Gum Disease, latest genetic testing

I have recently had a large number of clients presenting with aggressive periodontal (gum) disease. This is a very common condition which most of us have in either of its 2 forms, 1) Gingivitis: an inflammation of the gums characterised by bleeding on brushing. This is a reversible condition treated by simple professional cleaning and oral hygiene instruction. It is typically seen on the lower front teeth. 2) Periodontitis: this is when gingivitis goes untreated and develops into an irreversible condition where the chronic inflammtion of the gums causes the supporting structures around the teeth to ‘dissolve’ away. This loss of support ultimately leads to loose teeth and their loss.

It is this second condition that has taken my interest of late. Why? well we just see so much of it and I am interested to help educate our clients on why they have the disease and what can be done about it. What most people don’t know is that there are general health issues associated with having periodontal disease in the mouth, the most notable being cardiovascular disease. This is in addition to  the localised issues of bad breath, bad taste, psychological well-being and poor dental function. Periodontal disease is also exacerbated by smoking, which of course has many well known problems. The disease is caused by plaque and tartar gathering around teeth causing inflammation. Simple improvements in oral care skills will help; such as flossing, mouthwashes, correct toothbrushing techniques etc. These won’t be able to grow the lost bone back but they will slow the disease’s progression, and even on those patients that are fortunate and very attentive it can halt it. The treatment of a diagnosed periodontal case is typically started with a series of visits to see our hygienist, Tanya, and often the taking of baseline chartings of the bone levels and tissue damage. This is to ultimately reduce the inflammation around the teeth by removing the cause (plaque and tartar) and to educate the client in how to reduce the build up of the latter. Some respond well and others don’t, and even those who end up with good plaque control are not guaranteed improvement.. WHY? It can seem unfair that someone with excellent oral care and minimal plaque deposits will not have an improvement.

The reason is one big issue I have not mentioned yet, and that is ‘genetic susceptibility’. Simply put, some people have an inherent genetic predisposition to having periodontal disease. This means that for some people despite having ‘clean teeth’ they will still have a slow breakdown of the supporting structures of their teeth. This can be very frustrating for all involved and often explains many cases I see where there has been widespread breakdown depsite good care by the client and/or the attention of a hygienist. It would be nice to know what the genetic susceptibility is of those people I see with periodontal disease prior to getting involved in costly treatments. It would gives us all a heads up.

At Blueapple we offer this service!! and I have to say it is changing how we work, treat and advise many of our clients. The test is a simple swab of the cheek carried out by one of our clinical team and takes seconds. It is sent for genetic testing and quickly we have a response which essentially tells us how susceptible that particular client is to periodontal disease. This is invaluable information and allows us to educate and advise with very specific and personalised data at our finger tips. I am sure that having taken this on board as a practice we are in a better position than we were to provide our clients with the best advice we can, ultimately improving their dental health.

Piezosurgery and presents

Traditionally in oral surgery (wisdom tooth removal, implants) procedures a bur is used in a handpiece cooled by water. This basically cuts the bone (i can hear you going OUCH) in an environment that is as cool as possible (chilled saline should be used). Now, not much wrong with this but there is heat produced and this heat ‘burns’ the bone around the cut. This some believe can attribute to the after surgery pain and swelling which patients can experience. Today I got to use a new method of ‘cutting’ the bone, this is called ‘Piezosurgery’ and put simply it uses vibration of a cutting tip to do its ‘cutting’. The main advantage apart from an effecient ‘cut’ is that less heat is produced and hence the theory that less after pain is experienced. I have to say I was impressed by it and feel that if this does indeed offer our clients a better post surgery experience then it is something that we must consider carefully…… expect to see it soon!!

We had a great few days as a team last week, by this I mean lots of positivity. The team here love it when we get positive comments and this has been coming from all angles culminating in chocolates, flowers and lovely notes. Never underestimate what this does for a team which strives for the ultimate in client care, there was a spring in the step of everyone last week and it was great to see. As we have changed the practice to have its emphasis on customer service I as a clinician can almost stand back a bit and watch how wonderfully our clients are looked after. I am obviously a part of this and strive to do my best but the touch on the shoulder, the caring word, the comforting glance, the friendly face and appropriate body language all go a huge way in helping our clients have a poisitve experience out of what for many has never been an enjoyable experience. I have to say I was as proud of my team last week as I have ever been, we were on fire!! I hope they enjoy the nibbles and the flowers.

