allows privileged people and practitioners like myself to be able to support the training of a CSO and their induction into providing emergency dentistry for their communities. CSOs are assisted by the Tanzanian Government and provide basic medical and dental care for extremely large communities who have no other access to local health care.

It’s hard to tell you how proud I was when I received the email from Shaenna at Bridge2Aid telling me that our CSO, Tukelage Mhema, had passed the 2 week course and was now able to go back to her community to provide emergency dental care.

Over 70% of the world’s population has no access to emergency dental care. It may not seem that helping someone to learn skills to extract diseased teeth in Africa will change the world, but I bet it will change the world of someone in Africa who has toothache.

Quite a quirky little book this with very short chapters and very easy to read. It was put together by Stephen Hudson to try to inspire dentists who are feeling a bit flat or low, into changing their lives both professionally and personally. It is very quick to read and offers some quirky insights from some talented people but also from some people who are not quite as admired as they might think! The best chapter I found was by Kevin Burch who is a confidence coach. He writes a chapter about ‘stress-free’ dentistry from the basis of a time when he was completely distressed and explains how he managed to deal with it. I found it quite helpful and if you do come across it, it is worth a read. CC

This year, Campbell and Peace are aiming to raise as much money as possible for the Karen Green Foundation. To kick start the campaign we are aiming to bring in the first £1000 through our Facebook page; for every new page “Like” we get we will donate £1 until we reach our target. Please click here and “Like” our page, and help us to help The Karen Green Foundation:

• Raise money for Leukaemia Charities and Hospitals treating patients who are suffering with Leukaemia and other cancers of the blood
• Relieve those persons with Leukaemia, their families and carers
• Provide grant funding on an annual basis to one or more para-athletes to help them achieve their sporting goals

Visit the Karen Green website to read all about the great work the Foundation are doing, how you can help raise money or to make a donation.

As demand for improvement in dental and facial aesthetics is increasing the number of adult patients presenting for orthodontic treatment is also increasing.

A recent survey carried out for the British Orthodontic Society found that 45% of UK adults were unhappy with the appearance of their teeth and that 2O% would consider having some form of orthodontic treatment to improve the alignment and appearance of their teeth. Of those patients that would consider treatment their reasons were an improvement in appearance, self-esteem and health and oral function. However adults are often put of by the appearance of traditional metal braces.

Aligners are clear plastic gumshield type appliances that fit on over the surfaces of the teeth. They are made as a series of removable appliances that gradually move the teeth into line. These appliances appeal to the patients looking for minimal visual impact. There are various manufactures of aligners.

Clearstep is one of these systems.

Advantages of Clearstep

• Virtually invisible
• Comfortable to wear
• Minimal restrictions on diet as they are removed for eating
• Can also be removed for special occasions
• Impressions can be taken at any stage to alter the progression of treatment
• Little interference with speech as the plastic does not cover the palate
• Very good for mild to moderate irregularity of the teeth or patients who have had fixed appliances in the past and have had some minor relapse

Click here to see a patient video on the Clearstep website

Limitations of Clearstep

• Like any removable appliance these appliances require good patient compliance.
• It can be difficult to close spaces, derotate teeth or intrude and extrude teeth.
• Not really suitable where large amounts of tooth movement are required.

How does the process work?

• Upper and lower silicone impressions and bite registration are taken
• The orthodontist plans the individual tooth movements and completes the Clearstep prescription form
• The models are cast in the lab
• The technicians gradually move the teeth and a series of gumshield appliances are constructed.
• These appliances are worn in sequence for 2 weeks
• Patients attend the orthodontist periodically to check the appliances and monitor the progress of tooth movement
• Retention when desired tooth movements are achieved

Clearstep can be a highly effective way of discretely moving teeth with only minimal impact on the patients’ daily life. As with any orthodontic treatment an accurate diagnosis and treatment plan is essential and treatment with aligners is not always suitable for every patient.

Do you have any patients looking for a clear solution to a mild orthodontic problem? Contact the practice for more information  or to refer your patient.

Caveat – first do no harm.

The big medical news at the moment is concerning the rupture rate and safety issues surrounding a particular type of breast implant that was manufactured using industrial grade silicon. Arguments are being tossed around. Should they be removed or can they be left in place? What is the actual rupture rate? If they require removal who should foot the bill- the NHS, the patients or the private healthcare companies who placed the implants? The company who manufactured the implants no longer exists so is out of the picture and the argument. The lawyers must be loving this.

So who is responsible? And how does this impact our own world where increasing numbers of dental implants are being placed in patients within the private sector. This article will look at different facets of this argument and explain how we approach this issue in our own practice.

Recently the media has been reporting that some of the private health companies are prepared to put foot the bill for replacement of the implants in those women who want it. Good on them. They appear to be accepting full responsibility. Other companies appear to be arguing the toss and laying blame at the door of the regulatory bodies that passed the implants for use. Where the responsibility ultimately lies could be dependent upon a number of factors including why these companies chose to use these particular implants in the first place as opposed to other manufacturers’ products. Was the decision based on high quality scientific data, limited and perhaps poor data, spurious scientific data or perhaps a really good job lot deal? I don’t know and I cannot answer this question but how we choose what we use is perhaps critical to this argument.

