Newsletter Archives
What Dental Courses Are Right For You?
How to Decide What CPD is Right For You?
We have all heard and been told that our dental degrees are just the licence to start learning and while we have to do some CPD to fulfill our requirements for registration, dentists who want to excel and want to continue to learn and improve will always seek out CPD.
There are many reasons for taking CPD and this reflects in the huge variety of courses you see listed on CPD Junkie. The obvious reason for taking CPD is to learn. Learn a new clinical skill, learn to communicate, and learn to run a dental practice.
Beyond the obvious, CPD connects us with a community of dentists, serves to motivate and can even offer up a chance to travel.
How to Choose What Dental Courses are right for you?
As with most things, it is easy to get overwhelmed when it comes to choosing the right CPD. So how do you decide what course is right for you? This is a big topic and if there was one distinct and clear answer then we would all simply follow that path. In general there are two main schools of thought when it comes to this; the doubling down on your strengths school of thought and the expanding your clinical scope school of thought. Both of these approaches have merit and both of these approaches are superior to the alternative which would be taking CPD without a plan just to fill your requirements.
In general there are two main schools of thought when it comes to this; the doubling down on your strengths school of thought and the expanding your clinical scope school of thought.
The doubling down approach involves taking courses in areas of strength to expand skill within these disciplines to allow you to take on exceedingly more challenging cases. Over time, an approach like this would translate to you becoming a dentist with a special interest in these areas. For example you are in general practice and notice that you really enjoy and are good at root canals and so you decide to focus most of your CPD investment into endodontic courses.
Conversely, the expanding your clinical scope approach involves reflection about your current clinical abilities and determining the areas where you are weakest and deciding to take CPD in these areas to improve. This approach would make you a better generalist and allow you to be quite well rounded in terms of your clinical skills. A jack of all trades, master of none approach.
When it comes to deciding what CPD to take there are several factors you should consider and before making any big investment it would be wise to have thought these through:
- What types of procedures do I enjoy and want to get better at?
- What procedures do I find challenging and want to become better at?
- What types of procedures would serve my patients’ needs the best?
- What are my long term plans clinically?
- How do I plan on implementing what I learn at the CPD event back into my day to day practice?
The more I read, the more I acquire, the more certain I am that I know nothing.
Interested in Learning More and Using the CPD Junkie CPD Planner Cheat Sheet?
Blog Post: June 2021
CPD Junkie Blog
It’s best to use the DiSC behavioural system as a basic framework to help you present your treatment plan based on your patient’s “behavioural type” and their priorities."
Motivating Different Personality Types using the DiSC Behavioural System
Ever take a personality test and wonder how accurate the results are? More importantly, what can we gain from these different “personality types?” Communication. Particularly, how to communicate effectively with people who may be ‘wired’ differently. Dentists are always striving to motivate patients to adopt better dental hygiene regimes and accept treatment plans. However, the real challenge arises in tailoring these difficult conversations in a way that the patient is motivated to get something done and actually pay for it!
The DiSC behavioural system, originally developed by William Mouton Marston, broadly describes four different observable tendencies/ behavioural types and the personality traits often associated with them. In turn, this can give us a better insight of their everyday decision making process, personal preferences and communication style.
Dominance (D)
This type of patient needs to see results. There is no time for small chit-chat. They want you to get straight to the point and provide a solution. “There’s hole in your tooth, so let’s fill it.” Time is valuable and by respecting what they value, you are more likely to resonate well with them.
Influence (I)
Similar to the Instagram Influencer, this patient likes to socialise and build relationships. Don’t worry about the nit-picky details and focus your energy on carrying a conversation centred around their concerns. These patients are naturally enthusiastic and optimistic and will likely be keen to get treatment started. Get them involved in an effective oral hygiene regime and they will likely follow through.
Steadiness (S)
The quiet patient. This patient is described to be tactful, even-tempered and focuses on cooperation, consistency, and security. Their quiet nature may be due to anxiety, so it’s it best to provide them with enough information to inform them but abstain from bombarding them with too much. Small, gentle steps work best, similar to teaching someone. For example: To place a crown on a tooth, it usually takes two visits. One visit will be used to prep the tooth and place a temporary crown on it. The second visit is when we take off the temporary crown and place the actual crown on the tooth.
Conscientiousness (C)
Finally, this is the reserved, analytical, and systematic patient that highlights the importance of quality, competency and precision. These patients tend to ask a lot of questions and expect detailed responses. It’s best to provide the relevant information with pamphlets (when possible) and guide the conversation, otherwise you may end up on a tangent. That way they can do their own research after the appointment.
Although this is may seem rather simplistic as patients are more complex and can be a combination of various traits. It’s best to use the DiSC behavioural system as a basic framework to help you present your treatment plan based on your patient’s “behavioural type” and their priorities. However, it should also be adjusted according to the individual’s needs and not be used as a substitute to build meaningful relationships.
Expert Q&A – June 2021
Expert Q&A with: Dr. Geeta Perks
"Digital marketing is the most powerful way to get your brand in front of prospect patients, getting yourself and your team out in-front of prospect patients and building trust with prospect and existing patients."
Bio:
Dr Geeta Perks is a dentist with 20 years clinical experience having worked in prestigious practices and family dental practices, in both the UK and Australia.
Geeta has consulted for Dental Focus UK/Ireland for many years, helping dentists grow their businesses by attracting their ideal new patients. Dental Focus is founded by her brother, Krishan Joshi in 2001, in London during the dot com boom, and today is the leading dental digital marketing agency in the UK & Ireland.
Since moving to Australia, Geeta started the sister agency called Dental Focus Marketing It specialises in helping dental practices in Australia and New Zealand grow exponentially, by attracting their ideal new patients. This is achieved through integrated services: state-of-the art dental websites, Google Domination with Page 1 rankings through SEO and Pay per click advertising, and social media marketing to help to build PR and Brand Awareness online in local communities.
They provide clients with guidance and direction on aspects such as AHPRA compliance, and marketing strategies through consultation services using successful, proven strategies for dental practice growth. They are proud to have created over 1000 dental practice websites globally and have grown through word-of-mouth.
Coming from a family background in dentistry, Geeta understands the strategies needed for successful practice growth in this highly competitive consumer market. As a family, she’s helped to co-found of The Mouth Cancer Foundation Charity, which helps to spread the awareness of early detection of mouth cancer in the public, as this helps to save lives. Every year the MCF holds a free 10 km walk around London’s Hyde Park where survivors, carers, their families, dentists and the dental industry can join in.
Geeta understands how to find and grow a niche market, best strategies for ethical dentistry and how the power of social media can really grow your dental business. In 2019, she was awarded Fellowship of the Pierre Fauchard Academy for her contributions to dentistry.
Having practiced in both the UK and Australia, what’s one thing you wish you could implement in Australian dentistry that you’ve picked up in the UK?
I think the way that private dentistry is practiced in the UK and Australia is very similar. I think we’re very fortunate to live in an age where training and education is available online and dentists have easy access to further education, making practicing more uniform. And that’s certainly the case in the UK and Australia, where the differences in practice are small.
When I left the UK, ten years ago, dentistry was perceived as being much more accessible and affordable to the general public when compared to dentistry in Australia. Admittedly, the intervening years has seen this perception change somewhat. So, I’m all for making dentistry as accessible as possible. I’d love to see more accessibility to dental services across Australia, and we have the tools available to make this possible.
Was marketing something that you always wanted to get into, or did practicing dentistry and realizing the importance of marketing get you intrigued? How did you get started with creating Dental Focus Marketing?
Yes, I’ve always had a special interest in dental marketing. At the time I graduated from Manchester University my brother Krishan Joshi created Dental Focus in London. This was during the dot com boom. Through working in practice and helping Krishan with his business, I learnt a lot about dental digital marketing and how to grow dental practices. I’ve consulted for Dental Focus for many years. Today, Dental Focus is the market leader in dental digital marketing in the UK and Ireland.
After moving to Australia, I created the sister company called Dental Focus Marketing. I had experience in working for multiple practices, prestigious and family dental practices, in Australia and I soon realised that there was a real need for a digital marketing agency to help dentists grow their businesses here. I found most practices are doing ad-hoc marketing and using marketing companies that don’t know the dental industry. There was, therefore, a niche for a dental focused marketing company to help dental practices think more strategically about their marketing.
The main vision, when I started Dental Focus Marketing, was to create a digital marketing agency that would help dental practices grow their businesses by attracting their ideal new patients through integrated services: compliant websites that are bespoke, Google Domination strategies to be found at the top of Page 1 through SEO and PPC (pay per click) and social media marketing for PR and brand awareness for practices in their local communities. Giving clients guidance and direction on aspects like AHPRA compliance was also very important.
Today, dentists come to us because they want to engage digital marketing experts that genuinely care. We care about the dentist, their team and most importantly their ROI for practice growth. And the main reason why we care is because I’m a dentist. I’m also from a family background in dentistry, so we genuinely understand where dentists are coming from and the day-to-day running of their business.
So, coming back to the question, for me, it was all about creating freedom for the dentists to be able to save them time so that they could spend their time on things they enjoy: treating their ideal patients, or spending time working on their business and spending time with their families for instance. For me it was all about creating that ideal dental digital marketing agency for dentists.
When do you suggest dentists implement Google Ads (PPC)?
Google Ads are a way to get your practice name out there on Google by renting out advertising space. It works by someone clicking on the ad (the ad is typically a one liner offer which links to your website or a focused site called a ‘squeeze’ or ‘landing’ page). Google Ads are known as pay-per-click PPC advertising. How much is spent depends on the competition for keywords and location. Spending money on Google Ads leads is a quick way of getting in front of prospective patients, but it may not necessarily the best way. The patients who come through Google Ads are typically cold leads, and they may not be ready for treatment like those who have done more research.
I remember a dentist approached me for a consultation and we soon found out that he was doing his own marketing. He was spending a lot of money (>$3k/month) and, perhaps more importantly, spending is own time managing his practice’s Google Ads. He was only getting 1-2 leads a month. Firstly, he didn’t understand the best way to use and maximise Google Ads so wasn’t getting the results he should have. Google Ads is something you can start very quickly, but you need to understand the best strategies to get the results you want. Secondly, he didn’t realise that his website was not converting those leads and he was continuing to spend the money like a leaking tap. I always say that all roads lead to Rome, where Rome is your website. If you do decide to run ads, you need to make sure that you have highly converting website in order to convert these patient leads. Otherwise, most people will bounce off the website and you won’t see any return on that advertising spend.
Google Ads are a short-term strategy, typically recommended for practices that urgently need patients to fill up their books. They are also recommended for those practices who are investing in SEO and are waiting for their website to dominate in the top two spots on Google organically. Once the practice is dominating organically, they typically stop advertising as they don’t need it anymore.
If you’re not investing in digital marketing, then your competitors certainly are, and they’re steeling a march on you. Whether you know it or not, your competitors could be hoovering up your prospect patients.
Digital marketing is the most powerful way to get your brand in front of prospect patients, getting yourself and your team out in-front of prospect patients and building trust with prospect and existing patients. There are people out there who want your services, but they might not know you exist! They can’t find you in Google searches, have never heard of you or don’t trust you or don’t see the proof that you’re the experts at what you do. They’re going to go elsewhere where they can find the services that they need, or think that they need.
Understanding the right digital marketing strategy for your circumstances is therefore key. One size does not fit all! There are different aspects to digital marketing, and marketing strategies can as broad or as focused as they needed. For example, a new start up practice with no patients and no digital presence will require a different strategy from a practice with an existing patient list that wants to take their business to the next level and wants to attract high-end treatments such as Invisalign or Smile Makeovers. It’s also different from a specialist practice wanting to get more referrals from dentist or different to dental course providers wanting to attract more students.
For the majority of dentists out there, you really need to understand that it’s about the whole patient journey. You need to consider everything from the external marketing to the front of house to patient’s in-chair experience. All these things help determine whether patients return to your practice.
Whilst Dental Focus Marketing are typically tasked to deliver digital marketing, it’s really about making sure that the whole patient journey flows smoothly. We spend time with all of our clients adding value and consulting with them by learning about the internal processes of their practices so that their digital marketing strategy seamlessly compliments their practice’s operations. Dentists need the right guidance and direction to understand what’s the best strategy to deliver return of investment for them. This can make the difference between a practice turning over a 6-figure income or a 7-figure income
As I’ve said, all roads lead to Rome, where Rome is your website. Regardless of whether they are existing patients, new patients, or word-of-mouth patients, they will always do their research, and look you up. They will look you up on Google, they will look up your reviews, the public will look you up on social media, and everything feeds back to the website. Yes, digital marketing is not going away.
Dentists come to us for the right strategy and marketing management. We typically recommend practices to invest in their high-performance website and advanced SEO to dominate at the top of Google page 1. And invest in social media marketing for PR and brand awareness in their local community, and Google ads only if they need patients urgently.
Speaker Spotlight – June 2021
Speaker Spotlight with: Dr. Agnes Lai
The success in treatment I have learnt is beyond the clinical execution. It is, instead, about the change in the patient's attitude and commitment towards the maintenance of their teeth or prosthesis and their increased dental awareness. That is where creativity and gratitude thrive in both the clinician and patient, creating smiles in all."
Bio:
BDS USYD, DCLINDENT (Prosthodontics) USYD, MRACDS (Prosthodontics)
Dr Agnes Lai obtained her Bachelor of Dental Surgery from the University of Sydney (USYD) in 2002, during which she was awarded the G.S CAIRD Scholarship in Prosthetic Dentistry and shared Faculty Research Prize.
After practicing as an intrepid general dentist in Singapore, and metropolitan Sydney, Agnes completed her Doctorate of Clinical Dentistry in Prosthodontics at her alma mater, USYD in 2009, and was admitted as a member in the Royal Australasian College of Dental Surgeons in the same year.
Agnes had been involved with the hypodontia research in Westmead Centre for Oral Health, and has published her research in human neural adaptation related to an increase in occlusal vertical dimension using fMRI. She is also a contributor to the textbook “Oral Rehabilitation: A Case-Based Approach.”
Currently, Agnes practices prosthodontics in private practice at Sydney Prosthodontic Group, Chatswood, as well as a clinical specialist at Westmead Oral Restorative Sciences Department in the Public Sector.
Agnes had been a past Lecturer of Oral Rehabilitation at USYD where she was involved in both undergraduate and post-graduate teaching of prosthodontics and dental implants. She has been a past convener of a 5-day Continuing Education Program for Prosthodontics at USYD. She currently maintains an ongoing Clinical Educator role in the discipline of prosthodontics to Doctorate of Dental Medicine via her role at the teaching hospital. Agnes has served on the federal executive of the Australian Prosthodontic Society in the past, and is currently serving as a State Representative for the Australian and New Zealand Academy of Prosthodontics.
Her extensive experience in general and specialist practice, locally and overseas, and her friendly approach to patient-care provide our patients the highest quality specialist prosthodontic treatment in a warm, caring manner. She enjoys teamwork with her patients to rejuvenate, restore and create people’s smiles that is unique and tailored, with a comprehensive approach including mindfulness on aetiology, and recommendations on preventative strategies and risk mitigations.
Agnes is a mother of three delightful daughters and enjoys spending time with her family. She enjoys cooking, singing, theatre, travel, and playing the piano by leisure. She was born in Hong Kong and migrated to Australia in her primary years. Whilst remain fluent in Cantonese, she can also communicate in Mandarin and finds interest in Japanese and French though limited to holiday phrases only.