For me one of the sweetest things that has ever happened to me did so on Thursday. A much loved client delivered beautifully wrapped a gift for my children. I often chat about my children as clients go through their procedures and many very kindly take an interest in them. But here I had someone go out of their way to think about a gift that they would like judged on our personal conversations…. can I say it was well judged and the gift will take pride of place for some time I am sure….. this was a moment of disproportionate delight for me (more on these later).

Calm before the storm

Settling down to getting myself back into work mode after a lovely weekend. 3 of the pups went to, I can happily say, excellent homes over the past 2 days. This makes the whole thing of handing them over much easier as we have nurtured them closely for 7 weeks. Work mode started early this morning with a visit to the practice to prepare for a presentation I am doing on Tuesday night for the study club we run for the other dentists who kindly refer some of their clients to us for treatment. We are expecting some new faces and I look forward to welcoming them to Blueapple. The week ahead is crazy for us on a personal and business level and I am quite enjoying this little hour of calm.

Some of you will know that we pride ourselves on the level of customer service that we provide and that it is this that helps set us apart. I had an interesting conversation with the owner of my local shooting supplies shop at the weekend who told me that many similar businesses were closing in Northern Ireland due to the ‘recession’ but that for him he could not see any downturn in sales. I simply asked why he thought this was, and having been a client for several years was ready for the answer as i know first hand why I return time and time again….. CUSTOMER SERVICE….. Now the owner I refer to, I dont think fully realised what it was, that he had, that many in similar positions did not… comments like ‘well I fill the forms in for the guys buying guns’, ‘I will take back a waterproof coat that might leak and replace it’, ‘I take the time to help give the people new to the sport an insight and information’….. just spoke volumes as to why this guy continues to do well. He is adding value to your experience as a customer, he is removing obstacles that otherwise would make a purchase difficult ie: the form filling and gives you as the customer time. It was fascinating to hear that when I told him this was why he was successful he simply had not really linked the 2, he ‘just did it that way’. What makes it more remarkable is that the business is operated out of a converted garage at his house that people only know about through word of mouth. I felt that it was a great example of how certain businesses will survive in difficult times when others won’t.

On the line of my past time I was also chatting to a client who is a local farmer about his experience in Blueapple recently when he had a ‘Cerec’ crown and root canal filling carried out in one visit. He was delighted, no pain and eating was comfortable once the injection had worn off. I was of course happy about this but I was delighted at his next comment ‘you know you have fabulous girls in that place’…. I could feel myself quietly nodding in agreement with this and a feeling of pride. Here we had a client who on the face of it was there for a dental service but it was not this that he was raving about, it was how he was greeted, dealt with and approached by the team members…. perfect!!

The ‘larry’ week

Just back after a few days away from the practice taking care of the other aspects of life. Now back in the saddle with a very busy week. We this week have our 1 week in the month where our dental technician Mr Larry Browne visits. This has become something of a talking point at Blueapple, Larry with over 40 years in the business is a valuable and essential part of our team. His visits from London are looked forward to by staff and those clients who have had the privilege to be under his direct care as well as myself on a personal and professional level. For our clients as a whole this is a fairly unique service and many have benefited from his personal attention  to their work. His visits create an air of excitement which has us all on our toes.

Larry often combines his trips with speaking engagements and tonight we are presenting along with another colleague Mr Colin Howell on behalf of the ITI Ireland branch to a group of dentists interested in getting started in implant treatments. I enjoy this aspect of my work, it is enjoyable simply because I love to feel that I possibly have inspired someone to make the move into implant treatment.

We will over the next few days be placing 23 implants and seeing many clients who are either in the middle of treatment or those considering starting out. I am sure it will be fun.