Some companies are suggesting that if they replace the implants themselves then they will go bust. My opinion is that sadly this is part of business and if you are prepared to take the profits in the first place, then you must be prepared to face the downside. Some of this may be laid at the door of pricing. In our practice we place a 5 year guarantee on our dental implants, the only caveat being that patients attend for regular review appointments as prescribed at the outset, the frequency being based on their individual risk profiles. For example, patients susceptible to gum disease need to attend at least 3 monthly (often with our well trained Hygienist), other low risk patients perhaps annually. On the simple basis that most implants, once integrated will be fine then once they have reached 5 years the patient has had significant benefit and the majority of the dental implant structures are likely to last well beyond that point. We believe that it is a fair, very reasonable and open policy. However we do not come cheap and that is deliberate: we use top dental implant systems and take responsibility for our work. Simple and clear. (Some suggest that dental implant failures can peak at about 13 years – my instinct is that this is likely to be in patients who fail to attend for review appointments, highlighting the need for encouragement of on-going maintenance for life, just like teeth and gums).

In our practice we have only worked with dental implant companies with good long-term track records. We avoid new companies who have limited data. Caution must still exist because these larger companies innovate and perhaps bring some of these new innovations to market rather too soon. Commercial judgement calls can be difficult and I do not envy them in having to make sometimes very difficult decisions, but at the end of the day it is the clinician who has to truly face the music and the patient if things go wrong.

The other reason we work with the larger, well established companies is because they are less likely to go bust or get taken over. What happens down the line if an implant fails and you can no longer get the parts because the company no longer exists? As Truman said “The Buck Stops Here”. As clinicians we ultimately have to stand by our decisions. A good rule of thumb is would I allow this to be done to my loved ones- “the daughter test” – if you wouldn’t put this into the mouth of your nearest and dearest don’t do it.

We don’t always get everything right but we get very high success rates and are prepared to deal with the few problems that inevitably arise in the real world. We are constantly working on our practice philosophies and protocols to achieve our very best. A few simple and practical rules that we suggest are as follows:

•  Choose the dental implant system carefully and don’t just go for the best financial offer, bulk buy deals and packages
• Go for a larger well established dental implant company with a proven record, strong balance sheet and good cashflow – they are less likely to go bust down the line creating future problems
• Be cautious about the latest innovation, even with well-established and ethical companies – some clinicians are prepared to sit at this cutting edge and can do very well out of it but there are also casualties of this frontier style policy
• Reasonable and fair guarantees should be available on the treatment
• Consider very carefully whether dental implant insurance policies may be suitable

Any dentist placing dental implants must be highly trained and working well within their competency. We are very lucky that we work within a team of exceptional individuals, each of us working to our particular strengths. Our clinical audits exhibit very high success rates – approximately 97% over 5 years and figures are starting to suggest that this figure includes bone grafted areas where additional bone has to be built up. Watch this space. In the real world there is no perfect answer to everything. However, after this latest medical hiccup becomes resigned to yesterday’s news it might be worthwhile looking at the fallout and deciding which of the private healthcare companies you would rather deal with.

Ian Peace

Recently, as the practice has been expanding quickly, we realised that we needed to appoint further hygienist support.

The hygienist service at our practice is split mainly between support of Ian, our Specialist in Periodontics and implant maintainence, which also includes pre-operative preparation of implant patients.

As with all positions in the practice, it is crucially important that our hygienist has an exceptional ability to communicate with patients. We need our hygienist to be able to work under these circumstances, making complex clinical decisions about patients’ treatment whilst providing the highest level of customer service and patient care.

Communication and explanation to patients of their treatment requirements is essential whilst working under the prescription of a dentist.

With this in mind, we took on the task of appointing a new hygienist (our current hygienist is brilliant).

On discussion with Charlotte, our practice manager, we decided to set up a process to give us the best opportunity of appointing the best individual. Firstly this involved placing an advert that was different to the adverts you would usually see for a hygienist. It explained the benefits of working at our practice and was able to attract a fantastic field of applicants. Following this we shortlisted the process down to 5 for an initial interview. The most important part of the interview process was that we included our current hygienist. She is fantastic within the practice and what we want is someone who can work in the same way, giving the same level of care that she does. We felt it would be essential for her to be heavily involved in the shortlisting and interviews processes. Once the interviews were over we were able to select the 2 best candidates that suited our practice and these candidates have now been put forward to attend ‘trial days’.  This will involve the candidates seeing patients at the practice, under the supervision of our hygienist Karen and Hayley our senior nurse. The main purpose of this process is to ensure that the hygienists have outstanding communication skills.

We believe we can teach anyone to provide a clinical skill in the practice to a good standard but we cannot teach anyone communication.

I am delighted to say that the two hygienists who have been put forward for the trial days seem to be fantastic and it will be a very difficult choice.