Publications:
Machado M, Wallace C, Austin B, Deshpande S, Lai A, Whittle T, and Klineberg. Rehabilitation of ectodermal dysplasia patients presenting with hypodontia: outcomes of implant rehabilitation part 1. Journal of Prosthodontic Research. 2018 Oct;62(4):473-478. https://doi.org/10.1016/j.jpor.2018.07.001
Lai and Klineberg. Oral stereognostic ability associated with increased vertical dimension, its relevance to satisfaction and adaptation. Professor Klineberg’s Symposium
Lai and Desai. Cracked Teeth- Cracking Problem in Dentistry (Part 1 to 5). June 2018 Australian Dental Association Online Continuing Education Videos
Lai, Korgaonkar, Gomes, Whittle, Foster, Williams and Klineberg. fMRI Study on Human Subjects with Sudden Occlusal Vertical Dimension Increase, Jacobs Journal of Dentistry and Research 2015 2(2):020. https://jacobspublishers.com/fmri-study-on-human-subjects-with-sudden-occlusal-vertical-dimension-increase/
Chapter contributor to a text book, “ Oral Rehabilitation: A Case-based Approach”, Case 10.3, Case 11.2 and Case 13.2, Wiley-Blackwell Publishing (2010)
You have managed a case where the patient had Amelogenesis Imperfecta. What did you find to be the most challenging aspect of the case and how long was the treatment planning process prior to completion?
The most challenging aspect in these type of cases is patient’s expectations and mindset. Fortunately, this patient had a very supportive family, both emotionally, psychologically and financially. He also had an excellent paediatric dentist who provided strong dental awareness and commitment to good oral maintenance of his teeth and future restorations. All of these helped to finalise our treatment goals and readiness for active treatment and maintenance. The treatment planning took one appointment, as this patient has had treatment option discussions on multiple occasions with previous dentists throughout his childhood and adolescence; therefore, he came to me with clear directions of his treatment goals. The design process until completion took 10 appointments over 3-4months.
How do you manage patients that end up needing/ wanting full conventional dentures (without implants) for the first time? Have you had a case where the patient never adapted to the dentures and if so, what did you end up doing instead?
Patients who are about to receive conventional full dentures must understand the relative advantages and disadvantages of the removable prosthesis. They must also understand how the retention and resistance form and support work, in order to embrace the limitations of function, and the maintenance required. Like learning to use any apparatus, positive mindset, skill acquisition and adaptation are important elements of the rehabilitation process. Often, by this stage of understanding, the patient will have a good idea of whether or not they will accept conventional dentures.
In cases where the patient may find adaptation challenging (associated with prosthesis retention), dental implants can be great alternative, especially in cases where patient’s lack the muscular control or coordination for a loose conventional mandibular denture. Instead, implant retained or supported prosthesis can provide a dramatic improvement in adaptation, as the skill for learning to use them is less demanding. However, when the adaptation is difficult due to mindset, or other movement disorders, then we may have to work with those challenges more specifically. The solution may not lie with the dental prosthesis design or treatment., but rather with the alignment of the patient’s or family’s expectations and their needs.
Implants are often a replacement option. However, if an implant fails, what would you do? What other replacement options would you offer for a patient who is set on getting implants (i.e., placement of a second implant, bone grafting, etc.)?
Implants or its prosthesis can have complications or fail too. If an implant fails, that is, loses osseointegration or fails to integrate, it will need to be removed. The case will have to be restarted and should consider all possible treatment options. Implant re-treatment may or may not always be possible, and often would require multiple surgical procedures with increasing treatment complexity with the risk of failing again. If the patient is set on getting implants again, it is important to identify those particular risk factors that can contribute to increase chances of failure. Where possible, those risk factors should be controlled first. To minimise the occurrence, a history of periodontitis and parafunction must be considered. Sometimes it is not as straightforward as such, the patient’s level of comprehension to appreciate the complexity of treatment and outcome expectations need to be realistic and on par. An appropriate maintenance schedule or servicing need would also have to be discussed and planned along with case selection, especially patient motivation and suitability.
What is one thing you want everyone to know about prosthodontics or something you learned during your years that you would like to share with other dental professionals?
Prosthodontics is very rewarding because you help witness the oral rehabilitation process and improvement in the quality of life in your patients. The success in treatment I have learnt is beyond the clinical execution. It is, instead, about the change in the patient’s attitude and commitment towards the maintenance of their teeth or prosthesis and their increased dental awareness. That is where creativity and gratitude thrive in both the clinician and patient, creating smiles in all.
The success in treatment I have learnt is beyond the clinical execution. It is, instead, about the change in the patient’s attitude and commitment towards the maintenance of their teeth or prosthesis and their increased dental awareness. That is where creativity and gratitude thrive in both the clinician and patient, creating smiles in all.”
Blog Post: May 2021
CPD Junkie Blog
"Social media gives you the power to share knowledge, attract new patients and grow your dental practice."
Why Your Dental Practice Needs To Join Instagram, And How To Get Started.
Social media has undoubtedly transformed how dental professionals can connect with patients and educate the community. It’s time for you to dedicate some of your time, or your marketing budget, to social media. Social media gives you the power to share knowledge, attract new patients and grow your dental practice. Do you really want to miss out on all that?!
So many dentists invest in innovative technologies, but they don’t advertise them enough. Think about it, if your main method of external advertisement is Google Ads and flyers in the local community, are you really able to showcase all that you offer? Of course, you can fit in “CAD/CAM same day crowns available” in a corner somewhere; but, how many people not in the dental field really understand what that means? How many will actually google it or call you to understand it? I think we can all admit, not many. However, if you showcase your CAD/CAM machine periodically through your social media pages, you’re bound to capture attention and educate potential patients.
Just recently, I had generated 4 new patients for a dental practice by posting about their DEXIS CariVu. In the post, I explained what it is, how it works, and added a picture of it being used on a patient, and the image it generates. This ensured that people could tell it was safe, and they could see how we as dentists are able to detect decay with the resultant image. My favourite part is that I made that post months ago. I know sometimes we may take our time to create something, yet it barely gets any interactions. That’s where social media is great. That information will stay on your feed for people to see months, even years later. So, for those dentists that did start up a social media page and got discouraged because it was not generating any leads, I want to assure you that one day you will enjoy the fruits of your labour. But, for that to happen, you need to be consistent, you need to interact with followers, and you need to use the right hashtags.
Be consistent
The best way to ensure this is to outsource and have somebody in charge of the social media pages. Whether you want that person to be a hired social media content creator, an existing front desk staff member, or your nephew, that’s totally up to you. However, be mindful that people like seeing people. For your account to be successful, you cannot use entirely stock images and text. You or someone at the clinic, needs to take pictures of your office, technologies you offer, staff and patients (with consent). Another way to ensure consistency is to dedicate a few days that you will post on. To figure out which day will give you the most interactions, look at your analytics. This will show you when you get the most interactions with your posts. In the beginning, experiment and post on different days and times, then look at your analytics to determine the ideal time.
Interact with followers
This is a win-win interaction. Not only will this make them feel good about themselves, it also puts you out there for their followers to see. Whenever you comment on a patient’s photo, their followers will be able to see. This is an excellent way to provide your account and practice more exposure as most likely many of their followers live in the same area, thus can be potential patients. Also, as a general give and take rule that we as humans follow, the more you interact with their content, the more inclined they will feel to return the favour.
Use the right hashtags
Hashtags will be where most of your exposure will come from as you start up. Instagram allows you to use up to 30 hashtags. I recommend using about 10 dental/ content specific, 10 general and 10 location-specific. For example, if you are posting a video of you scanning a patient’s mouth with an iTero scanner for Invisalign, utilize hashtags such as:
- #invisalign, #clearbraces (dental/ content specific)
- #videooftheday, #smile (general)
- #Townsvilledentist, #Townsvillebusiness (location specific)
These ensure you reach out to people interested in the service you offer (Invisalign), and also people in your area (Townsville). The general hashtags will help you get more interactions, which most likely won’t generate leads; but it helps the Instagram algorithm notice that users are liking your content, and Instagram will display it more to other users. This will ultimately give you more engagements in the end.
Those are the 3 main tips I recommend for running a successful dental practice instagram. It may seem overwhelming and not worth it at first, but if you are dedicated to it, it will prove itself beneficial. Of course, Instagram is not the only social media, but it is becoming increasingly popular for users to discover businesses on. So, why should you miss out on these leads? Join today on instagram.com.
Expert Q&A – May 2021
Expert Q&A with: Dr. Kalyan Voruganti
Implants are a long game – they can have issues and they are complicated and expensive to fix...they can be great and truly life changing but you have to pick your cases – make your life easy!"
Bio:
Kalyan qualified in 2005 with Merit from Cardiff University in the UK, as one of the top ten students in his year. Not long after graduating, he did further study and gained the prestigious Member of the Faculty of Dental Surgery (MFDS) in 2006 from the Royal College of surgeons of Edinburgh. With a thirst for learning, he has also completed a 2 year orthodontic diploma (with Dr Derek Mahony in 2017) which focuses on early interceptive orthodontics. This tries to prevent problems and treat them early. He has been placing Dental implants for almost 10 years and often mentors colleagues and graduate dentists to plan out their own cases. He has also worked in Liverpool Dental hospital and in Community specifically treating highly anxious patients. His focus is making his patients’ dental experience as pleasant as possible and communicating very clearly to ensure patients understand their treatment.
He is actively involved in Dental associations as well as multiple Dental forums. Training younger Dentists is something Kalyan really enjoys. He has also completed a teaching certificate in 2017 at the University of Melbourne and has been involved in training Dental Therapists and Hygienists as well as general mentoring of younger Dentists with the General Dental Residency (GDR) scheme.
You are an expert in managing anxious patients. How did you go about that and how have your techniques changed over the years?
Treating anxious patients is one of the most rewarding, yet also the hardest parts of our job. During my time as a maxillofacial senior house officer working in hospital, I would introduce myself to patients as a head and neck Doctor instead of a Dentist. The difference in patient anxiety levels vs introducing yourself as a Dentist is noticeable – you’ve all heard the phrase “It’s nothing personal but I hate Dentists”.
After graduating I went into hospital rotations doing Maxfax and general dental. This included special needs, severely phobic patients, IV sedation and GA. This allowed me to hone my skills. It’s the simple strategies that work. You’d be surprised how often these patients can be managed with conversation and comfortable Dentistry.
Technique wise, a lot of people jump to RA, IV or GA. These are options that should be provided but don’t need to be used as your first port of call. It’s important to look at the patient journey, especially as a practice owner – every little thing needs to be considered. Often these patients experience anticipatory anxiety and have been thinking about your appointment for the whole week beforehand. When they walk into your clinic (and even the phone call before), how are they greeted? What does the patient lounge look like and smell like? Are there any pictures which would increase their anxiety? When they come into the surgery, how do you greet them?
With experience, I have found that by working all these touch points out and making sure everything is set up to support anxious patients, they are getting the best experience possible. At the end of the appointment, I also ask how it went and make a note of what we can do better next time. Some patients want extra anaesthetic right from the start. By doing this, I get referrals and more anxious patients and the more you see, the better you get at treating them.
Even if you use oral sedatives or IV sedation etc the basics still apply – use topical on dry mucosa for 2 minutes, use hypnosis / distraction techniques while you are giving local, your DA can give the patient a gentle hand squeeze or a touch on the shoulder. These don’t sound like much but to a nervous patient it can make a massive difference. When I give an ID block, I check the tooth due to be worked on with ethyl chloride to make sure the patient is numb before I place dam on and start drilling. This ensures there are no shocks after you start drilling! I also check and ask how they are doing each step of the procedure as well, giving them updates e.g. “I’ve removed the decay / I’m filling it now about 20 minutes left”. This gives the patient something to look forward to as otherwise they have no idea how things are going.
Tell us more about your teaching. What do you enjoy the most and what do you find to be the most challenging aspect of it?
I’ve been very lucky to have some great mentors. They were generous with their time and very patient with their teaching and I’d like to think that I’ve picked up some of this generosity from them. Teaching is something that I genuinely enjoy, there’s a phrase “rise by lifting others”. I honestly find it so rewarding to watch people I teach gain confidence and implement things they’ve been taught. To watch newgrads go from being nervous about their first DO, their first prep, their first “big” treatment plan to then consistently doing them couldn’t make me prouder.
The most challenging aspect of it is probably the student / mentee. Mentees vary a lot and I’ve noticed in more recent times, there can be a lot more confidence (quite often misplaced) in people who are relatively newly graduated and inexperienced. They want to place implants and do big cases in their first year or two of graduation. I really do believe the first 2-3 years should be spent on mastering the basics, especially communication skills before venturing on to more complicated things.
You have worked in both Australia and the UK, did you find the transition to be smooth or what were the main differences you faced when moving here?
That’s a very interesting question. I’d been brought up and lived in the UK my whole life so it was a momentous change moving to Australia. A lot of things surprisingly fell into place. Despite a tough job market, I found a job and accommodation etc quickly and when that happens I always think it’s a good sign.
It was relatively lonely I guess when I first moved though, I lost my friends and my dental network overnight. It was daunting not knowing anyone. Thankfully, I had a great group of people at my work, including my now business partner who helped me settle in. I was introduced to the DPR facebook group when it only had maybe a thousand or so people in it and met so many people who are now my close friends.
The main differences I found are that in the UK people are happier to sue their dentists and it happens quite frequently over very minor things. The NHS also devalues dentistry in my opinion as people expect everything for free. Here in Australia, you can earn well whilst doing really good quality work. The risk of getting sued is a lot less and so you can actually enjoy your Dentistry. I love it over here and honestly don’t think I could ever go back, thanks ‘straya
After a decade of planning and placing implants, what is one thing you wish you knew back when you were first starting?
Also, a great question! This is an easy one – learn to say no. When you first start placing implants, you want to place them in every gap you see, every fractured tooth or post crown that debonds. You may also place them in places where there isn’t much occlusal room or oral hygiene isn’t quite right.
Implants are a long game – they can have issues and they are complicated and expensive to fix. Unfortunately, the longer you’ve been doing them, the more of this you see including failures. I have actually added a long section to my consent form about peri-implantitis and other complications because I want my patients to know what they are getting themselves into right from the start. Implants are great and can be truly life changing but you have to pick your cases – make your life easy!
Speaker Spotlight – May 2021
Speaker Spotlight with: Dr. Toni Surace
Practice ownership is more about managing a team than it is about clinical dentistry. Just being a good dentist is not enough to make you a good business owner."
Bio:
Dr. Toni Surace graduated from Melbourne University in Dental Science in 1995 and formed her practice, Smile Style Dental in 2000. As a Principal Dentist, Dr. Surace went through the Momentum Management Program and found by implementing procedures, protocols and systems, she could run her practice remotely and leverage her time. This enabled her to be selective in the type dentistry that she personally did and allowed her to fulfil her other passion of helping dentists run their business more effectively and efficiently. She then became a coach and trainer at Momentum Management and loved it so much that she decided to buy the company!
Today as the head of Momentum Management, Toni has become a renowned international presenter where she is able to draw on her own experiences as well as her clients to help others tackle any issue impacting their practice. As the winner of the ADIA Dental Industry Professional for the Year in 2012, she was formally acknowledged by the industry for the much-needed work she does to assist other Dentists.
To further assist dental practices, Dr. Surace has also written a book titled “Be Exceptional – 50 Dental Practice Systems to Kill Average and Wow Even Your Mother-in-Law”. Dr. Surace further assists dentists by addressing questions concerning the dental community within her Q & A column “Best Practices” in Australasian Dentist.
