Making decisions to make progress - Tim Bradstock-Smith

Making decisions to make progress - Tim Bradstock-Smith

The most responsible elements of a dental professional’s remit is making effectual clinical decisions and planning appropriate dental care. Most often patients seek treatment to address comfort function and aesthetics but this can be compromised by fear, cost, time and access.

Practitioners are able to base clinical decisions on their professional knowledge, scientific evidence and experience. However, in order to preserve the trust and to serve patients well, dental professionals must take time to understand their expectations and limitations before any treatment begins.

Patients favour a personally active approach to dental treatment. A collaborative decision, with patient and dentist equally sharing responsibility for decision-making, is increasingly popular.[1]  As well as examination, diagnosis, determining aetiology and formulating appropriate treatment options, individual preferences and requirements should be tailored into the treatment plan. Additionally, well-informed, engaged patients are placed in a stronger position when deciding between treatment options and are more likely to take ownership of the final treatment decision and outcome.

Patient expectations should be considered carefully and practitioners need to recognise that the focus of the general population has shifted from ensuring teeth are healthy and pain free to an ever-stronger desire that they should also be aesthetically pleasing.[2] As a result, the demand for higher standards of treatment and cosmetic procedures are on the increase, but when both the practitioner and patient bring value and information to the treatment plan they can build an agreement together, which is more likely to result in patient satisfaction.

There will, of course, always be occasions when things happen that are beyond our control but by covering every eventuality, both patients and professionals can be aware of any factors or risks that could compromise the treatment outcome. When shared decision-making takes place, patient acceptance of any less desirable consequences increases and the likelihood of complaints and claims arising from clinical decision-making are also reduced.

Planning well is an attribute that all professionals aspire to achieve. It is particularly important in the dental practice because a detailed treatment plan is beneficial not only for the patient and practitioner but the dental team and laboratory. With forward thinking, realistic scheduling and organisation, the skills, services, materials and time can be communicated and allocated efficiently to ensure the most effective results.

At times, cases present that are beyond the technological parameters or skill set of the practice. This could be due to the complexity of the treatment or due to the patient needs and enhanced imaging, sedation or specialist clinical skills may be required. Whatever the circumstances, dental professionals need to recognise any limitations and make a decision to refer.

Calling upon the additional assistance will ensure the success and accuracy of treatment. Furthermore, it extends the professionalism of the referring dentist and practice. However, these professionals must be able to trust the people and services they chose to work with and have confidence in their expertise.

London Smile Clinic is able to provide a referral service that can be integrated into any treatment plan. Referring dentists can rest assured that they will remain informed throughout the treatment and feel confident that their patients will receive first class treatment to achieve the most successful results possible.


For more information, please contact 020 7255 2559 or



[1] H Chapple, S Shah, A-L Caress & E J Kay. Exploring dental patients' preferred roles in treatment decision-making – a novel approach. British Dental Journal 194, 321 – 327.  Published online: 22 March 2003 | doi:10.1038/sj.bdj.4809946.

[2] House of Commons Health Committee Dental Services Fifth report of Session 2007-08 HC 289-I 2 July 2008.


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You’re never too old to wear a brace - Tim Bradstock-Smith

You’re never too old to wear a brace

With near-invisible options available, plus faster treatment times, it is no surprise that more adults than ever before are embarking on orthodontic treatment.

With the means to afford it, they know that improving their teeth will benefit them professionally as well as personally, particularly if they add an adjunctive treatment like whitening. Orthodontics are now much more stable than they were in the past; correcting work they had done as a child is also highly appealing.

It is far easier to practice a successful oral care routine and keep the mouth clean if teeth are aligned properly and gaps closed up. Correct a patient’s bite and you can reduce toothwear too. A course of orthodontics may also prevent problems with the gingiva getting worse.

However, it might be the case that not only do you not currently offer orthodontic treatment, but that you have no plans to do so either. The cutting-edge OPG machines and 3D scanners on the market are exciting, yet out of the reach for many, particularly if you are only seeing a couple of potential cases a month. The technology is moving fast and staff need to be trained and retrained.