Implanting Fun

We had a busy day of implant placement here today with 3 delightful ladies having treatment which all went well, and I trust was a positive experience for them as soon as they walked through our door. It was after the second placement of the day I remembered about an implant system I had recently seen and how plausible it all seemed: nicely presented, well priced and well marketed. Delving under the surface revealed a very different story and I thought again, as I have often done, how vunerable the public is in these situations.  Especially if even I who deal with this stuff every day was momentarily impressed.

At Blueapple we use the ‘Straumann’ dental implant system (www.straumann.co.uk) , the most widely used system in the world and, more importantly for our clients, the most heavily researched. There are hundreds of implant systems on the market, with many copies and - to be honest - poor systems available.  As a potential patient the worrying thing is that only really 4 (possibly 5) have evidence based research for use in the clinical environment. This is a problem as we are seeing more and more implants being placed (some even manufactured from the top 5 companies) which have little or no research base. A lot of these come onto the market quickly in a rush of hype and go even quicker as problems arise with them.  They are usually released following the bare minumum of testing and with only a few ‘case studies’ to back them up. Unfortunately the people who suffer are the patients who have them placed in their mouths…. essentially these people are being used as a research base without their knowledge. I often chat to my clients and ask them if they needed a hip replaced what would they prefer, a scientifically tested and proven hip or one that comes with little more than a nice brochure? It’s an easy decision in that light, but actually the choice is not given or highlighted for the patient in most cases.  I feel it is very important that they are made aware of this factor when looking around for implant treatment….. ‘an implant is not just an implant’.

Now, it is important to realise that the top systems essentially have very little to choose between them and often the success or failure of them comes down to operator skill, judgment and the environment into which they are placed. A lot of the time it is what the operator feels comfortable with. Implants are a fantastic means of restoring missing teeth, rebuilding a failing mouth or supporting dentures; and  if used correctly in the right patients are extremely successful.

So I suppose what I am saying is just ask, you should know what is going into your mouth. In reality our clients, and I suspect they are no different to anywhere else, simply trust the practice, its ethos and ultimately the operator who is in charge; it is our responsibility to honour that trust. 

At

I LOVE CEREC!!

I have had the most enjoyable morning, I had the wonderful privelege of treating one of my top referring dentists. It is a great vote of confidence when a fellow professional is happy for you to carry out treatment for them, the dentist in question required some back teeth restored, on discussion we decided to use the CEREC technology.

What is CEREC? , well log onto www.sirona.com and follow the link at the bottom to find out in detail. For those not wishing to do this it is basically a software package using Computer Aided Design and Computer Aided Manufacture (CADCAM) to make all ceramic (metal free) crowns and inlays for teeth. The biggest advantage for patients is that they leave with their crown or inlay being made on site (in front of their eyes) in 1 visit, no second trip, no impressions, no temporaries and no extra time of work. Overall it saves money and time and as a patient you get a top quality restoration.

We at Blueapple purchased one of these units earlier this year and to date I have been very impressed with the results, so much so I was happy to carry this treatment out this morning on probably the most critical of all patients…… a fellow dentist. It went very well and a relaxing few hours was spent by all, it really is a nice form of treatment to have and to carry out. At the end a new inlay and crown had been fitted and everyone was happy. Blueapple is the only dentist in the west of Ireland to have  one of the CEREC units are proud to be the forefront of being able to offer our client base this exiciting and beneficial treatment option. At present looking back most of the cases we have done have been involved in the replacement of large unsightly amalgam (mercury) fillings which have fractured or been leaking.

Here you will see a before and after picture of the inlay.

Have a nice weekend

New Blog

Those that have been following my blog to date will be wondering what has happened, why can I not see it? Well I have taken some advice from those close to me and I am going to attempt to run 2 blogs 1) Blueapple and 2) Professional. The former will be designed for our existing client base and those logging onto the website, it will have dentistry news and what is happening in Blueapple, this is open to everyone. The latter will be a bit more directed at dentists and those in related professions and will only be accessible via a password. Now as we speak my web guys are sorting this for me and I hope to have it operational by the close of today. Essentially you register and once you recieve a password can then log on.

I hope that you keep reading and tell your frinds and colleagues.

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