Toni is an enthusiastic, energetic presenter that delivers high value at every course she presents. She has formal training in team building and team management, positive psychology, digital marketing, business and leadership. Toni is passionate about people and dentistry. In her role as international presenter, coach, trainer and mentor to dental practices, she thoroughly enjoys assisting people to grow within dental practice management, marketing and communication.
Toni is changing dentist’s lives and lifestyles every day. She is passionate about people and passionate about dentistry!
Did you find that having five years experience post- graduation sufficient to start your own business? What were the benefits and challenges you faced?
Does anyone ever have enough knowledge to start their own business?! I wish I knew then what I know now! I think there comes a time when you realise that working for other practices is not right for you anymore and that it is time to take a giant leap of faith in yourself. I had got to a point where I could not find a practice to work in that shared a similar clinical philosophy to me. I am very much a preventative dentist who loves to practice biomimetic dentistry. I often found I was not able to provide clinical options that I believed were the correct ones for my patients. I was ‘encouraged’ to place crowns etc. when I believed a well-done composite would have been more beneficial for the patient and I decided that I had enough, and I would buy my own business. I was very fortunate to have an extremely supportive family and accountant by my side who made the transition into ownership relatively easy. I was also able to draw on my experience in running a practice for an absent owner when I worked in country Victoria. My 2 years in the country gave me a lot of confidence, both clinical and business. I had no one to refer to, no one to discuss cases with and I just had to learn how to do things on my own! Confidence is paramount if you want to succeed in dentistry!
One very early challenge was my first day in my own practice that I had purchased from a dentist who had been practicing for 20 years. I remember my concern about having full books of patients and not even thinking about staff. The night before I started on my first day, the DA called in sick. I had no idea what to do and didn’t even know the name of temp agencies, so I panicked until I called one of my previous bosses for support. That was not the end of it! The next day when I was seeing patients, the receptionist came and told me that unless I paid her $5 more per hour, she was leaving! I had no idea how to respond, so I panicked and said yes. What a bad move…. A year later, she was still causing issues but by then I had found my footing as a practice owner and was able to deal with the situation in a better way. Practice ownership is more about managing a team than it is about clinical dentistry. Just being a good dentist is not enough to make you a good business owner. I wish I had known this back then!
How did you transition from being an in-chair clinician to working remotely? How long was this process?
I was practicing in my own business for about 10 years before I was able to ‘autopilot’. There was a lot of water that went under the bridge during that time, and I have to say, life was not easy for me as a business owner, mum and wife. To be perfectly honest, I struggled greatly with anxiety, depression and perfectionistic tendencies that after about 5 years of trying to balance all of my hats, I had a nervous breakdown and tried to commit suicide. I was lucky, I survived but I still remember the feeling of hopelessness, the mental pain and stress that I just wanted to stop and taking my life seemed like the only answer.
Once again, I had an incredible support team by my side and once they knew there was an issue, they were there to help. I didn’t talk to anyone about my issues, didn’t ask for help and that proved to be the cause of my demise. My family wouldn’t let me go back to work without getting help. I did every practice management course under the sun in Australia and overseas, and I was able to implement systems and protocols that made the business more about my team than myself ,and that allowed me to practice 3 days a week. ‘Mummy hours’, rather than 5.5 days per week full time. After a few years of working this way, and after multiple requests for help from my colleagues, I decided to put my practice on ‘autopilot’ and run it remotely, while I helped people through my company, Momentum Management. One of the key requests I get is for help with systems and enabling owners to buy multiple practices, work less and still have a great income. I know that on average, it takes approximately 3 years from going into work full time to working exclusively remotely. It takes a lot of work and effort, but it is worth it!
You are now the Managing Director and Director at Momentum Management and Practice Entrepreneur Network, respectively. Tell us more about these businesses. What courses/ words of encouragement would recommend to others thinking of venturing into the business world/ new practice owners?
Momentum Management is a company that helps dentists become the best possible version of themselves. We teach communication skills, leadership, practice systems and processes and we help people start their own businesses and live out their dreams. We are all about life and business mastery. I am very proud of my company, which I am involved in on a hands-on level. Everyone we employ has been working in the dental profession for many years and we focus on building a support team in practices, so dentists can do more of what they really enjoy rather than being tied down by business. We give dentists freedom!
Practice Entrepreneur Network is a partnership that I own with Emanuel Recupero from Dental ED. We have combined high-end clinical education together with communication and practice management skills to help dentists grow and provide superior outcomes for their patients. Check out our Facebook Group Dental Evolution, we provide free continuing education for dental professionals.
If you are considering business ownership, I can highly recommend you attend one of our Mini Business Programs. This is a 3 day course on practice management and business ownership that will help you understand what it takes to run a dental practice in 2021! (We will be able to offer a discount to your group if you would like!)
Blog Post: April 2021
CPD Junkie Blog
Like everything good in life, there must be a balance. It is not something you find, but something you create."
Work-Life Balance–
Can we Really Have it all?
So why the imbalance? It is thought that work can provide purpose, can encourage a sense of community, boost productivity and good habits, and more importantly, provide the financial basis for living. As we all know, overhead costs are not free. Although work may provide many desirable rewards, there is a misconception that ‘more is better’, which can result in people working long hours for diminishing or even worse returns.
But why is work- life balance necessary? It can
- Prevent early burnout and reduce stress– by keeping your work and life separate, you can try to leave the stress at work and retreat home for some necessary rest and relaxation;
- Promote a healthy mind and body– the mind and body are inseparable, having a healthy mind and body can lead to higher energy levels and emotional stability;
- Increase productivity– it is about the quality of time spent not the quantity. Studies found that people work more overtime hours are less productive (Shumizu et al., 2004). Remember a fatigued mind is an unproductive mind; and
- Make you more well-rounded– it is okay to have a life outside of your job. In fact, it is encouraged. You are, above all else, a human. Try to use those outside interests to connect with others and pursue hobbies outside of the mouth.
So how do we manage to pursue your passion while still having a life at the same time?
Here are a few ways to start:
Stop and take care of yourself – burnout is not the solution
Spend some time to re-evaluate your values and prioritise interests that matter to you. Ensure you take breaks, get some daily exercise and incorporate good habits. Patients can tell when you are stressed, so instead of rushing through that last filling, use the extra time to go over treatment plans, type your notes or enjoy a quick stroll in the sun.
Live in the present
Although easier said than done, try to focus on the now. Deadlines and tomorrow’s woes will happen whether you worry about them or not. Best to direct your energy towards the task at hand and leave the worrying for tomorrow.
Set Boundaries
Establish a routine that encompasses both work and outside activities. It is okay to say “No” when situations arise outside those hours, most appointments can be rescheduled, anyways.
Practice Time management and Make a Plan
Try to restructure and organise your schedule more efficiently. Manage your time, so you can continue doing activities outside the clinic. Work smarter (remember those “SMART” goals you wrote down at the beginning of the year? Well, it may be time to revisit them), so you don’t have to break your back while working harder. Make a schedule, pencil in those date nights and make sure you follow through. Happy spouse = happy house.
Ask for help
If you find yourself overwhelmed, try to reach out to someone. Developing a healthy work-life balance can be difficult, but help is available, even when you think you do not need it. Learn how to manage stress effectively and let go of the little things, your staff will thank you for it.
Dentistry can be demanding, but it does not have to consume your every thought. Like everything good in life, there must be a balance. It is not something you find, but something you create. We work to live rather than live to work. Try to smile and enjoy those moments when you’re not thinking about how crooked those teeth are, although difficult, it can happen.
Expert Q&A – April 2021
Expert Q&A with: Dr. Melissa Chew
I think it is important to get good mentorship. Mentorship is invaluable, especially post-graduation. "
Bio:
Dr. Melissa Chew studied Bachelors of Dental Science at the University of Melbourne, graduating in 2013.
She fervently believes that education plays a major role both in empowering clientele with oral health knowledge as well as in one’s own continuing professional development.
Melissa’s area of expertise as a 7 year long practicing dentist in Lilydale resides in cosmetic and restorative dentistry.
Aside from the technicalities, Dr Chew possesses an innate ability to connect with patients at a personal level, building long standing relationships whilst assuaging apprehensions to put their minds at ease.
Besides work, she is quite fond of escape rooms and travel.
How do you find working in community clinic vs. private and how was our transition?
Both community and private clinics have their advantages and disadvantages. As a new grad, I found community clinic to be a place where I could improve my clinical skills after graduation. I was able to enhance my techniques, increase my efficiency and develop the fundamental ‘bread and butter’ of dentistry without having the pressure to meet business demands because you are on salary. I was also fortunate enough to work with great staff and make life-long friends. Alternatively, I found that working in the public sector also had its limitations. Depending on your particular interest, you will not be able to see a lot of prosthodontic and complex multi-disciplinary cases. You will spend most of your time doing restorative work, emergency care and cleanings.
On the other hand, in private practice, there is the additional pressure of meeting targets, time management, keeping your books filled and patient retention. Communication became the biggest obstacle. In community clinic, I found that I did not have to sell my treatment plan and building rapport was not as necessary. While in private, I could not sell the treatment plans without building rapport. Dental work can be costly and patients can be very reluctant about treatment expenses, so it is imperative that you convey the information well and provide patients with appropriate options. The transition from public to private was initially difficult; however, rewarding. There are genuinely positive aspects to both, but ultimately, I felt I had more potential to grow as a clinician in private practice.
Being a few years out, what advice would you recommend to new grads?
I think it is important to get good mentorship. A mentor can be anyone who imparts knowledge like a friend, relative, peer, teacher or someone you merely meet in passing. Someone who is willing to simply listen, make suggestions/ give advice, is supportive and understands what it means to be a new grad. Look for positions that offer mentorships specifically in your field of interest. Do not be afraid to leave a company if they are not willing to teach you and facilitate your learning, particularly early on. Mentorship is invaluable, especially post-graduation.
If you are struggling with something, ask for help (online or in person), take CPD courses, watch videos, etc. Be proactive and use the resources that are available out there, e.g. dental forums, Facebook, Instagram, podcasts. We are fortunate to have the information at our fingertips.
Speaker Spotlight – April 2021
Speaker Spotlight with: Dr. Mehdi Rahimi
I always approached research with a “Can do” attitude and believed that “Persistence is the key
to success.” Although you can fail, you can learn a lot from that failure, which motivated me to go forward"
"The most important thing is to inform the patient and deliver the news in a non-inflammatory way. Often, clinicians struggle with telling their patients of the misadventure and when they do, they stumble explaining it."
Bio:
Dr. Mehdi Rahimi (Principal Endodontist)
BSc, BDS Distinction (NZ)
DClinDent (Melb), FICD, FPFA, MRACDS
Adjunct Associate Professor (CSU)
President of the Australian Society of Endodontology (ASE NSW)
Guest Lecturer (Melb & Syd)
ADA NSW Councillor
Dr. Rahimi is an Adjunct Associate Professor at Charles Sturt University (Orange). Mehdi graduated with a Bachelor in Dental Surgery with distinction from the University of Otago (New Zealand) in 2002 and received his Doctorate of Clinical Dentistry (Endo) degree from the University of Melbourne in 2008. He has been actively involved in Endodontic teaching at various continued education levels, both nationally and internationally. Mehdi is a guest lecturer at Sydney and Melbourne Universities, and a CPD mentor and Councillor for the Australian Dental Association NSW. Mehdi has obtained a number of publications in the field of forensic dentistry and Endodontics (resin based obturation material and fractured instruments). In 2000, he was awarded the Sir Allan Wilkinson award for the most worthwhile research in Medicine and Dentistry from the University of Otago, in 2001 he was awarded the International Association for Dental Research Young Researchers Award and in 2002, Mehdi received the Pierre Fauchard Academy Award of Merit.
Mehdi is the current President of the Australian Society of Endodontology (NSW branch), the immediate past-president of the Australian Asian Association of Dentists, a fellow of the International College of Dentists (FICD), a fellow of the Pierre Fauchard Academy, a member of the Australian Dental Association (NSW) Education & Research Committee, a member of the Royal Australian College of Dental Surgeons in Endodontics, and a member of the Australian and New Zealand Academy of Endodontists.
You have published some articles on forensic dentistry. Tell us more about that and what you think all dentists should know.
My background, before dentistry, was in research, and I continued to pursue dental research during dental school through summer studentships. I was fortunate enough to start a project with a world-renowned researcher who had an interest in forensics and bite marks at a molecular level, precisely what bite marks left behind – bacteria.
Having had experience from my previous degree in genotypic analysis, I looked at the bacteria to determine what constituted the dominant strain in a bite mark. This can then be used to determine the perpetrator’s identification, so if it is speculated that the perpetrator is a male, e.g., the stepdad of the child, you can swab his teeth and the bite mark and compare the dominant strains. This is particularly important in the first 12 hours, where you can recover enough bacteria to determine the dominant strain and then match it to the possible perpetrator.
After I left, this research went further, and another colleague of mine looked into the dominant strain between twins and found this to be an objective method that can be used at the crime scene after rape or child abuse. Before, they compared the imprint bitemarks left on the skin, which can be subjective and difficult to match.
Once I got into post-grad training, I found research to be more rewarding. I genuinely enjoy having a project where you might do something repetitive whilst searching for an answer. Unfortunately, I did not have enough time to take on a PhD type research, but I continue doing a little research with students. One of the research projects I supervised the Sydney University students through is about to be published in the Australian endodontic journal in May.
If a file fractures, what is one thing you wish you had known as a new graduate or something you advise to all dental professionals when this happens.
I think the most crucial thing when these things happen is communication and management. Try to think about it in three parts:
- Did you inform the patient of the possible complications of treatment, and did you mention how it will be managed? If so,
- Did you do so in a non-inflammatory way, and
- Will a fractured instrument change the treatment outcome?
From the literature, we know that if most of the chemo-mechanical disinfection was completed before a file fracture, the patient would likely heal. It makes no difference whether the fractured file is left or not. It’s all about the communication beforehand, which many people tend to skip or do in a hurry because of the urgency of the situation: getting the patient out of pain. Often, clinicians forget that it is not until the second or third visit when the full instrumentation occurs, so I always recommend giving the patient the information before they leave so that they can read about it before the next visit. That’s how you make sure they are fully informed!
Being on the Dental Council, I have seen a lot of people dig their own holes. We find that complaints arise when patients are unaware of a file fracture because the dentist fails to inform them. Dentists refrain from telling the patient; they assume no one will find out, or they do not fully disclose the situation as soon as it happens. The most important thing is to inform the patient and deliver the news in a non-inflammatory way. Often, clinicians struggle with telling their patients of the misadventure and when they do, they stumble explaining it. What most clinicians often forget is that these file fractures do not impart a significant impact on the overall treatment outcome. An instrument fracture is a part of treatment and is something that we must accept as a misadventure rather than medical negligence. Many of us will say, “Oh, I feel terrible, I feel so bad. I’ll pay for the treatment,” and that’s when things start to go wrong; clinicians begin to take responsibility for an unfortunate mishap wrongfully. What happens if the case goes pear-shaped and turns into a root fracture and eventual tooth loss? These are the cases where the patient never leaves the dentist alone. They keep blaming the dentist, and before you know it, no one is happy.
How do you overcome ‘hot pulp?’
“Hot pulp” commonly occurs in lower molars, specifically in the 6-7 area and less commonly in the upper region. This could be due to the lower region’s complexity, so whenever you are giving a block, you might be aiming a little lower than you should because you got the anatomy wrong. Also, the tooth is probably located in an inflamed area, meaning there are more tetrodotoxin (TTX) sensitive channels present and the c- fibres are highly resistant to local anaesthetic, meaning you likely require more anaesthetic.