Referrals are not something to be feared - you will not ‘lose’ your patient. Instead, referring out can enhance and expand your treatment provision. It can also be a conduit to building and consolidating loyalty. By referring people out to a trusted partner, you are saying that, although you do not have the resources to provide the required orthodontics yourself, you want to give your patient a successful route through the (expensive) minefield. Especially if their previous experience of this kind of treatment was not a positive one, you will be supporting patients to improve their smile and oral health with the help of a clinician that you trust.

Adult orthodontic patients have high expectations of aesthetically pleasing and stable results.  They are aware of the choice out there and will use the internet to look at practitioner reviews and compare pricing. They will know what they want to achieve, including a reassurance that they are in safe hands. Choose your referral partner wisely – you want to feel confident about a successful outcome every time. For example, The London Smile Clinic has world-class specialists, plus has the latest technology already in place to guarantee fantastic results for even the most complex problems.

Investing time and money in developing new services can be daunting and, for many practices, an impossible notion. Referrals can be an easy solution to the rise in demand for adult orthodontics. The right referring clinic will work with you to allay your patients’ fears and promote the benefits of the latest ethical and minimally invasive techniques. It is therefore crucial to find the best referring partner for you, to make life easier for your patients as well as guaranteeing excellent results.  


For more information, please contact The London Smile Clinic on 020 7255 2559 or visit


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Scanning solutions for elderly patients - London Smile Clinic

Scanning solutions for elderly patients - London Smile Clinic

Orthopantograms, or OPGs, have many benefits and a huge number of uses. They are especially useful in the treatment and care of elderly patients, who will be a huge proportion of your caseload if not now, but in the future.

OPGs are a powerful tool to have at your disposal. They can give you information on periodontal bone loss, help find the source of pain, assist with the correct placement of implants and much more. Digital OPGs mean fewer repeat scans are needed, so less time and cost required, and also less exposure to radiation. Patients can usually understand a panoramic image more easily and they can be emailed to colleagues effortlessly.

These images are also invaluable when dealing with challenging cases, such as elderly patients. The number of older patients you will be treating in the future is growing – and fast. In 2012, the BDA published a review of its 2003 Oral Healthcare for Older People report[1] which concluded that the ageing population was growing faster than had been originally predicted.

OPG scans are quick and comfortable. The detail means that you will be able to anticipate future complications.  Caries, periodontal disease and recession of the gingiva can have devastating consequences as a patient gets older and can lead to life-threatening complications, such as cardiovascular problems and diabetes. Type-2 diabetes generally affects people over the age of 40, and oral health is a key component of diabetes management, so it’s a two-way relationship. If a patient has type-2 diabetes, they are also more likely to develop gingivitis, caries and xerostomia, too.[2]

Setting up an OPG scan is quick, and OPGs can be used comfortably for elderly people who cannot open their mouths wide. Patients are usually asked to bite down on a spatula for about a minute while the machine moves around the head. A detailed, informative scan that won’t have to repeated and is easily explained will help you move forward with implementing an effective treatment plan with confidence.

If you do not have OPG technology, look carefully for the right referral partner. Work with a practice that not only has the latest OPG equipment in place, but that employs clinicians who can be trusted to work sensitively with older people and other vulnerable groups. The London Smile Clinic takes referrals, for example, and will meet all of these needs with ease and professionalism.

OPGs will help you deal with the enormous challenges ahead as you treat more elderly and vulnerable people. With a saturated market, and expensive technology that is developing fast, you don’t have to invest in new equipment. Referring out can be the perfect solution to provide the highest-quality care for these patient groups now, and in the future.

For more information, please contact The London Smile Clinic on 020 7255 2559 or visit


[1] BDA. Oral healthcare for older people 2020 vision. Check-up January 2012. Found at (accessed 7 July 2015)


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Periodontal disease: more than an oral health concern

Periodontal disease: more than an oral health concern

Described as a global burden, severe periodontitis has been reported to be the sixth most prevalent medical condition in the world.[1]


In the UK, periodontitis affects about half of all adults with up to 15% estimated to have the condition severely.[2] These shocking statistics echo the findings of the 2009 Adult Dental Health Survey, which reported that, although this generation has a better outlook than their predecessors, there are still many people whose oral health and function does not meet the best possible standards.[3]