I would also say that throughout this process I have been massively impressed and uplifted by the professional standards of hygienists and their commitment to their work.

It seems to me that they put a lot of my dentist colleagues to shame.

We are looking forward to working with our new hygienist at the practice and we hope that this selection process will mean we will have a new team member for a very long time to come.

Studies show that 40% of denture wearers in the United Kingdom are unhappy with their dentures for eating, comfort and appearance. An ill-fitting denture can lead to a miserable life, affecting peoples’ ability to socialise, enjoy food and generally function in day-to-day life. Advances in dental technology and treatments have meant that the inconvenience of ill-fitting dentures doesn’t need to be suffered by anyone anymore, and the use of dental implants can help almost any denture wearer to improve their situation. Dental implants can be used to secure existing dentures, or even remove the need for wearing dentures by providing fixed bridgework.

Providing patients with a dental implant solution to ill-fitting or uncomfortable dentures is a procedure which needs time, care and exceptional planning. At Campbell and Peace we are a specialist-led practice with a combined experience in dental implants of over 30 years. Our facilities include state of the art x-ray and imaging equipment including a 3D scanner which allows us to plan cases very carefully and avoid unnecessary risks associated with the procedure when 3D scanning is not undertaken.

We are a team of caring individuals who understand the misery ill-fitting dentures can cause and take great pride in providing solutions which vastly improve patients’ quality of life in a relaxed and friendly setting.

If you are caring for patients whose life is being affected by unsatisfactory dentures, call, email or click here to refer them to Campbell and Peace.

T: 0115 9823913 | E: info@campbellandpeace.com

The Last Enemy an autobiographical account of Richard Hillary, Oxford graduate and World War 2 fighter pilot. Badly burnt in action he was one of the first “guinea pigs” of Archibald McIndoe, the famous plastic surgeon. It is a beautiful account of the mind-set of a young man facing the last enemy – death. Sadly Richard Hillary died young, a casualty of the war. We must never forget these true heroes.

Referring your patient to Campbell and Peace is easy, simply choose the method that suits you best:

• Referral form and pre-paid envelope. We send these out with all correspondence; let us know if you’d like more to be sent to your practice
• From our website- fill in the online form and click submit- the quickest way to refer
• Print off a referral form from the professional area of our website and fax it to us on 0115 9823917
• By telephone- our receptionists will take all the details we need from you
• Referral letter on your own practice headed paper
• Text or email one of our clinicians directly

Recently at Campbell & Peace we completed a large market research project in conjunction with our implant supplier, Straumann.  This involved sending questionnaires to a selection of our referring practitioners as directed by the German market research company Reigl.

The questionnaires were then returned directly to Reigl and analysed along with a series of questionnaires which were directed to the staff at the practice. All responses were analysed and the report was presented to us by the Straumann Marketing Department at the practice in October. The results were fascinating, and while it’s always easy to focus on the negative points which emerge from these types of reports, much of the picture was positive and that was very gratifying for all of us. 

The significant part of the project is that the practice was “benchmarked” by Reigl against a large database of other implant practices in the East Midlands, following work that Straumann has done with their customers. When we looked at the results, there were several areas which were suggested that we could improve, but in some of these we feel we are already providing an excellent service and rather the problem is communication with our referring practitioners.  In this article we want to bust a few of the myths that seem to emerge from this, and the most important of these were as follows:  

1. Some practitioners suggested that we have unacceptably long waiting times. In truth, since we began zoning our appointments the waiting times at Campbell & Peace have reduced significantly, and we aim to see your patient two weeks after receiving your referral. If there are any delays, it is generally down to a request for a specific appointment or difficulty in contacting the patient. For urgent referrals you need only contact the practice by e-mail or telephone and we will make every effort to see the patient as soon as possible. In oral surgery cases this is often the same day and at the very worst the same week. 
2. There were one or two questions over how emergency cover is provided for implant patients. As has always been the case, patients who undergo implant surgery with Colin are given his mobile number to contact him directly in case of problems. If there are any issues, they are seen immediately.
3. Ease of referral was also highlighted from this questionnaire. There are many methods of referral available which will be covered in a future article.
4. I would like to reassure you that all of your patients will be returned to you following treatment unless you have asked for treatment to be carried out as an on-going procedure at the practice. Please do make sure you are still seeing your patient for regular check-ups though, as depending on the treatment we are providing for your patient, they may be in our care for up to a year or more.
5. Some of the practitioners felt that our specialists were not always accessible. If you wish to speak to Ian or Colin directly regarding one of your patients, our receptionists will be able to provide their mobile numbers on request. Please do not share this information with your patients though! To contact our other clinicians, ask our receptionists and they can usually arrange a phone call within the day, holidays permitting.

 I hope that this helps to clear up some of the myths that have arisen around the practice over the last few years. On the whole we are delighted with the results of the Reigl project and have scored highly compared with other implant practices in the East Midlands in all of the categories.

 Many thanks for your continued support and please do not hesitate to contact us if you have any further suggestions for improvement of Campbell and Peace.