So, I recommend having a good plan, remembering your anatomy, giving the block higher up, similar to a Gow Gates version of the block, together with a higher volume, doing supplementary infiltrations and giving more time for the local anaesthetic to work before the commencement of treatment. Older patients might have more dense structures, so it might take longer to get to those cells and anaesthetize the region entirely. My first block is an ordinary block with a lignocaine. Then I give a Gow Gates, higher up, aspirate, and deposit Scandonest and although this may be seemingly insignificant, what I have done is mixed the drugs. When you look at the pharmacology, when you combine drugs, they become more effective, especially in the local anaesthetic delivery. Anxiety can also play a role, particularly in a patient who has not slept and is inflamed. Sometimes you need more time to get them comfortable and into a relaxed state. Nitrous oxide can also be effective in accomplishing this. It gives you a state of euphoria, especially in patients that have been under stress, and when patients feel less stressed, they are less likely to feel pain.
You have accomplished a lot during your career. How did you get into research, and how did you overcome all the challenges that involved?
As I mentioned, I have a background in research. My graduate-entry was in gene therapy, and I had an honours degree in the field of pharmacology and physiology. When I entered dentistry, I had time to do further research and spent my summers doing projects.
I always approached research with a “Can do” attitude and believed that “Persistence is the key to success.”
Although you can fail, you can learn a lot from that failure, which motivated me to go forward. Not every paper or article is going to be revolutionary. If your research is not successful and does not yield results, it can be used as a methodology paper to discuss the shortcomings. Research can pose a lot of challenges, but you can still learn a lot from it. At the end of the day, I think it is not about making a difference; it is about understanding what research entails, especially if you are doing a doctorate, like a Master’s. What you are trying to achieve is an overall understanding and, quite possibly, make a difference, albeit small, to the scientific field. It can be challenging and has its downsides but understanding the purpose and the process is the important part. If it were not for research, the COVID vaccine would not exist, and they would not be able to improve on it from vaccine to vaccine. There had to be some research or some science to do this. Some people go, “I’ll never do another research project again”, but they still look up and respect the researchers that get a lot of articles published and make a contribution. In the way we practice, the equipment we use and the technology behind it, this all stemmed from research. For example, Nickel-titanium or the more flexible files would not exist. We would still be limited to manual filing and would be having the same sort of procedural problems as we used to have 20-30 years ago if we did not have research.
Blog Post: March 2021
CPD Junkie Blog
How high you go in unconscious incompetence and how low the realisation that follows is up to you. Check yourself, your patients will thank you."
The Unconsciously Competent Dentist
During my undergraduate degree I spent a lot of time studying. The thing was, most of that time was spent studying poker.
Along with the game itself I dove into psychology, learning, emotional control and meditation. A lesson that stuck with me long after hanging up the poker hat was about the four stages of competence, first described by Noel Burch during the 1970’s. The concept is to move skills to the unconscious competence state, where even the most emotionally frustrating situation (losing a ‘bad beat’, analogous to treating an unreasonably difficult patient) would not affect the core skill. It is unconsciously working.
Unconscious Incompetence
“You don’t know what you don’t know” is one of my favourite sayings. And this is unconscious incompetence, a time where we don’t know that we can’t do something. This is actually a dangerous time where we can get into trouble and not even know it. The aligner case that has more to it than meets the eye or the guy who wants to have his teeth built up from attrition yet not understanding his square jaw and sleep apnoea impact this. Be wary.
Conscious incompetence
You realise that you don’t know it all. A humbling yet important realisation that perhaps this case has more to it or should be referred off. Perhaps you didn’t graduate ready for ortho, implants and full mouth rehabilitation. While a safer zone for you and your patients, you might find yourself a bit unmotivated, I felt this at 18 months post-graduation. When you find yourself here, you need to shift your perception. Allow this to intensify your learning and progression in the areas you now realise you’re deficient. It’s a goal. And you’ve done many years of study, you don’t struggle with hitting clear goals.
Consciously competent
You’re competent at what you do but it takes focused ongoing effort. Crown preps once you’ve done your first 50. You can do them fairly easily and sufficiently well. But not with your eyes closed. You’re on your way there.
Unconsciously competent
Turn the car on, handbrake off, put it in gear. Driving was once a stressful endeavour but now it can pass without you even registering any of the decisions it took to get there. Perhaps, all you consciously noticed the whole way was the (DHS) podcast you were listening to! Some aspects of your dentistry may get there (so I hear!) but perhaps not all.
How high you go in unconscious incompetence and how low the realisation that follows is up to you. Check yourself, your patients will thank you.
Expert Q&A – March 2021
Expert Q&A with: Dr. Vy Phan
"I find that in this competitive climate, patients want to get to know you and your practice before even stepping into the surgery."
Bio:
What led you to the decision to return back to university for the Master of Health/Medical Law program? What’s one thing you’ve learnt from the program that you think is valuable as a dentist?
Have you seen any direct benefits from having social media pages dedicated for your dental office? Do you curate posts yourself or outsource?
How did you go on about beginning to offer cosmetic procedures, such as lip fillers? Do you recommend any CPD? Did you launch marketing campaigns to advertise and get it running or just informed existing patients of it?
Speaker Spotlight – March 2021
Speaker Spotlight with: Dr. Clarence Tam
"Everyone is so concerned about how the “face” or buccal surface looks in a reconstruction... The most critical angle of view is actually the incisal or occlusal - if you are fastidious in recreating primary, secondary and sometimes even tertiary anatomy from this view, the “face” will take care of itself."
Bio:
Clarence Tam, HBSC, DDS, AAACD, FIADFE
Dr. Clarence Tam is originally from Toronto, Canada, where she completed her Doctor of Dental Surgery and General Practice Residency in Pediatric Dentistry at the University of Western Ontario and the University of Toronto, respectively. Clarence’s practice has a focus on restorative and cosmetic dentistry, and she strives to provide consistently exceptional care with each patient. She is well-published in both the local and international dental press, writing articles, reviewing submissions, and developing prototype products and techniques in clinical dentistry. She frequently and continually lectures internationally.
Clarence has multi-faceted dentistry experience that extends across multiple tiers of leadership. She is the immediate past Chairperson and Director of the New Zealand Academy of Cosmetic Dentistry. She is one of merely two dentists in Australasia who are Board-Certified Accredited Members of the American Academy of Cosmetic Dentistry (AACD). Moreover, Clarence maintains Fellowship status with the International Academy for DentoFacial Esthetics. She sits on the Advisory Board for Dental Asia, and is part of the Restorative Advisory Panel for Henry Schein Dental New Zealand. Aside from the professional organizations she belongs to, Clarence is a Key Opinion leader for an array of global dental companies, including Triodent, Coltene,Kuraray Noritake, Hu-Friedy, J Morita Corp, Henry Schein, Ivoclar Vivadent,Kerr, GC Australasia, SDI, and DentsplySirona. Moreover, she is the sole Voco Fellow in New Zealand and Australia.
Clarence participates in a number of charitable endeavors and takes great pride in achieving beautiful smiles for patients in and around her community. She sits on the board of Smiles For the Pacific, an educational trust and charity that aims to expand professional dentistry services across the entire South Pacific region. She is involved with Delta Gamma Sorority and aims to spearhead projects harmonious with Service for Sight in the South Pacific.
What is one thing you want everyone to know about aesthetic dentistry or something you learned during your years that you would like to share with other dental professionals?
Everyone is so concerned about how the “face” or buccal surface looks in a reconstruction, whether limited to one tooth or 10 teeth. The most critical angle of view is actually the incisal or occlusal – if you are fastidious in recreating primary, secondary and sometimes even tertiary anatomy from this view, the “face” will take care of itself. This applies to both anterior and posterior teeth. Photography is your greatest critic and ally – take photographs of everything and evaluate them afterwards – it will continually humble us as we strive to make our creations more and more like Mother Nature each day.
You are originally from Canada, what is it like studying in there and then making a big move to New Zealand? Do you notice any difference in values/ priorities between Canadian and New Zealand practices?
You have developed prototype products and clinical techniques. Tell us more about that and how you got into it.
What did you do to enhance your clinical skills? (Did you find certain CPD courses to be helpful, watched videos, carved soap?) and during this COVID era where new graduates may be stuck at home, what would you encourage them to do to refine their skills?
I made the decision to undertake one of the most challenging and life-changing ventures in gaining Accreditation with the American Academy of Cosmetic Dentistry in 2017. It is a structured, board-certified protocol that will hone your hand and eye towards creating predictable nature. One of the people I look up to re: direct anterior esthetics is no other than Accredited Fellow, Dr. Marshall Hanson. His ability to nail cases every time whilst being non-or-minimally invasive is something we all strive to do. Attending the annual Scientific Sessions for me (pre-COVID of course) were a fantastic way to learn both in and out of the classroom. With myriad course subjects and workshops to whet the appetite of even the most seasoned esthetic dentist, that is the playground from which my passion was seeded and drive ignited. Something I heard years ago that I still holds true to every speaker: “You can always learn something new.” We just have to pay attention.
Thanks for reading and thanks for the opportunity to share with you all. Looking forward to seeing you in the vaccinated era to come.
Blog Post: February 2021
CPD Junkie Blog
"The possibilities to continue learning (and enjoying it) are endless."
What Continuing Professional Development (CPD) Stage Are You On?
Written by Ibaadat Sidhu
How many times have you heard, “learning is lifelong”? Well, I’m here to tell you once again! As Stephen Mitchell said, “Education is no longer thought of as a preparation for adult life, but as a continuing process of growth and development from birth until death.” As dental professionals, we go through years and years of learning, only to finally get into a clinic and realize we still don’t know a lot. In dental school you don’t learn much about practice management, dental photography, or the latest dental trends such as clear aligners or digital scanners. That’s where Continuing Professional Development courses come in to save the day! Although it is mandatory to complete 60 hours of CPD activities over a three-year CPD cycle, we have the freedom and resources to learn about anything we desire.
During different stages as a dental professional, you’ll have different CPD aims and interests. Continue reading to determine which stage you’re at now!
Stage 1: The Student
Most dental students are focused on university lectures (and the occasional Osmosis or Khan Academy video) for gaining knowledge. However, starting to attend CPD while you’re a student can really give you a head start on your career. Attending a variety of CPD on different disciplines is a good way of testing the waters and figuring out what interests you. For instance, university lectures may make oral surgery seem boring, but seeing a live surgery during a CPD event can really change your perspective. Of course as students, we need to save all the money we can but that shouldn’t stop you from registering for CPD. With CPD Junkie not only can you get discount codes for CPD, but can also browse free CPD as well. If you know you want to specialize or open your own practice soon after dental school, CPD is a great way to gain more knowledge and experience before you commit.
Stage 2: New Grad
You may think after years of school your dental education was complete. But, this is just the beginning! Once you’re out in the real world practicing, you begin to notice areas you can improve on, and areas that you want to advance on. You can chose to take courses in areas of strength to enhance skills and take on more challenging cases over time. Or, take courses to improve clinical skills in areas you are weakest in. Attending CPD at this stage can also help you network and connect with other dentists that could potentially become mentors, dental associates or lifelong friends!
Stage 3: Gaining Expertise
By this stage, you’ve gotten experienced performing your day-to-day procedures. Now is when you’re going to want more. More cases, more patients, more variety in your day. This is the perfect stage to really explore and experiment with different CPD, considering you’ve got greater funds and knowledge now. Venture out and attempt some courses on botox and fillers or various orthodontic options. At this point it may also be possible for you to dive into digital dentistry and invest in a digital scanner or 3D printer. Of course, to perfect and maximize the benefits of these investments, you should attend CPD courses. At this stage, taking CPD courses with your co-workers is a fun, interactive way of not only team building, but also enhancing the skills and knowledge of your practice. Whether it’s going to events together, or doing Lunch and Learns in the office, this is something that can give team members the chance to grow together.
Stage 4: Getting Comfortable
At this stage, you’ve gained the dental knowledge and skills you strived for. Although some dentists begin viewing CPD as a mundane task that must be completed at this point, it doesn’t have to be this way. If you’re interested in travelling, look into CPD events across the world. If you’re ready to begin relaxing, try attending continuing education courses on a cruise. If you want to dress up and go out with friends, try and attend a CPD event together and go out for dinner after. The possibilities to continue learning (and enjoying it) are endless.
As a busy dentist you may not have the time to search for the perfect CPD for you. You may just register for that random event you’re not really even interested in, but it popped up on your FaceBook someday and gets you those CPD Points. It’s time you start discovering the courses you truly want to attend, rather than signing up for something “good enough”. The team at CPD Junkie wants you to gain the knowledge and skills to become the best practitioner you can, all while truly enjoying what you’re doing. We do the searching for you so you just have to take a few minutes out of your day to find the perfect course from our comprehensive selection. I want to end off on a quote by Gary Takacs to inspire you to go register for your next CPD: “I have yet to meet a world-class dentist who isn’t also deeply committed to ongoing continuing education and has taken a massive amount of continuing education.”
Keep aiming high and learning so we can continue to change the world, one smile at a time.
Expert Q&A – February 2021
Expert Q&A with: Dr. Damian Teo
"The reality is, most of the treatment us dentists can offer our patients for TMD is a splint. The design, and bite registration of the splint is important, but end of the day, the splint can only do so much, and if we become too dependent on the splint, we’ll limit the amount we can help our patient."
Bio:
- Sleep & TMJ Dentist in Melbourne
- Bachelor of Health Science (Dentistry) – Latrobe University
- Masters of Dentistry – Latrobe University
- Post Graduate Diploma Dental Sleep Medicine – University of Western Australia
Damian is a holistic dentist with a focused interest in snoring, sleep disorders, teeth grinding, TMJ disorders and airway focused orthodontics. In his dentistry, Damian is passionate about looking “beyond the mouth” and treating the body as a whole. He believes dentists play an important role in being able to recognise airway/breathing issues, sleeping problems, and craniofacial pain (such as headaches, neck pain, and TMJ disorders). This led him to undergo extensive postgraduate training with world renowned specialists in the field of sleep medicine and TMJ disorders, and achieving his Post Graduate Diploma in Dental Sleep Medicine with the University of Western Australia. Damian also previously worked in Darwin’s first official TMJ & Sleep Therapy Centre, where he exclusively treated patients for snoring, sleep apnoea, teeth grinding and TMD.
Damian has setup his own specialised TMD and Sleep clinics: Melbourne Dental Sleep Clinic. Damian understands the value in working with skilled allied health practitioners outside of dentistry. He currently consults with the sleep respiratory physician team at Lung And Sleep Victoria, and the specialised TMJ physiotherapy team at the Melbourne TMJ & Facial Pain Centre. He has presented lectures and held seminars to medical and dental professionals to spread the knowledge that dentists can help one’s health and quality of life “beyond the mouth.” You can find free online lectures presented by Damian on https://sleeptmjstudyclub.teachable.com/ and he also has a Facebook dentist group: Sleep & TMJ Study Club where he uploads cases and tips for dentists treating TMD, bruxism and sleep disorders.
What do you think is the most common misconception about TMD?
I believe the biggest misconception is: “I can treat the TMJ alone.” This doesn’t apply just to dentists, this applies to any health professional that delves into treating TMD (e.g. physiotherapists, chiropractors, surgeons etc). When I first started my TMD journey, I was so amazed by the knowledge I was exposed to. I was taught not just about the TMJ, but I was taught about head/neck posture, chronic pain neurology, sleep apnoea, proper sleep, proper nasal breathing, myofunctional therapy, nutrition and more (and this was all from just one TMD residency).