Periodontal disease is a particular area of concern because it can cause serious oral health problems and when left untreated, and can result in tooth loss as well as deterioration of both gingiva and bone. Ominously the potential effects and implications of periodontal disease may also extend beyond oral health and recent research has established that periodontal infection is a probable risk factor for various systemic diseases, including pulmonary disease.[4]


Furthermore, periodontal disease has the capability of changing the chemical composition of the blood and glucose levels as well as interfering with the body's inflammatory system and thereby increasing the risk of diabetes, rheumatoid arthritis,[5] respiratory[6] and cardiovascular diseases.[7],[8]


As we know, tobacco use, stress and obesity may be significant risk factors in the development and progression of periodontal disease. However people with other general health conditions also have an increased risk of developing the condition. Evidence has consistently revealed that diabetes is a risk factor for the prevalence of gingivitis and periodontitis[9] and a five-year follow-up, population-based study in Taiwan[10] has also indicated that patients with osteoporosis might have an increased chance of developing periodontitis.


Over the last few decades the concept of a genetic vulnerability to periodontal disease has also been investigated.[1] Since the completion of the Human Genome Project (HGP)[2], researchers have found evidence to suggest that a key element of whether individuals develop periodontitis appears to be controlled by the way they interact with environmental agents including biofilm. These researchers also believe that periodontal disease could be categorised more effectively using pathobiology-based grouping as well as the clinical presentation of the disease, rather than the current clinical only classifications of ‘chronic’ and ‘aggressive’.[3]


A new system for categorising periodontitis based on the molecular profiling of gingival tissues has therefore been devised, which could enable earlier diagnosis and more personalised treatment. It is hoped that patients found to be highly susceptible to severe periodontitis may be considered for assertive therapy even if that person only show indicators. This would then prevent aggressive progression, bone and tooth loss.


Helping patients to understand the threat of periodontal disease not only with regard to oral health but also in relation to other potential health risks is vital. Of course treatment for periodontal disease depends upon each individual case, but every patient must appreciate the importance of practicing good oral hygiene. Employing an improved oral health care regime may be enough to kerb further development of the disease in some patients, although professional scaling and debridement is commonly required to remove plaque, calculus and biofilm from the teeth and roots.


For some patients it is necessary to include on-going periodontal therapy with medication to keep infection under control and to heal periodontal pockets. Nevertheless, in aggressive cases it may be necessary to perform flap surgery to clean the area thoroughly and suture periodontal pockets. Some of these patients may also require bone grafting to promote new growth or tissue regeneration to cover any exposed tooth roots.


In many cases a general dentist, therapist or hygienist can treat patients with periodontal disease successfully. However, in complex or unresponsive cases the skills of a specialist periodontist may be needed. By creating a good working relationship with a reliable referral practice, such as London Smile Clinic, your patients can benefit from specialist clinical skills in a wide spectrum of dentistry. With a wealth of experience in oral and maxillo-facial surgery, Dr. Hatem Algraffee, specialist periodontist at London Smile Clinic


[1] N.J. Kassebaum, E. Bernabé, M. Dahiya, B. Bhandari, C.J.L. Murray, W. Marcenes.  Global Burden of Untreated Caries: A Systematic Review and Metaregression J DENT RES, May 2015; vol. 94, 5: pp. 650-658, first published on March 4, 2015

[3] 2009 Adult Dental Health Survey (ADHS)

[4] Scannapieco FA, Papandonatos GD, Dunford RG. Associations between oral conditions and respiratory disease in a national sample survey population. Ann Periodontol 1998;3:251-256.

[5] American Academy of Periodontology.

[6] Association between respiratory disease in hospitalized patients and periodontal disease: a cross-sectional study. Sharma, N., Shamsuddin, H. J. Periodontol. August 2011. pp1155-1160. Available at:

[7] Machado AC, Quirino MR, Nascimento LF. Relation between chronic periodontal disease and plasmatic levels of triglycerides, total cholesterol and fractions. Brazilian oral research, 2005, 19(4):284–9.

[8] Genco RJ et al. Overview of risk factors for periodontal disease and implications for diabetes and cardiovascular disease. Compendium of continuing education in dentistry, 2001, 22(2 Spec. No.):21–3.

[9] Mealey BL, Oates TW. Diabetes mellitus and periodontal diseases. J Periodontol. 2006;77:1289-1303.

