To help improve the teeth4life App, I have had the support from Design for Growth. I need to ask the public and the profession what they want. It's not as easy as it sounds, but a couple of articles I came across this weekend. One from 2004
A pilot study of patients' views of an oral health scoring system
And this comment
Of respondents, 97% considered that the OHS gave them a better understanding of the condition of their mouth and 98% considered that the OHS was a good method for communication between dentist and patient.
As it was before we had smart phones, so perhaps a free App could help?
The other much larger article was eighteen years later, this is the LINK and this
is part of the conclusion.....
Of these, psychological and emotional factors such as control, shame and trust are very important.
Our patients trust us, and we have to encourage them to keep themselves healthy, and so recommending your App by sending an email, as well as physically handing over a card specifically about the good and poor aspects of their teeth has a minimal cost, but a big benefit saving both you and your patient time, and improving both your financial wellbeing.
Getting support for the App has been an interesting experience, and why would you "trust" the App and its contents? Well it could be if it was endorsed by the NHS, which was my approach last year. It failed like many health innovations, and the reason is below. But if it was endorsed by the profession, or part of it. All these like the App, BDA, BSDHT, BSDT, FGDP, BADN. but will any of you endorse it? If there is an element that you don't approve of, please add in the feedback section on this website, or DM.
The teeth4life App has a traffic light scoring system, and to help promote the App for the public and the profession, I wanted it to be endorsed by the NHS. I paid for an Orcha review and the necessary changes in the App structure to get it on the NHS App library. At a later discussion, they advised that it was in a tier 3 status because of the traffic light scoring, and I needed to carry out an RCT. I couldn't use any current evidence-based research; I had to do my own. I couldn't afford the RCT, and their suggestion was to remove the scoring, and it would get approval as a tier 2 App, like Brush DJ.
However, it will be of less value for the user and not encourage them to take ownership of their health. It would be a mobile webpage, not an App.
How did the scoring system work in the pilot studies? If the scoring system is the same as the pilot scheme, the App may get NHS approval, as all the videos on prevention in the App follow the government's guidelines on delivering better oral health.
Please get in touch, and we could discuss how your experience could be used to improve the content of the current App, and for a future premium version of the App. All AHSNs I have spoken to like the App, but say it needs funding- but not by them. When it is self-funding, the NHS may be interested. But if the profession funds it, we should take the credit.
I was a trainer for twenty years, and really enjoyed the training, but was aware that our VTs, VDPs, then FDs were fully aware of the real stresses in running a practice committed to the NHS. Our patients trust us, but the NHS doesn't. To provide the best treatment you should not work stressed. Click on image for engaging talk from 12 years ago. The post below is from a discussion on GDPUK forum, and may help our way forward.
Re: Time to stand up and be counted
30 Dec 2021, 11:39
There were a number of reasons for my post:
1. To try to get senior dentists to look in the mirror and admit that, by and large, THEY have caused/allowed the system to continue because THEY prop it up. I first converted one of my practices in 1991. Back then the system abused dentists but, as Keith alluded to, dentists abused it back. The Area Teams knew this but also knew it was the only way to keep the system going. Nowadays the Area Teams/NHSE are out to get anyone who "tries to play the system". Senior dentists sit in a comfort zone and, by and large, are blissfully unaware of how younger dentists are suffering.
2. I have done it before and I am doing it again. I paid over £1,000,000 for an NHS practice + property 3 years ago. The loan is personally guaranteed. But I am giving the contract back. Not selling it. I am doing the right thing for my patients and staff and sending a strong message to others.
3. In the last 30 years, I do not know one single practice that has ever transitioned from NHS to private that has regretted it. As has happened, in some posts, I want more people who have done it to come out encourage others to do it. Perhaps the BDA should start to create a database of all those that have done it as an example for others.
4. I want to introduce the concept of an abusive relationship which needs to be called out. I want dentists to sit back and actually analyse what kind of relationship they are in with NHSE/the Treasury.
5. I wanted to call out everybody who works in an admin role supporting NHS Dentistry to ask themselves whether they are supporting an abusive relationship. This includes the OCDO, LDCs, Deaneries, DF Trainers......
I remain furious with the profession that rather than disengaging from NHS Dentistry, by continuing to engage, they are supporting the abuse of younger colleagues and patients. Patients think, "It's the NHS, it must be good". It is not and under the current system, it never will be.
Tinkering and trying to "make it work" will never work. NHS General Dental Practice needs to be chucked on a bonfire so that a new fit-for-purpose system is designed from the bottom up but will probably only be an emergency and/or children-only service.