This made me understand that I alone, as a dentist, can only do so much. The reality is, most of the treatment us dentists can offer our patients for TMD is a splint (sometimes surgery or orthodontics). The design, and bite registration of the splint is important, but end of the day, the splint can only do so much, and if we become too dependent on the splint, we’ll limit the amount we can help our patient. A splint won’t fix all our patient’s postural issues, or improve their diet, or unblock their nose. A splint may be able to “help” these issues, but very likely, we will need to work with a team of other health professionals to properly help our patients. I send 80-90% of my TMD splint patients to a properly trained TMD physiotherapist, chiropractor, or osteopath. I currently work a few days in a TMD physiotherapy clinic, and the recovery rate in my patients has improved rapidly, compared to when I was treating with only a splint. My treatment modality has changed to the point, some of my patients; don’t even need a splint.
What do general dentists/ specialists often miss when diagnosing and or managing TMD?
The first thing I learnt about properly treating TMD, is to look at the sleep and breathing. There is a huge link between TMD and sleep breathing disorders such as snoring and obstructive sleep apnoea (OSA). Proper quality sleep is so important in the maintenance of many bodily functions we use daily. For example, if we are sleep deprived, our body’s immune system and healing rate decreases, and our sensitivity to pain increases. Many chronic pain patients (which include TMD sufferers) are sleep deprived, which will contribute to their TMD pain.
Many of my TMD patients have undiagnosed OSA (and vice versa), and sometimes the key to treating them, is focusing on their sleep. During my other work days, I consult in a specialist sleep physician clinic and I see many OSA patients with undiagnosed TMD and bruxism everyday. The relationship I see joining these OSA and TMD patients is sleep bruxism. One theory in the literature relating to sleep bruxism, is the tensing of the orofacial musculature (bruxism) is a sympathetic nervous system response to help the person breathe when they are choking (e.g. experiencing snoring or apnoea). If you ever see a TMD or bruxism patient in your clinic, before you shove a splint in their mouth, first assess their breathing and sleep.
In your experience, what did you find to be the most interesting thing you have learned about the field?
Learning about TMD opened my eyes to look into the health of humans as a whole. I was really fascinated to learn how a healthy human body works, and how sometimes innocuous things such as changing our diet, can “fix” a person’s TMD. In these chronic pain patients, some people say the body is in a chronic “fight-flight” state. We should only be in a fight-flight state when we are in danger. We shouldn’t be in a fight-flight state watching TV at home. E.g. At home, we want our smoke alarm to go off while there’s a fire. We do not want it to go off when we’re cooking. A person in chronic pain, has a ‘smoke alarm’ that goes off whenever we’re cooking. Their senses are constantly ‘fighting/flighting’ to protect itself.
The fight-flight response involves activation of the sympathetic nervous system. Activation of the sympathetic nervous system triggers a number of bodily responses such as increased ventilation (breathing issues), increase in adrenaline/noradrenaline (disturbs our sleep), increase in cortisol (increase stress- bruxism), inhibits bladder contraction and reduction in digestion (diet/stomach issues). If our body is constantly performing the above actions 24/7, our overall health will gradually decline, and a piece of acrylic in the mouth is only going to help so much. I believe our role as health practitioners in this field, is to recognise these people are suffering many bodily changes, and our goal should be to try guide them from a sympathetic ‘fight-flight’ state towards a parasympathetic relaxed state. Treating their TMD will help start them down this path of healing, though dentists may only be a small piece of the puzzle.
Some of the most interesting things I have learnt in this field are from my own patients. I have seen patients suffering from debilitating TMD for years, and I was able to eliminate 90% of their pain with a splint. However, the last 10% still lingers. Then, these same patients were able to completely eliminate their pain by starting a gluten free diet, or starting personal training to strengthen their core muscles and posture, or sometimes learning to breathe properly through their nose using their diaphragm. These encounters fascinate me, because it goes to show how amazing and complex our bodies are.
Speaker Spotlight – February 2021
Speaker Spotlight with: Dr. Desmond Ong
"A patient’s psychology, compliance and perception of their treatment can all change significantly over time, which may ultimately affect the actual treatment outcome or their satisfaction with the outcome!"
Bio:
Desmond Ong BDSc (Hons), MDSc (Ortho), MOrthRCS (Ed), MRACDS (Ortho)
Desmond Ong is currently a Clinical Academic in the Discipline of Orthodontics at the University of Queensland School of Dentistry, where he is involved in both the Undergraduate and Postgraduate Orthodontic Programs.
Desmond is also in full-time specialist orthodontic private practice in Townsville.
Desmond received the Raj Prasad Award from the Australian Society of Orthodontists (SA) in 2016 and is a past winner of the Young Lecturer Award from the Royal Australasian College of Dental Surgeons.
What is one thing you wish you knew before getting into orthodontics? What do you find the most challenging aspect of orthodontics?
One thing I wish I knew in advance was that theoretical ideals are not always possible to achieve or maintain indefinitely. Despite the planning and biomechanical process of orthodontics being highly logical and generally predictable, the teeth being moved are part of a real-life patient. We all know that some patients can be highly unpredictable! A patient’s psychology, compliance and perception of their treatment can all change significantly over time, which may ultimately affect the actual treatment outcome or their satisfaction with the outcome!
Probably the most challenging aspect of orthodontics is managing retention and relapse. In 1934, Oppenheim stated “Retention is one of the most difficult problems in orthodontia; in fact, it is the problem.” Almost 90 years later, clinicians continue to struggle with the same issue. Even the most well-treated orthodontic case can demonstrate undesirable tooth changes without long-term retention.
Robert Pickron, a well-known and successful orthodontist from the USA, stated that “Relapse happens. No matter what you do or how well you treat, you will have to deal with this important part of the orthodontic practice, or move to a new town every 5 years!”
Littlewood et al (2017) concluded: Relapse after orthodontic treatment is the result of teeth moving back towards the original malocclusion, but changes in tooth position may also occur as a normal part of the growth and aging process. Relapse is also unpredictable, and so it should be presumed that every patient has the potential for long- term changes. As part of the informed consent process for orthodontic treatment, patients need to be fully aware of their commitment to wear retainers for as long as they want to keep their teeth in their corrected positions.
The formation of ‘black triangles’ may be a consequence of orthodontic treatment, when this happens, what do you recommend to your patients?
The formal terminology for a ‘black triangle’ is an open gingival embrasure space. Such spaces can be a significant source of patient concern or dissatisfaction. To a certain extent, the likelihood of developing black triangles during treatment can be predicted prior to commencing orthodontic treatment. Fortunately, the majority of mild to moderately sized black triangles can be effectively reduced or eliminated with judicious interproximal enamel reduction and appropriate root positioning.
Kandasamy et al (2007) noted that black triangles are more likely to develop following labial movement of imbricated or palatally displaced incisors and closure of a diastema. In contrast, black triangles are less likely to develop following the palatal movement of labially placed or imbricated teeth and the intrusion of one tooth relative to another. Kimura et al (2003) investigated various factors associated with the development of black triangles following orthodontic treatment. In summary, black triangles were more frequently found in patients over 20 years of age and were associated with resorption of the alveolar crest. Therefore, clinicians should be alert to the possibility of black triangles developing as a result of specific orthodontic tooth movements and also with increasing age.
From a personal perspective, I have found that diagnosing the pre-treatment periodontal condition and discussing the potential (or relative likelihood) for black triangle development during orthodontic tooth alignment as part of the pre-treatment informed consent process very helpful to avoid (or alleviate) patient concerns when such spaces become apparent. It is also important to discuss the potential impact of long-term periodontal changes (e.g. alveolar bone loss and changes in the anatomy of the gingival papillae) with all patients, particularly adult patients.
How do you prevent root resorption during orthodontic treatment? What do you do if you notice root resorption following orthodontic treatment?
External apical root resorption (EARR) is a potential problem associated with orthodontic tooth movement, which results in the permanent loss of the dental root structure. Orthodontically induced root resorption can affect any tooth, although the maxillary central and lateral incisors are generally considered to be the most susceptible to resorption. From the available literature, it appears that increased force levels and increased active treatment duration may be associated with an increased risk of root resorption. A history of incisor trauma may also increase the risk of severe resorption. Therefore, careful treatment planning for each individual case and the use of sensible force levels remains of paramount importance. There is probably no plausible means to truly avoid orthodontically induced root resorption other than to not provide any orthodontic treatment! This again highlights the need for appropriate informed consent prior to commencing any orthodontic treatment.
Thankfully, only 2% to 5% of the orthodontically treated patients experience severe root resorption (more than a quarter of the pre-treatment root length) as severe loss of root structure may threaten the function and longevity of the affected teeth. For the vast majority of orthodontic patients, the extent of any root resorption during treatment is very minor and not of clinical significance.
I was fortunate (or unfortunate!) enough to write my orthodontic postgraduate thesis on severe root resorption cases. From this research, it would seem that the difference between minor and severe resorption cases is unlikely to be associated with the treatment that is received, but instead inextricably linked to the genetic makeup of the patient. This could explain why most patients show very little resorption regardless of the treatment technique, whereas the unfortunate few that experience severe root resorption, do so despite receiving a virtually identical treatment. A family history of root resorption and/or pre-existing root resorption prior to any orthodontic treatment are also important warning signs.
Should significant root resorption be noted during treatment (progress radiographs are highly recommended), a pause in the orthodontic tooth movement is recommended to reduce the risk of further root resorption, as ceasing active treatment allows the resorbed cementum to heal. Should significant resorption continue despite the suspension, the active orthodontic treatment should be finished as soon as possible (or immediately), which often involves a need to knowingly accept an incomplete treatment outcome. Post-treatment physiologic splinting with fixed wire retainers may be beneficial depending upon the extent of the clinical tooth mobility.
Blog Post: January 2021
CPD Junkie Blog
"New Year’s resolutions are vague and outcome-driven, goals provide you with structure and the means to reach your destination"
Know the Difference – Resolutions vs. Goals
Written by Jennifer Truong
New Year… New Year’s resolutions… new you! It’s generally accepted that a new year is a perfect time for new beginnings, greater productivity, and an unyielding effort to be better than your former self.
But what exactly are resolutions? More importantly, what is the difference between resolutions and goals? A resolution is the decision to either do or not do something. It is tied to an outcome or an end result. For instance, consider the New Year’s resolution: “I want to increase patient rapport.” Solution: Improve communication skills. Resolution: Build stronger patient rapport.
So how do resolutions differ from goals? A goal is the means to a desired result. Contrary to resolutions, an effective goal encompasses both the solution and resolution. In other words, a goal considers the steps you should take to achieve a resolution. Consider the previous example. An effective goal for the same resolution might be: “I plan to enrol in communication courses to improve patient rapport, which can be measured by an increase in treatment plan acceptance rates”.
This discussion begs the question: which is more effective, a goal or a resolution? If you have ever (or already!) succeeded in achieving your New Year’s resolutions, take pride and congratulate yourself, because this is a rare feat. According to U.S. News and World Report, approximately 80% of New Year’s resolutions fail within 30 days. But why do so many fail?
Well, resolutions are based on the end goal, rather than the process. The expectations for resolutions are often too high, and we go in with an all-or-nothing attitude, resulting in disappointment and demotivation when we don’t instantly obtain our ‘perfect’ results. Often, resolutions lack real commitment and are probably the result of some heavy-duty procrastination, “I’ll start tomorrow! No, I’ll start next week. Well, maybe I’ll start next year.”
Alternatively, effective goals require preparation, thorough planning, an aim, and appropriate execution. What, then, makes a goal “effective?”
Types of goals
The three main types of goals are: process, performance, and outcome goals.
- Process goals are the ‘how to’ or the processes involved in obtaining your outcome, and they are entirely within your control. For example, if your resolution is to get a new job, your goal might be to apply to three clinics a week.
- Performance goals are based on performing to a certain level/standard. Using the previous example, your goal might be to secure at least three job interviews in the next month. Process goals are mostly within your control.
- Outcome goals are the ultimate goal, or “winning” aspect. Again, using the previous example, your outcome goal might be to get hired to work at your dream practice. Unlike process and performance goals, outcome goals may be outside your control due to uncontrollable factors (e.g. the performance of other job applicants).
Process, performance, and outcome goals are linearly dependent. Achieving your process goals will likely help you achieve your performance goals, which will then help you obtain your outcome goals.
Make SMART goals
To help formulate effective goals, the “SMART” approach deconstructs goals into five components:
Specific
- Make sure your goals are clear and tailored to your needs. Avoid vague goals by keeping in mind the five ‘W’s’ (what, when, where, why and who).
Measurable
- Set a goal that will allow you to objectively track your progression and determine how far you are from obtaining your desired results.
Achievable
- Be realistic and ensure that your goals are attainable. However, your goals should still be moderately challenging—that makes it more satisfying when you reach them!
Relevant
- Your goal should be specifically tailored to you and your needs.
Timely
- Set a realistic time frame to achieve your goals. Doing so allows you to measure your progress, ensures that you are on track to complete them, and keeps you from becoming discouraged.
Consider another example where ‘increasing productivity’ is your New Year’s resolution. A SMART goal might be to increase the number of patients you see at clinic by 5% annually.
Whereas New Year’s resolutions are vague and outcome-driven, goals provide you with structure and the means to reach your destination. I’m not trying to say New Year’s resolutions are doomed to fail, but if you find yourself struggling with yours and feeling defeated prior to the year’s end, then you may want to consider rephrasing the resolution as a goal (or series of goals) that lead to the resolution. After all, a goal without a plan is merely a dream.
Expert Q&A – January 2021
Expert Q&A with: Dr. Mikaela Chinotti
"For young dentists that are looking to make connections and seek mentorship and/or support as they begin their career, attending ADA branch meetings and meeting colleagues who practice in the local area is a great start."
Bio:
Dr Mikaela Chinotti is a Sydney based general dentist. She graduated as part of the inaugural cohort of dentists from James Cook University (JCU) in 2013, having grown up in North Queensland. Mikaela returned to JCU to complete a Master’s in Public Health majoring in health promotion in 2018 before moving to Sydney, taking up the role of Oral Health Promoter at the Australian Dental Association as well as continuing to practice general dentistry.
As the ADA Oral Health Promoter, Mikaela works within advocacy and health promotion. One of her main roles is the organising of the ADA’s annual oral health campaign, Dental Health Week, but jobs range from creating the ADA’s new oral health education podcast for the Australian public and facilitating the creation of the ADA Consensus Statement on Ankyloglossia and Oral Frena to creating resources for ADA members to easily download-and-go when looking to partake in oral health promotion activities within their local community.
Mikaela is also a founding member of the Colgate Advocates for Oral Health: Editorial Community where she has written articles on discussing nutrition in the dental practice, the importance of oral health literacy as well as decision making and knowing your limits. Her articles can be found here.
Once you graduated, how did you go on about seeking a mentor? Do you wish you did anything differently after graduation?
I grew up in Ingham, North Queensland and being a small town, decided to undertake my mandatory year 10 school-based work experience at one of the local dental clinics which had recently been purchased by two recent graduate dentists. I continued to return of my own accord in years 11 and 12 and then throughout my dental degree. When graduating in 2013, I was offered a job at the dental practice which I accepted, not because I had the strong desire to return to my hometown because location wise, I was interested in living and practicing in the Atherton Tablelands; it was the mentorship and support that I sought. Unfortunately, I moved on from the job after 1.5 years as another dental practice opened, oversaturating the small population, however it was a great first job and if I were to have my time over, I would take the job again.
You became involved with Colgate and ADA soon after graduating, do you have any tips for new graduates on how they can get involved with such associations?