[10] Population-Based 5-Year Follow-Up Study in Taiwan of Osteoporosis and Risk of Periodontitis
Wei-Pin Chang, Wei-Chiao Chang, Mei-Shin Wu, Jei-Tsung Pai, Yuh-Cherng Guo Ku-Chung Chen, Mu-En Liu, Wen-Ta Chiu, and Kuo-Sheng Hung

4 Research, Science and Therapy Committee of the American Academy of Periodontology. Informational paper: implications of genetic technology for the management of periodontal diseases. J Periodontol. 2005 May;76(5):850-7.   

5 Schafer AS, Jepsen S, Loos BG. Periodontal genetics: a decade of genetic association studies mandates better study designs. J Clin Periodontol. 2011 Feb;38(2):103-7.

[2] National Human Genome Research Institute (NHGRI), National Institute of Health US.

[3] Gingival Tissue Transcriptomes Identify Phenotypically Distinct Classes of Periodontitis. Panos N, Papapanou M, Kebschull R.T, Demmer B, Grün  P, Guarnieri P, Pavlidis P (University of British Columbia, Vancouver, BC, Canada) March 2014.  [Accessed 25th March 2015] 


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How Long Do Dental Implants Last?

How Long Do Dental Implants Last?

Although dental implants have been used for around fifty to sixty years, it used to be that they were considered very much a last resort, and only really meant for those patients who really struggled with their dentures.  However, with recent advances in cosmetic dentistry, and the accessibility thereof, people are beginning to realise that there is a better, more comfortable and potentially more permanent way. Dental implants, whereby a biocompatible titanium screw, inserted into the jawbone, replaces the failed root of the tooth with a prosthetic tooth, crown or bridge are becoming more and more popular.  Whilst they’re still considered ‘cosmetic’ dentistry they bring far more benefits than just a lovely smile – they can improve speech which has been affected by tooth loss; improve eating and allow the patient to eat foods which may otherwise cause them a problem; prevent deterioration of the surrounding bone; have no negative impact on surrounding teeth and, due to their completely natural appearance and feel, dramatically improve confidence and self-esteem.

As with all cutting-edge techniques, people may have concerns about whether dental implants are for them, what problems may occur, and most commonly, how long will they last?  After all, a smile is possibly the most clear and instant form of non-verbal communication and if that’s compromised then life in general can be adversely affected.

The simple – and rather reassuring - answer is that, as dental implants actually fuse with the bone, they could quite literally last a lifetime (although, as with other surgical implant procedures, there is no lifetime guarantee) and cared for correctly, should certainly last many years.  This also makes them an economical solution in the longer term, as the initial treatment can cost little more than more conventional options.  However – and this is a big however – this very much depends on two important aspects:

1.      Expert Aftercare

This is why it is so crucial to ensure you use the very best specialist dental practice, one which has an exceptional reputation in dental implants and restorative dental treatment.  When researching which to use, you will need a comprehensive examination and consultation resulting in a distinct and individual treatment plan detailing exactly what treatment is proposed, the total cost of the procedure, what experience the dentist has in this work, and what the alternatives, if any, could be. 

They should provide clear guidance and instruction on how best to care for your implants along with regular maintenance appointments and ideally as much help and advice as you need, even long after treatment has finished.

2.      Ongoing Hygiene Care

Meticulous hygiene, inter-dental cleaning, perhaps an anti-bacterial mouthwash and regular check-ups are imperative whether teeth are natural or not and the general health of the rest of the mouth and gums is fundamental to the success of implants – as well as the longevity of natural teeth. 

Implants themselves do not decay but the build-up of plaque around the surrounding gum can cause inflammation which may even lead to peri-implantitis, a bacterial infection which causes gradual loss of the bone supporting the implant, and the ultimate failure of implants.  Inadequate oral hygiene is the number one cause of failed dental implants.

A healthy diet, avoiding sugary foods as much as possible is also vital to all dental health and thus the success of implanted teeth, as is the avoidance of smoking.

Observation of common sense dental care and overall good health, along with an expert practitioner will give the very best chance of your implants lasting for a very long time – and give you reason to smile for many years to come.

Article supplied by London City Smiles, specialists in dental implants and cosmetic dentistry procedures.

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