Happy New Year.
Dr Simon Gallier BDS
Future Health Partnership
Biomin is a more recent product. If you like Science I've added the links after the following video on Erosion. This is a rather longer version of the video I have put in the App for the public. You can hear the audio joins, and some repetition of previous videos.
This one has a potential solution at the end of the video. It's a bit different. I placed about ten. I used Lava Ultimate. I had a fracture of one, but it still covered the dentine, and so I left if. I only placed one Emax and that fractured, and I repaired it with composite.
I have made a few videos that include BIOMIN. If you like your science then the first video is for you. The potential for new products is interesting. If not the second video is of the current applications with regard to dentistry as a clinical prospective. Click on the image to watch this fascinating history of the development of Biomin. The second image for the current clinical applications.
There are a lot more details via the Biomin website.
This video was on the My Care section of the App, without audio. When I was making the videos initially, feedback from friends and family was my voice is dull, so I removed it. The recent feedback from the public was they prefer the videos with audio. However, your voice may be better?
The following video is an explanation of how to add your own voice to the video. Initially, it may take a while, and as irritating as finding the forth MB canal. Stick with it. It will be a great email link to provide empathy for your patients. Alternatively, send them the App with the videos, and your details there.
If you don't want to use the App, and simply send emails that you have made or prefer, then these are on the App Registration site.
Promote and protect yourself through the App.
I don't remember much of this when I first qualified. I saw a lot of neglect and caries, but this has been a recent observation as you can buy litres of carbonated drinks and fresh orange now that is more affordable than when I was growing up.
I'm sure when John Gummer famously made his daughter a beef burger, no one commented on the more obvious problems of the drink with a happy meal.
Well I'm sure the food lobbyists will cave in and the intake of sugar laden acidic drinks will be banned.
This was the immediate outcome, and at the age of fourteen, I think its a good result. I will never know how long it lasts.
My observation is I rarely see this sudden erosion in adults. I think after about 10 years of fluoride toothpaste the mature enamel surface, it is less likely to erode?
This is a video I made explaining the procedure. I made a few unusual restorations. I always ensured that if there was a failure, the original alternatives were not lost. There is nothing better in the mouth than the teeth we are born with. It is surprising how long these restorations last in the correct caring environment.
This first digital radiograph was taken back in 2007.
I remember when I first saw him, about 20 years ago I thought his tooth was unrestorable and said I should extract the tooth. I didn't like the look of the mesial root, and after some discussion, we left it alone.
I invested in an intraoral camera in 2013, and this is what his tooth liked then. It didn't look great but was functional.
I bought my Cerec back in 2010, and at some stage, his tooth broke, or I convinced him to try out my new gadget. I don't have a picture, just the radiographs. It looks like it failed! Twice?
This was the tooth in 2018, and when I retired earlier this year, it was the same. In fairness, I have had a lot of success with my Cadcam. This isn't one of them
What is interesting is the tooth is functional. I don't remember any problems. No Antibiotics.
As an older practitioner, I definitely prescribed more antibiotics than is currently advised, especially when I was called out on my own without an assistant on a Sunday. What was interesting is many of these patients never returned for their extraction, and some returned a few years later and requested antibiotics to an extraction—a bit like the guideline for pericoronitis. As a lot of these AAA cases were noted on Compass from last March, I wonder if the data will show the timeline between the initial antibiotics and the final treatment?
Do you think after twenty years, he has regretted not having an extraction? Do you think we may be taking out teeth in our best interests, or the patients?
Have any of you come across this?
I first heard the term five years ago in Las Vegas. With the wonder of Google, I have found that it was probably first referenced in 2008 by Dr Rella Christensen. Nothing more recent. Why?
In 2015 I was in Las Vegas for the Sironaworld Cerec conference along with 5000 other dentists. It was the 30th annual event, and the Omnicam was released superseding my Blue cam, which was preceded by a Red Cam.
The Omnicam was a massive improvement, and now there a Primescan which is capable of far more than I am prepared to attempt, or my employer to buy.
Volks was the term used as it was for the people. It means that it was affordable for the majority of the public as in Volkswagen, not Porche. Both are functional, but one could argue one is more aesthetic and innovative than the other as well as is a different pricing structure.
Dr Rella was extremely enthusiastic about the Volks crown. She had set up a non-profit organisation CRA employing 40 scientists and staff with a network of 400 clinicians.
The volkscrown was a hybrid material, in this case, 3Ms Lava Ultimate, which I was starting to have difficulty in the UK with supplies. The reason was apparent in the lecture, as there were failures!