I have been an ADA member since university and have always valued the support and provision of information that associations can provide; however, I did not get involved until making the move from Townsville to Sydney in 2018 when I began as staff at the Australian Dental Association. For young dentists that are looking to make connections and seek mentorship and/or support as they begin their career, attending ADA branch meetings and meeting colleagues who practice in the local area is a great start.
Additionally, the ADA has a volunteer committee called the Recent Dental Graduates Committee where members can have input and influence in the new graduate space and in supporting their colleagues who are no doubt experiencing similar situations.
As an oral health promoter, do you have any recommendations for dentists on how they can efficiently convey the value of regular hygiene appointments to their patients who only visit in case of emergencies?
This is not always easy and for individuals who only see oral health as the absence of pain, this can require significant changes to behaviour and mindset, but it is possible to turn a problem-based attender to a regular patient. Conveying the value of regular dental care and hygiene appointments is associated with health literacy, which is an individuals’ ability to access, understand and use health information to make health decisions as well as the ability to access and navigate the health care system.
During an emergency appointment, while you are waiting for the anaesthetic to take effect, have a squiz around the mouth…does the patient have any other signs of oral disease such as gingivitis, carious lesions or calculus built up? Plant the idea of returning by showing them an intra-oral image or radiograph if the one you potentially took during the emergency shows this. Create concern and motivation to return.
Speaker Spotlight – January 2021
Speaker Spotlight with: Dr. Ahmad Al-Hassiny
"Digital dentistry is more than just hype. When implemented properly you can expect an excellent return on investment, increased joy in practicing dentistry, and better care for your patients."
Bio:
Dr Ahmad Al–Hassiny is the Founder and Director of the Institute of Digital Dentistry (iDD), which is a leading and future focused online training academy, with a mission to ensure dentists globally have easy and affordable access to the best digital dentistry training possible.
Having graduated from the University of Otago with First Class Honours and being awarded many clinical and research prizes, Dr Ahmad has continued his pursuit of excellence in dentistry. He has seen first-hand through his own work how CAD/CAM and digital dentistry can positively change daily dental practice. He has carried out many aspects of complex digital dentistry including CAD/CAM full mouth rehabilitation and smile design.
Dr Ahmad is a global leader in digital dentistry and intraoral scanners, carrying out lectures for many companies and industry. He is one of the few in the world who personally owns and uses all mainstream scanners and CAD/CAM systems in his clinic. Through iDD he is happy to see dentists around the world develop the confidence and perspective of adopting modern techniques and reap the many benefits that CAD/CAM and digital dentistry can have on their career/practice.
Having used numerous digital scanners, which one do you recommend a new dentist invests in? What advantages does it have over the others?
This is a question I get asked almost everyday online and it is something that will entirely depend on the practice and what you want to get a scanner for. There is a huge range now available and the best way to decide is to first understand what procedures you want to carry out and your budget.
For instance, for those wanting to carry out in-house CAD/CAM, there are few systems that can compete with CEREC in terms of efficiency and ease of use. This is not an entire reflection of the scanner per say but the whole workflow, software, and milling machine. For those who have no interest in CAD/CAM and do not intend to produce restorations in-house, it does not make sense to spend big on something like this.
Rather, for those on tight budgets or just want a low cost scanner to get rid of impression material in their practice, the Medit i500 should be on your radar as this is one of the most cost-effective scanner options on the market right now. It is relatively cheap, works well and has no subscription costs. The downside being that it does not inherently come with a CAD software, and although it can be integrated with exocad and a 3rd party mill, this can feel a bit piecemeal, compared to more complete systems.
There are other factors to consider as well, for instance, those who have built their practices around Invisalign, it makes sense to seriously consider the Itero scanners as these are the only latest generation scanners that are accepted for Invisalign treatments. And so forth and so forth.
It seems the market has spoken and the leading scanners seem to CEREC, TRIOS, Medit and Itero. In our practice, I routinely use CEREC Primescan, a absolutely fantastic scanner, for all in-house work, TRIOS for anything not to be produced on the same-day (implant guides, splints, dentures, full mouth rehab) and Medit as a back-up.
What is one digital dentistry investment you made that you wish you had done sooner?
It would have to be intraoral scanners. Even though we got into it over 10 years ago, I still wish we did it sooner and our main hesitation was the unknown. It is a complete game-changer in dentistry. Everyone without a doubt should be investing in one.
Second to that would be 3D printing, which we got into 4 years ago. This is another one of those things you do not know how you practiced without before. 3D printing is a complete game-changer for clinics and really revolutionised how we practice dentistry. The handy thing about 3D Printers is, for the most part, it does not matter what scanner you have. They are all open and can communicate with any scanner via STL files. They are also relatively cheap compared to the investment cost of a scanner. 3D Printing for us has opened a lot of different possibilities including most recently printing dentures and being able to offer a turn around of about 2-3 days for most denture cases (especially immediate ones). The other benefits are being able to quickly design a smile design/wax-up and print it ready to try-in for the patient in aesthetic cases. An easy way of boosting case acceptance for cosmetic procedures.
Again, with 3D printers there are a whole lot on the market now and its best to do your research. I can recommend Formlabs for its ease of use and NextDent 5100 for its blazingly fast printing speed.
What are some resources you recommend for dentists interested in stepping foot into the digital world?
I run the Institute of Digital Dentistry which provides CPD courses focused on all things related to the digital workflow. We have also launched an online training platform in the past 12 months, which is one of the most comprehensive in the world right now and covers all topics from the basics of intra-oral scanning, 3D printing, digital implantology, to expert masterclasses and everything in-between. Right now, the digital dentistry industry is being led by the suppliers of the technology which have a conflict of interest – we exist to provide knowledge that is up to date, impartial and based on clinical experience.
Our goal has always been to provide the highest quality CPD courses that are engaging and well-structured. For those interested you can learn more about us and check out our courses at https://instituteofdigitaldentistry.com/
Another incredible resource is social media. Depending on your scanner of choice you will find several different Facebook groups, with fantastic communities to learn from. This includes the likes of the “Keep CERECing”, “3Shape Study Group” and “Medit Users – i500, T-series”. These groups are priceless with tens of thousands of users all sharing cases, information, advice etc. One of the most important factors before jumping into the digital world is support. Make sure you have adequate support both online and locally through your sales reps. It will make your experience a lot better. Digital dentistry is more than just hype. When implemented properly you can expect an excellent return on investment, increased joy in practicing dentistry, and better care for your patients.
Blog Post: December 2020
CPD Junkie Blog
"Think positive, be positive, and positive things will happen”
Positive thinking: A tool to becoming better
Written by Jennifer Truong
Being a dentist is a demanding career.
You spend so many hours studying as a student, followed by many more hours working in the field. It’s not all sunshine and rainbows. Days can be either gratifying or absolutely chaotic having to deal with complication after complication. Hence, it’s very important for dentists to not only focus on their hand skills, but on their mental health as well.
You probably think this is not a new concept, but yet it’s estimated that, on average, 80% of our thoughts are negative. “I should have done… I wish I could have… if only I had more time…” sound familiar?
So, what’s a simple way we can go about changing this?
“Think positive, be positive, and positive things will happen.”
One emerging area of research in mental health is on positive thinking, which is a set of techniques aimed to replace negative thoughts with more positive ones. Positive thinking is based on the theory that our thoughts, emotions and behaviours are all causally related. Changing our thoughts should therefore change both our emotions and behaviour. Thankfully, positive thinking is a skill that can be learned, so even those who are ‘Debbie Downers’ can benefit from these steps.
Step 1: Understand your negative thoughts
The first step to positive thinking is to recognise your negative thoughts and what triggers them. Although you’re likely aware that you have these thoughts, probably many of them, the idea here is to understand when and why they happen.
Some common types of negative thoughts are:
- Personalising. Blaming yourself when something bad happens.
- Polarising. Seeing things as either good or bad. You either succeed or completely fail.
- Filtering. You focus on the negative aspects of the situation, despite all the positive aspects.
- Catastrophising. You expect the worst possible outcome for a situation.
- Should statements. You attempt to force yourself with should and shouldn’t statements and punish yourself when you don’t comply.
Try to spend some time and effort being familiar with when your negative thoughts occur. You could note your negative thoughts in a diary or on your phone. This may sound over the top, but it’s important to understand the patterns of your negative thinking. For example, you may notice that you tend to rate your performance in the clinic as either entirely good or bad (polarizing). Alternatively, you may make a small mistake and then expect the patient to never see you again (catastrophising). You focus on that one negative comment someone left you on google reviews even though you have been showered with compliments in the preceding posts (filtering).
You’ll be surprised as to how many of these negative thoughts you have, and how tedious they seem to be in the grand scheme of things, I mean, we did spend most of 2020 in lockdown.
Murphy’s law states that things happen beyond our control and rather than dwelling on things you cannot control, challenge these thoughts and shift your energy to things you can control.
Step 2: Challenge your negative thoughts
The next step is to challenge your negative thoughts with a rational response. For example, if you rate your day in the clinic as either good or bad, challenge these thoughts with a rational response such as “My day was filled with wins and losses, which I call a typical Wednesday”.
Perhaps you automatically blame yourself when a patient’s restoration fails and you begin to question your skills as a clinician. A rational response could be “The restoration was likely to fail given the patient’s malocclusion”.
You could think of a rational response as being similar to what you’d say to a close friend when they’re having negative thoughts. This is not to say that you should adopt a “It’s not me, it’s you” kind of attitude and you definitely don’t want to make excuses for your behaviour. However, consider whether your negative thoughts are valid and more importantly, whether they will improve your skills in the future.
Step 3: Practice positive thinking
Along with challenging your negative thoughts, it’s important to spend some time focussing on positive thinking. Positive thinking is a skill that needs constant practice, but once you’ve become good at it, it’s easy to maintain. Here are some examples of positive thinking:
- Gratitude- think about the things in your life that you are grateful for. These will naturally bring your attention to the good things in your life. Think about your co-workers, your mentors, and your support system, and how much of your venting they had to endure.
- Think about your successes. It’s important to think about your recent and past successes and give yourself that little pat on the back from time to time.
- Imagine your best future. Instead of thinking about the worst outcome, instead, think about a future where your life is going well, which will make you excited for what’s to come.
- Focus on your strengths. Similar to your successes, think about your personal strengths and what you can achieve with them.
These techniques are best integrated with a structured time each day, perhaps first thing in the morning or just prior to bed. After some practice, all these techniques should become second nature. You should find that your negative thoughts will become less frequent and severe, while your positive thinking should increase.
“Instead of worrying about what you cannot control, shift your energy to what you can create.” – Roy T. Bennett
In dentistry, we have the luxury to create beautiful smiles, let that be our focus. I think I can, I know I can, I will, I did.
References
Burns, D. (1980). Feeling Good: The New Mood Therapy (1st ed.). William Morrow and Company.
Rood, L., Roelofs, J., Bögels, S. M., & Alloy, L. B. (2009). Dimensions of Negative Thinking and the Relations with Symptoms of Depression and Anxiety in Children and Adolescents. Cognitive Therapy and Research, 34(4), 333–342. https://doi.org/10.1007/s10608-009-9261-y
Expert Q&A – December 2020
Expert Q&A with: Dr. Amanda Phoon Nguyen
"There are limitations, but if we recognize these and work within them, Teledentistry has the power to change lives for some of our patients, especially those in remote or regional areas."
Bio:
Amanda is an Oral Medicine Specialist in Perth, Western Australia. She is also a PhD candidate and adjunct senior lecturer at the University of Western Australia. Her clinical and research interests include orofacial pain, temporomandibular joint disorders, oral mucosal disease, dental sleep medicine and paediatric oral medicine. She is Treasurer of the Australian Dental Association (WA), the Editor, and an examiner for the Royal Australasian College of Dental Surgeons (RACDS), reviews and publishes in multiple journals, and has been on the WA Dental CPD committee for many years. Amanda believes in interdisciplinary teamwork and represents her specialty at multidisciplinary groups. She is heavily involved with various professional committees, and also dedicates her energy to supporting various community and volunteer causes. In particular, she loves making children smile by volunteering as a mascot of the local children’s hospital. Dr. Nguyen has served in the Royal Australian Navy as a Dental Officer for 3 years. She is also passionate about her speciality, regularly lecturing, running oral medicine interest pages and dental forums, and teaching at the University of Western Australia.
With stress increasing worldwide due to this pandemic, there is a correlated increase in bruxism. What advice do you offer patients to manage their teeth grinding?
From the 2018 International Consensus by Lobbezoo et al., in otherwise healthy individuals, bruxism should not be considered as a disorder, but rather as a behaviour that can be a risk (and/or protective) factor for certain clinical consequences. Not all cases will need management.
In order to manage cases of bruxism, I encourage dentists to review the current evidence-based literature, attend quality CPD and to base their practices on good scientific literature. There are many unsolved issues concerning the etiology of bruxism itself, for example, contrary to popular belief, night-time bruxism is actually not as well-correlated with psychosocial factors and stress. Bruxers with jaw muscle pain also have been shown to have LESS bruxing episodes than bruxers with pain. With my patients, taking into account their age, I explore the type of bruxism they may have, determine the predominant behaviour in their type of bruxism, for example (clenching, bracing or grinding), look at possible associations (with differentiation between associations and causation!), and then assess the behaviour of a continuum before discussing any management. With proper patient discussion, most patients then understand why management has been recommended and the potential sequelae of non-management. I think my best tip there is to think of it as education rather than “convincing” them to have a night guard. If your patients understand the “why”, they are invested in their own health outcome and are empowered to take ownership of their diagnosis. I find clinical photographs to be a really useful aid!
Unfortunately, I do not believe management of this is as simple as providing one type of occlusal splint for all cases of suspected bruxism. Management is not always innocuous either, there is some literature on how provision of a maxillary occlusal splint can worsen sleep disordered breathing, and it is clear from the literature that occlusal adjustments to treat bruxism and temporomandibular joint disorders are very outdated and should not be done for this reason.
With routine dental check-ups coming to a halt due to this pandemic, many dentists began examining patients virtually. Do you see a future for tele-dentistry? Do you think it is possible to effectively diagnose oral diseases through pictures and videos, or do you think problems can easily go unnoticed?
Yes, I do think Teledentistry will become more of a reality at some point in the future. I think it has been in the works, simmering for some time, but the COVID-19 impetus really gave people the drive to make it accessible. I think it will be good for reducing one of the barriers to care. I was lucky enough to give a TEDx talk on this topic, which is available here: https://www.youtube.com/watch?v=jZBPPBgD_MI
Our medical colleagues use it well, and I know some dentists who implement its use in their practice, both pre and post COVID. Among some of our dental specialist colleagues, it has been used successfully for a while, for example in dentomaxillofacial radiology. There are limitations, but if we recognize these and work within them, Teledentistry has the power to change lives for some of our patients, especially those in remote or regional areas.
How was your experience serving as a dental officer in the Royal Australian Navy?
One of the things I loved best about serving in the Navy were the close relationships I formed with many of my team-mates, and some of us maintain our friendships to this day. It was a really bonding experience. The Australian Defence Force was really supportive, with providing great access to additional training and dental CPD, which I appreciated. The whole 6 months of officer training in HMAS Creswell was an experience for me, to this day I detest ironing and will trade much for the condensed milk in the ration packs!
Speaker Spotlight – December 2020
Speaker Spotlight with: Dr. Omar Ikram
"To the aspiring endodontist- this is the most heart sinking feeling- to be able to locate the mb2 but then create a ledge due to this curvature or not be able to negotiate the canal it’s full length."
Bio:
Probably your most asked question as an endodontist, how do you find the MB2 canal? Any tips for increasing visibility and accessibility?
To be able to find this microscopic canal (and most of the time it is microscopic) requires a whole lot of clinical equipment to visualise it and confidently remove dentine in the right area and read what you all know is called the ‘dentine map’ or pulpal floor, without perforating! The LN bur and the Endotracer burs are fabulous. But just drilling in the right area isn’t enough. You also need to be able to visualise the canal. To do this requires at least 4 times magnification, Once you locate the canal, it is not enough to just locate it. It also requires negotiation and this is the challenging difficult part. Because Hess discovered this canal in 1920–and Weine mentioned it in 1969. But dental students weren’t really taught about it until we had the equipment to negotiate it. The canal has an acute coronal curvature in the first 2-3mm meaning that unless you are able to drill past this level the access to the apex is impeded by this acute curve. To the aspiring endodontist- this is the most heart sinking feeling- to be able to locate the mb2 but then create a ledge due to this curvature or not be able to negotiate the canal it’s full length. This acute curvature accounts for about half the referrals we receive. Negotiation usually requires opening access to the straight part of the canal using the XA rotary file and use of C pilot or C+ files to widen the canal, enough to allow instrumentation. The hand filing stage is perhaps the most treacherous stage with the acute curvature in the coronal region being a focal point for torsional fatigue and fracture of the hand file. Negotiation requires knowledge of the various tapers and different rigidity of stainless steel available.
Any recommendations on techniques for extirpation and location of calcified canals?
Use of the white dot technique where a slow speed round bur, such as the endo Tracers or LN bur create dentinal debris to plug the canal helps to locate the orifice. Magnification is essential. I work at around 10 times magnification. This is usually sufficient.
Patients can be extremely anxious about root canal treatment, how do you explain the procedure to them and do you have any advice on how to alleviate anxiety and make them comfortable?
Patients have to be on board if they want root canal treatment. We are essentially performing microsurgery of a tooth. Most of the time an explanation that the procedure will not be uncomfortable due to the use of local anaesthetics will suffice. If the patient is really nervous we can use nitrous oxide. We also have the option of IV sedation or general anaesthesia where I work. If I see nervous adults then IV sedation is usually a good way to treat the patient. General anaesthesia is usually reserved for young children or special needs patients. If in doubt give the patient time to think about the option of root canal treatment they can make that decision for themselves, given all the various options.
Featured Article – November 2020
Case Study
How to achieve a better, faster and more predictable result with aligner treatment planning
Dr. Geoff Hall Bio:
Dr Geoffrey Hall received his dental training at the University of Melbourne in 1983, and pursued his postgraduate orthodontic training at the prestigious University of Pennsylvania in 1990.
Dr Hall has an extreme passion for clinical orthodontics and orthodontic training for Dentists, specialising in adult and children treatments including early treatment, conventional adolescent therapy, short-term orthodontics (Smilefast) and cosmetic treatment options including lingual braces, Invisalign and other aligner systems, and a strong emphasis on interdisciplinary treatment, including orthognathic surgical cases.
Dr Hall has been a pioneer in modern day orthodontics and education and all backed by 27 years and over 10,000 cases of orthodontic experience.
In 2020 OrthoED has developed a Complete Aligner Treatment Planning Service (Caps) to help dentists provide optimal digital setups and allow them to treat even the most advanced of aligner cases. This service makes aligner therapy for the general dentist very predictable and profitable .This service supports Invisalign, SureSmile aligners, Smilestyler and Angelalign.
Dr Hall is a member of many associations including the Australian Dental Association, Australian Society of Orthodontists, American Association of Orthodontists, and various Lingual Orthodontic Associations. He has 2 wonderful adult children and been blessed with a gorgeous grandson.
Traditional orthodontic thinking would require a patient with severe crowding and an open bite anteriorly to be treated orthodontically with fixed appliances/braces in combination with dental extractions and more than likely a surgical approach as well.
Could aligner therapy alone (without extractions or surgery) resolve the issues of crowding and anterior open bite – quite possibly.
Case: A 15-year-old female presents with a class 1 posterior relationship with significant crowding in her upper and lower anterior region and a 7mm anterior open bite. What would you do?
From a facial perspective, the patient had a slightly retrognathic mandible. There was a dolichofacial and vertical growth pattern with a long lower facial height and demonstrated significant lip strain on closure.
Initial Digital Setup
The initial digital set up was returned and further attachments were placed, staging of treatment was modified significantly and most importantly over correction of the posterior segments was incorporated to provide the digital set up a posterior open bite. Here is the digital set up and final treatment plan for the first set of aligners.
We decided to treat the patient with Aligner Therapy. The results were extremely impressive:
Through excellent treatment planning – and with a final plan of 17 upper aligners and 15 lower aligners, the following treatment result was achieved – an excellent correction of the anterior open bite and now a further modification is required to perfect the anterior alignment and in particular the crown tip of the lower right lateral incisor and also requiring further improvement in providing a nice socked in occlusion posteriorly and adding further buccal root torque to the upper second molar teeth. In the past this type of patient – who presented with an anterior open bite and crowding – was traditionally treated with a combination of orthodontics and orthognathic surgery.and dental extractions to resolve the crowding issue. If left untreated, the patient would have significant functional problems as well as serious occlusal wear on the posterior teeth. She may also have issues with proper mastication;unable to chew and digest food properly. Not to mention the aesthetic and potential psychological issues she may suffer in her delicate teenage years and beyond as a result. However, there are a number of potential problems and challenges that many dentists face with aligner therapy, including:
• Poor case planning
• Incorrect stageing of the tooth movements
• Poor placement or use of incorrect attachments based on the biomechanical requirements
• Not providing the necessary over-corrections
• Offering an unrealistic treatment outcome; a common mistake aligner companies cause and general dentists experience frequently.
To perfect the result, a refinement is planned with a further 15 upper aligners and 10 lower aligners – making the treatment in total of 32 upper aligners and 25 lower aligners – and the patient has been changing each aligner weekly, so we expect a total treatment time to be less than nine months.
Digital Setup and Final Treatment Plan
Here is the digital set up and final treatment plan for the first set of refinement.
This case demonstrates the value of a good diagnosis, excellent treatment planning which factors in ideal staging of treatment, understanding the use and biomechanics of different attachments, when and how to over correct different tooth movements and
ensuring the set up provides predictable movements with aligners to allow a predictable outcome for your patients.
With the right team of orthodontists experienced in aligner therapy planning the treatment for you, these mistakes can be avoided and even the most difficult
cases can be managed and completed successfully with aligner therapy.
Like to learn more about how to provide high-quality orthodontic aligner treatments with predictable, profitable and positive outcomes every time?
Learn about CAPS, visit capsdental.com.au today.
Letter from the Editor – October 2020
Letter from the Editor October:Your Partner in CPD
We launched CPD Junkie at the start of 2020 with the goal of being the go to source for dentists looking to find CPD. Our aim was to create a comprehensive directory to help dentists browse, search and compare CPD in areas of interest. CPD made simple. We are proud of the our growing directory (now over 500 courses listed) and the tools and services that we are developing to help our colleagues find the CPD they are looking for. We are working with our partners to bring Junkie Deals exclusive to our members and have some exciting plans in the works for 2021. To our members, we will soon be delivering you email notifications for CPD events that you have indicated interest in. This customised and curated email will be tailor made to match your areas of interest – delivered to your inbox monthly. As we grow and bring on more partners from the CPD industry, we are focused on finding value and finding ways to help you take the guesswork out of CPD. Our monthly newsletter and the amazing resources such as the “How to get the most out of CPD” E-book and the CPD Junkie x Szabi Hant photography cheat sheet are also some of the perks we are proud to provide our members.
So we hope that you continue to check in often with CPD Junkie and trust us as your go to platform for finding CPD. If you enjoy the site and find value with what we are doing, it would be great if you could recommend us to your friends, colleagues and classmates.
Enjoy this weeks expert Q&A with Dr Aovana Timmerman!
Dr. Omid Azami
Co-Founder CPD Junkie
October Newsletter
Expert Q&A in Endodontics with Dr. Aovana Timmerman
Expert Q&A with: Dr. Aovana Timmerman
"Good communication with the patient is something that I find that most dentists struggle with. I would suggest building up rapport with senior clinicians at work, a mentor through an organisation or with the specialists that you refer to and ask them lots of questions on how they would communicate with their patients in different scenarios and learn from their experiences."
Bio:
Aovana graduated with a Bachelor of Dental Science from the University of Melbourne in 2001 and after completing her fellowship with the Royal Australasian College of Dental Surgeons (RACDS) in 2010, she continued with her specialist training obtaining a Doctor of Clinical Dentistry in Endodontics.
Aovana has been involved with endodontic education since 2011 and was awarded the Graduate Certificate in Clinical Teaching in 2019. Currently, Aovana is a clinical demonstrator for the Doctor of Dental Surgery Endodontic program at The University of Melbourne and examines dentists in the Membership (GDP) program for RACDS and Australian Dental Council.
Aovana is currently working part-time in private practice at Collins Street Specialist Centre and is also pursuing her PhD part-time at the University of Melbourne and has published research in both local and international peer-reviewed journals.
Endodontics can be quite a stressful procedure for many dentists. What advice can you give around case selection and workflow so that dentists can confidently assess and choose cases which they will be able to complete confidently?
Case difficulty assessment can help general dentists decide if they would consider proceeding with endodontic treatment or consider referral. There is a useful form published online by the American Association of Endodontists which can be downloaded on this link – https://www.aae.org/specialty/wp-content/uploads/sites/2/2019/02/19AAE_CaseDifficultyAssessmentForm.pdf.
I would suggest using the form until the clinician feels comfortable in assessing a case without using the form.
From my own experience as a general dentist, I definitely found it better to work on simpler cases at the start, before managing more challenging cases, as this approach helped me to build up my confidence and workflow as a clinician.
In addition, I often encourage general dentists to discuss their cases with their endodontists if he/she is uncertain about managing a complex case. I found that when I was a general dentist, the patients really appreciated that I have discussed their cases with the specialists before making a referral. First of all, it gave the patients reassurance that they definitely need specialist care. Secondly, it helped me to gain a deeper understanding of the case such as potential complications and risks and helped me look into alternative treatment options in managing a complex case after discussing it with the endodontist.
With workflow, it definitely becomes easier with time once you have established the way you like to work, and every practice tends to have a slightly different set up with materials, equipment and staff support. If you have just joined a practice, I would suggest observing the experienced dentist(s) at the practice and note the workflow and see if you would make any changes that would suit your needs.
As an endodontist who also educates dentists, what are some of the key aspects of endodontic treatment that you find most dentists find challenging? How can they overcome these challenges?
Good communication with the patient is something that I find that most dentists struggle with. I would suggest building up rapport with senior clinicians at work, a mentor through an organisation or with the specialists that you refer to and ask them lots of questions on how they would communicate with their patients in different scenarios and learn from their experiences.
The first aspect is communication of case difficulty with the patient. It is a good idea to clarify to the patient at the consultation visit if his/her case is simple or complex to manage. And if the case is complex, then go through with the patient what makes the treatment of their tooth/teeth complex and to provide an option of seeing an endodontist.
Second aspect is communication of complications and risks to the patient and reading the patient well enough before starting treatment. For example, when you discuss the risk of instrument fracture to the patient, have you discussed through what you plan to do if that occurs, so that the patient is prepared that he/she may require further management with a specialist afterwards?
We do manage patients with differing expectations, and it is good to understand what the patients expect before starting. For example, if I am going to discuss endodontic treatment of a tooth with poor prognosis, I often put the question back to the patient and ask, “how would you feel if this tooth would require extraction and replacement within five years?”. It gives me a clearer idea of what the patient expects me to achieve and if he/she would be disappointed if treatment does not work out in the short term.
At times, it can be useful getting the patient to sign an acknowledgement form, if he/she definitely wishes to proceed with treatment regardless of the poor prognosis of the tooth, just so that there is another level of acknowledgement and to make sure that the patient is on board with you regarding the potential short term survival of the tooth, before proceeding.
Magnification is an important tool in successful endodontic treatment. What other tools do endodontists use on a day to day basis that general dentists can benefit from using?
I definitely think it is a good idea to get a tool for transillumination to detect cracks in teeth in a clinic, such as the microlux 2 transilluminator. A lot of dentists find it hard to confirm the finding of cracked them then end up placing metal bands around cracked teeth as a result. However, there are a lot of issues with placement of metal bands. With transillumination and high magnification with a microscope, it definitely helps in confirming the location and extension of the cracks, so we can inform the patient promptly regarding the treatment options and prognoses without delay.
Second tool that I enjoy using is definitely the electronic apex locator. I hope all dentists learn how to use one well because it does help with determination of the working lengths besides relying on the radiographs. If you are uncertain about using one, definitely contact your endodontist and consider observing him/her using it.
Thirdly, I like using the WAM key crown remover. It does make removal of crowns much more efficient and could be a useful tool in have in the clinic.
Letter From the Editor: September 2020
Letter From the Editor
Looking Ahead
As we enter the last quarter of 2020 it’s time to start looking ahead. Within the new normal, dental practices, CPD organisers and dentists are all working in creative and impressive ways to excel. At CPD Junkie we have been pushing ahead as well. We have launched our new fresh website with added functionality and an improved interface to make finding CPD easier than ever. We have been bringing on new partners and starting collaborations to finish 2020 strong.
If you are new to CPD Junkie, be sure to check out the website and spend time exploring all the CPD available. Start planning to finish 2020 strong and look ahead to 2021 with a concrete plan for how you want to spend your time and money investing in yourself.
Dr. Omid Azami
Co-Founder CPD Junkie
Blog Post: September 2020
CPD Junkie Blog
"Everyone has different levels or experience and natural ability. When you are out on a run you may run past some people and this can make you feel great about yourself and how fast and fit you are. Similarly, there will be times when you are running and people fly past you and this can make you feel slow, unfit or take away motivation. That is why it is important to run your own race."
Co-Founder CPD JunkierHost of Noobie Dentist Podcast www.noobiedentist.com
Expert Q&A – September 2020
Expert Q&A with: Dr. David Attia
BDSc (Griffith), GradDip (Dent)(Griffith)), MSc (Oral Implantology)(Goethe) PGDipClin(Ortho)(CoL), FICOI
"when it comes to oral surgery and implant dentistry, I believe it’s important to crawl before we can walk, and walk before we start to run. Beginning with fundamentals such as treatment planning, case selection and the importance of medical history for example, will provide us with a solid foundation on which we can truly develop our skills and build our experience and confidence levels. Having a good grasp of the basics allows us to discover and acknowledge our limitations and therefore lead, to good case selection"
Bio:
Dr David Attia completed his undergraduate training at Griffith University, Queensland. Following graduation, Dr. Attia completed a Post Graduate Diploma in Orthodontics and Dentofacial Orthopedics through the City of London Dental School and is now a clinical instructor for dentists completing the program through EODO, Australia.
His passion for surgery led him to complete a Master’s in Oral Implantology through Goethe University in Frankfurt, Germany. David’s Master’s dissertation focused on a novel approach in full-arch implant rehabilitations and he presented his research at the 6th Annual Congress of Innovation Jumps in Oral Implantology. Dr. Attia has also presented on the importance of dental photography and clinical documentation, as well as the soft tissue management around implants both locally and abroad. David is also involved in live surgical training of dentists looking to begin their journey in dental implantology.