I have only read the article from 2008 today, and it reports the "failures" I have experienced. But they are manageable and repairable as you haven't removed the usual amount of tooth structure. I spoke to Dr Christensen at the end of the lecture. The reason for failures was predominantly debonding, and with that clearly, some lawyers were sniffing around. The reason for debonding was an incorrect procedure carried out by dentists, probably male as they hadn't read the basic instructions. The outcome was possibly as 3M were anxious about getting sued, rather than the dentist, they withheld the product. The opposite of the other main digital technology of clear aligners where while the treatment plan is by distant AI using GANs, the responsibility of the outcome is with the dentist.
I fitted a few all-ceramic Dicor crowns in the past, and they did fail, and I quietly stopped making them as I thought it was my technique. If I went on Facebook, I would have known better, but it was twenty years ago. The crowns I have fitted more recently have had greater success with similar material to Dicor because they are milled, and not made in a furnace. The other obvious advantage is it's a single visit.
As with most technology, it will continue to advance and with new features. But there may be the alternative to get last years model at a reduced price which is still excellent, similar to electric toothbrushes. Think of your phone and your contract, perhaps intraoral scanners may be leased in the same way? For the vast majority of the public and dentists, the technology is good enough now. And concerning learning new technology, it's all online.
Volks crown Article 2008
DR Rella Christensen
I retired yesterday, and while I will no longer treat any patients, I hope to support both dentists and the public through some reflections on my years in practice.
Last month this patient reminded me of how I'd looked after her when she was anxious and unhappy with her previous dentist who had fitted some veneers. She then told me how I wouldn't replace the veneers until she cleaned her teeth better and had some outstanding work carried out.
These are her BWs from 1997. Below are my comprehensive notes of the period and an indication of how the majority of our record keeping. We had to keep them to a minimum; otherwise, the record card would explode.
There is far much to discuss, but the root filling LL6 had a fractured instrument was poor, but lasted longer than the root filling I did in the ll5. It is strange how variable the outcomes are for root fillings despite their radiographic appearance.
I was never confident enough to make a crown on the ll6. I repaired it with Dyract in 2002, as you can see here. She is not concerned with the appearance. In fact, none of the teeth since 1997 have failed apart from both lower second premolars.
below are her recent digital BWs with many original amalgam fillings from 1997.
Finally, I sent off for permission to replace the veneers. This is the current appearance in 2020. I removed the offending cosmetic restorations and did not attempt temporaries. Two weeks later she returned for the fitting but decided she liked the appearance as they were. She still has the veneers at home.
I saw this patient under the NHS, if you look how long she was booked in for and my notes, you can see how different it is today. If you had a few of these NHS patients in your chair, what would you do? Give them some cash, and ask them to go elsewhere?
In retrospect, avoid any RCT where you intended to get near the apical foramen? Simply extract may have been better, as seems the new norm in NHS dentistry. If I hadn't gained her confidence back then, I doubt if she would have any molar teeth now. As for the person who placed the veneers, they gave the profession a bad name.
This is part of a bridge that I modified. I had inherited a patient list, and his 17-year-old girl had a missing front incisor replaced by an acid etch bridge made traditionally by the previous dentist. It failed regularly. One day I decided to remove a wing. As you are aware most American animations show two wings, but I had heard the logic of a single wing, and while she literally cried in the chair while I removed a single wing, and replaced it as seen below.
I'm afraid most photos I take are low quality, but they are taken quickly as a record to jog my memory not to present at a lecture.
These pictures were taken about five years ago. And when I last saw her earlier this year the bridge was still there, fitted with the original Panavia from 34 years ago.
It's a vivid memory as I knew she thought I was making a massive mistake, was asking her mum to stop me. I had just become a partner in a practice, and even then I thought I could get sued and my name being mud.
At the same time as the photos, I took a PA. Hmmm
I had to raise a two-sided flap, remove labial and lingual bone, and push the root fragment through lingually, and place two resorbable sutures, having warned her of the potential debond due to me not having the correct luxator, as well as all the other potential risks. I want to say it went well, but that would be lying. I said "Oh, that's interesting. Do you get any discomfort under the bridge?". No was the fortunate reply for both of us.
After a while, when using an ultrasonic scaler, my mind drifts off. Sometimes I even wonder what I am doing, and why? In March 2016 Mrs Collins isolated premolar supporting her CoCr -/p was M2 and bleeding. Desperate measures were required, so I sent her a YouTube video form the excellent group Perio Courses. In July 2020 she still has no bleeding, no mobility, and a lower denture she likes-even more unusual. She was the tipping point for my teeth4life APP.