Among others, he is an active member of the Australian Society of Implant Dentistry (ASID), The International Team for Implantology (ITI), the International Congress of Oral Implantologists (ICOI), and has completed his fellowship with the ICOI.
Dr Attia thoroughly enjoys the multi-disciplinary approach to dentistry. David’s unique combination of education and training allows him to implement cutting-edge treatment, offering patients comprehensive, predictable and long-term treatment solutions.
Oral surgery and implant dentistry is a big aspect of dentistry that a lot of dentists want to learn more about. From case selection, flap designs, extractions and implants, how do you suggest people get started in safely expanding their clinical scope?
I’d like to start with a quote from one of my mentors – “The knowledge of today can be the error of tomorrow”
In all aspects of clinical (and non-clinical) dentistry, continuing education is essential and should form an integral part of your schedule when planning the year ahead. Whether you want to open your eyes to an aspect of dentistry you don’t know much about, or completely immerse yourself into something you are truly passionate about, ‘ongoing education’ will always be key….and education comes in many different forms. We are very blessed to be practicing dentistry during an era where education is so readily available – not only live, but also online.
However, in my opinion, when it comes to oral surgery and implant dentistry, I believe it’s important to crawl before we can walk, and walk before we start to run. Beginning with fundamentals such as treatment planning, case selection and the importance of medical history for example, will provide us with a solid foundation on which we can truly develop our skills and build our experience and confidence levels. Having a good grasp of the basics allows us to discover and acknowledge our limitations and therefore lead, to good case selection – especially during the early stages of our journey where mistakes and complications can often stunt our growth and deter us from taking on cases.
There are so many great courses run by phenomenal educators out there – from short weekend courses to modular-style mini-residency programs – there is just so much to choose from. Although these courses offer great value in their own regard, I am a big advocate for structured, blended learning programs through recognised tertiary institutions provided by highly respected clinicians within their field. In my personal experience, these programs offer a solid literature-based foundation, coupled with hands-on clinical exercises and a variety of clinical case requirements that are completed under the close supervision of experienced mentors.
In addition to great education, the importance of mentorship cannot be overstated. Surround yourself with mentors whom you trust and have aligned philosophies with. A good mentor will be someone who will not only guide you and help you prepare for cases, but will also be honest in their critical appraisal of your work with the sole motive of helping you improve. This will lead to a greater appreciation for the finer details that can often be overlooked when we begin to venture out into more clinically demanding, multi-disciplinary cases.
The say you are average of the five people you hang out with the most. There seems to be a huge movement of top young clinicians in Australia that you are a part of. How much of your personal growth as a clinician do you attribute to the growth of your peer group? How do you suggest other clinicians surround themselves with more like minded clinicians?
Personal growth is the result of a number of factors that synergistically work together within each individual. We each have an inherent desire to continue to develop and progress both personally and professionally. However, one cannot overlook the impact that the environment we are in, or the people whom we chose to surround ourselves with have on our trajectory.
Dentistry can be quite an isolating profession and this can be clinically and mentally taxing – particularly when we find ourselves stagnating. Going through these ruts alone can be extremely difficult – especially early on in our careers. Whether we are adapting to a new work environment, struggling to fulfill financial obligations, striving to meet clinical demands, or managing the pressure we so readily place on ourselves to continually improve – we all need help!
The people we chose to align ourselves with can directly influence our mindset. We always have a choice and can either surround ourselves with like-minded individuals and therefore “as iron sharpens iron, so one person will sharpen another”, or we find ourselves surrounded by negativity and the “bad company will corrupt our good character”.
By aligning ourselves with those who want what’s best for us, we create a close net group of colleagues (friends!) who are genuinely interested in our growth and wellbeing as much as they are interested in their own. What does that mean or look like? It means associating with those who will not only share in your successes – but will do so without any shred of jealousy, hatred or envy. It also means that when you experience less-than-ideal results, complications, or even failures, that same group of friends will not shy away from providing the honest feedback and tough-to-swallow pills that you need in order to improve. There is no sugar-coating and no holding back – because you know it comes from a good place.
As we see each other elevate both clinically and personally on a regular basis, our natural response becomes to lift our standards both individually and collectively. We are each on our own journey and carry our own experiences, possessing different strengths and weaknesses. We each have two eyes and two hands, and we will always look at our own work in a different light to others. The more time we spend analysing the good and critiquing the not-so-good in each other’s work, the quicker we begin to assess and plan our cases from a completely different dimension and our eyes will begin see what our minds can now comprehend. It is all about collegiality and being genuinely happy for the individual and collective growth of those around you.
You have used social media and Instagram in particular to build a following, connect and collaborate with dentists and specialists from around the world. How can dentists leverage the power of social media to accelerate their learning?
Over the last few years, social media has had a huge impact on the dental industry. Facebook, and more recently Instagram have both served as great platforms for clinicians to not only market themselves but to also share their work and connect with like-minded professionals. Great clinicians from all over the world are regularly sharing an incredibly high calibre of dentistry that it is readily accessible at our fingertips. As we connect with dentists and specialists through their clinical work, we also gain an insight into their personal journeys and unique experiences that have shaped them into the clinicians they are today.
This has allowed me to personally form friendships with many general practitioners and dental specialists from different corners of the globe that would have not been possible without Instagram. It is through these friendships that we have been able to learn from one another through case discussion as well as grow and develop not only as clinicians, but also as people. Such interactions have opened up my eyes to a world of dentistry that I had never thought would be possible. It introduced us to new concepts, ideas and philosophies in both clinical and non-clinical dentistry and encourages us to think outside the box in the way we run our practices and complete cases, all for the ultimate betterment of our patient.
The fact that there is so much positivity on social media at the moment is a great thing, as historically, social media developed a stereotype of negativity and bullying. Nonetheless, despite the many positives that can be drawn out from the power of social media, it is equally important to recognise that it can also serve as a double-edged sword – especially for younger clinicians. As we see the standard of dentistry elevate through the work being put on display daily, it can leave us with a sense of overwhelming pressure as we reflect on our own work. Oftentimes, we are left to ponder “will I ever be able to provide these outcomes for my patients?”. However, it is important to remember that what we see on Instagram is a not only a small snapshot of a particular case, but also the author’s journey, and there is often a lot of blood, sweat and tears shed behind the scenes.
Furthermore, in order to ‘keep up’, ‘remain active’ and ‘engaging’, clinicians can be tempted to shift from striving to achieve patient-centred outcomes, to obtaining that perfect photo ‘for the gram’. However, social media should be aspirational. It should serve as a source of inspiration to helps us discover our passions. We ought to look at the incredible clinicians that post phenomenal work and rather than think “why isn’t my work that good?”, have the mindset of “how can I fulfill my own potential with the skills I have been blessed with?”.
Social media is a great tool and it doesn’t need to change. Alternatively, we should develop a sound mentality of how we perceive social media. For younger clinicians – seek out and connect with those who are not only more experienced than you, but also people who align with your values. Social media is not for us to ‘learn dentistry’ so-to-speak, but rather point us in the right direction to get the education that we thirst for, and we should look beyond social media for mentors. Remember to stay in your lane, run your own race and compare yourself to who you were yesterday, not who somebody else is today.
For those with more experience, be ready and available to help the new generation of dentists. Be willing to share your experiences with them and wherever possible, offer them sound advice or point them in the direction where they can find solutions to their unanswered questions. Just as we were offered help during the earlier years of our careers (and now as older clinicians!), we too should help those who are to come after us. We owe it to ourselves, our patients and to our profession!
Speaker Spotlight: September 2020
Speaker Spotlight: Dr. Padma Gadiyar
There is never going to be a perfect time to start. Be passionate and add value first. Execution is the key.
Bio:
Dr. Padma Gadiyar is a dentist, practice owner, Artificial Intelligence enthusiast, founder Smilo.ai & healthcare consultant to the dental & medical industries. An experienced clinician, Dr. Gadiyar launched her first dental practice in Australia 9 years ago . Author of Buy, Build, Sell-A step by step guide to a multimillion dollar practice empire, Dr. Gadiyar has been seen in Business Insider, Yahoo Finance, Digital Journal, The Times, International Business Times, ABC , BITE magazine & more. An advocate for bringing entrepreneurship & technology into dentistry, driven by a desire for practice owners to create a business supporting both for dentists and their patients using Artificial Intelligence and Remote Monitoring.
I graduate in 2007 from India and finished my ADC exams in 2011. My special interests as a clinician in restorative and cosmetic dentistry. I am trained in clear aligners, smile makeovers, implants, lasers and facial injectables. But my real passion is the BUSINESS PART OF DENTISTRY. I have attended numerous courses on communication, business, digital marketing HR and financial management courses within and outside of dental industry. I speak on topics such as:
- Rapid Practice Portfolio Management- Entry and Exit Planning
- Utilising Artificial Intelligence to transform dental practices and patient engagement
- Innovation-how to create & implement disruptive strategy, technology and ways of delivering care
What made you interested in teaching and becoming a lecturer in your given area of interest?
I believe in adding and keeping everything simple whether its clinical practice or business ownership and making them profitable, enjoyable and scalable. I help clinicians maximise their productivity and generate the best outcome to their entry and exit strategy.
From a lecturer’s perspective, what can CPD Junkies do to get more out of CPD events they attend?
Make a CPD Portal for individual user to keep their CPD attendance certificates, monitor points and send alerts.
Make Virtual running of events and promotions easier and hassle free for presenters
What advice do you have for anyone hoping to become a speaker/lecturer?
There is never going to be a perfect time to start. Be passionate and add value first. Execution is the key.
Letter From the Editor: July 2020
Letter From the Editor
An Update on CPD Junkie
2020 has been a challenging year for all of us. The dental profession and community has had to be strong, adaptable and creative in overcoming the various challenges thrown at it. At CPD Junkie we have been working to continue to build our brand and to provide value for our members. Through the How to Get the Most of CPD E-Book (https://www.cpdjunkie.com.au/e-book) and the CPD Junkie X Szabi Hant Photography cheat sheet (https://www.cpdjunkie.com.au/photography) we have been doing our part to contribute. The CPD Junk community is continuing to grow and we are excited to be the go to source for Dental CPD as we emerge from the COVID pandemic and CPD events begin to start up again.
Over the past month we have been working very hard on the inaugural CPD Junkie Industry report. Our aim with this report is to provide insight on the state of Dental CPD in Australia/NZ. So keep an eye out for the industry report over the coming weeks and enjoy our monthly newsletter!
Omid Azami DDS, Co-Founder CPD Junkie
Blog Post: July 2020
CPD Junkie Blog
"If you walk the same path day after day in a field, a track will form – this is a habit. To break this habit or to form a new one requires you walking a different path and sticking to that path day after day. Change is not quick, and change is not permanent, so persistence and valuing change will be the key."
Speaker Spotlight: July 2020
Speaker Spotlight: Dr. Anthony Mak
“In our career, there probably isn’t going to be many opportunities or a long period in your career that people will take time out just to come to listen and learn from you, so if the opportunity arises and you are invited, you should take it”
Bio:
Dr Anthony Mak graduated with multiple awards from the University of Sydney in 2002. He then went on to complete his Post Graduate Diploma in Clinical Dentistry (Oral Implants). Dr Mak is one of Australia’s most sought after speakers, especially in the field of digital and restorative dentistry. He has lectured extensively in Australia, New Zealand and across Asia; and his hands-on workshops have gained such popularity that they are almost always booked out soon after registrations open. He is also gaining great popularity on the European and US circuit. Anthony is the author of two compelling compendiums detailing direct composite and indirect ceramic restorations, the clinical photography and documentations can only be described as exceptional. He has published numerous case studies and articles for local and international dental bodies and associations. Anthony’s interest lies in dental technologies, advances in materials and techniques; and he has a unique understanding of CAD-CAM digital dentistry. Anthony runs two practices in metropolitan Sydney, focusing on quality modern comprehensive care, including aesthetic and implant dentistry. He is also a clinical consultant and key opinion leader for several global dental companies focusing on development of new dental technologies. Outside of clinical practice, Anthony also sits on the Restorative Advisory Board for GC Europe, the Executive planning committee for the Graduate Diploma in Implant Dentistry (Syd Uni), an executive committee member for the Dental Alumni of the University of Sydney, and is the team leader in Australia for the renown BioEmulation Group, a global group of high achieving dental practitioners.
What made you interested in teaching and becoming a lecturer in your given area of interest?
I fell into the teaching space about 10 years ago. I had great mentors who were, and still are renowned lecturers in our community right now. When I started my own practice, I was able to meet with some of these dental companies and from there… it’s history. I first started speaking on diode lasers and then moved onto composites with the ADANSW. I just took it one step at a time and when I was asked to teach, I tried to take the opportunity. I was once advised by a colleague that… “In our career, there probably isn’t going to be many opportunities or a long period in your career that people will take time out just to come to listen and learn from you… so if the opportunity arises and you are invited… you should take it”… and that advice has stayed with me 10 years later. Who knows when this journey will end…so I take it day by day and try to concentrate on my patients and my practice. As at the end of the day, I’m a clinician and I love what I do in practice and anything outside of that, I tackle with a careful stride.
From a lecturer’s perspective, what can CPD Junkies do to get more out of CPD events they attend?
I think there are a lot of CPD events currently available. And this is great as only a few years ago this was completely different. I think young dentists should plan their CPD journey from when they graduate to when they become a bit more experienced. Try to focus on topics that are most useful early on in your private practice careers. As you mature as a clinician, you can attend some of the more advanced programs.
What advice do you have for anyone hoping to become a speaker/lecturer?
I think just like we learn dentistry from our mentors when we start in private practice, if you are interested in teaching and lecturing then you should try and learn from those who already do it. Try and connect with and learn from those mentors that have been lecturing of speaking for many years in this space. They will be able to guide you and to provide feedback on what you need to do to become successful.
Letter From the Editor: June 2020
Letter From the Editor
A Return to Normalcy
Omid Azami DDS, Co-Founder CPD Junkie
With the easing of restrictions and a return to business, for the first time in a few months a group of friends and I went out to our favourite local restaurant. On the surface the experience was at it would have been in a world prior to the COVID pandemic but on reflection it’s amazing how much has changed. We had to “sign in” by scanning a QR code and filling in our details upon entry. The restaurant also did not have physical menus instead relying on their website’s mobile takeaway menu to order and process payments, finally a restaurant in Melbourne that will let you do split bills!
I am amazed at the adaptability and creativity of local small business to operate within the ever changing landscape of restriction, regulations and customer mindsets. Dentists are in a similar situation and practice owners, staff and associate dentists all face these similar challenges of a return to work and have been incredibly creative and adaptive in their approach.
It is great that we are back in the chair doing what we do best and serving our patients. It will be interesting to see how things evolve over the next few months and what changes are short term vs permanent, a new normal.
At CPD Junkie we appreciate the support of our members and subscribers during the past few months. With the majority of CPD events being cancelled, postponed and rescheduled, we also had to be creative and provide different services such as our webinar directory and on-line CPD education listings. We have also been improving the site to make sure that we can provide you the best experience possible when it comes time to find your next CPD event.
Enjoy the June Newsletter and be sure to check back with CPD Junkie often to see the latest offering of CPD available.
Omid Azami DDS
Co-Founder CPD Junkie
Blog Post: June 2020
CPD Junkie Blog
“Culture is the sum of everyone’s attitudes, beliefs, behaviour, traditions and skills. So culture really belongs to everyone within a team”
Be part of a Winning Culture
Written by Dr. Jesse Green
We hear about the importance of culture all the time. We know we need to inculcate it in our thinking and daily actions but that is only the beginning of a long, tedious, confusing but extremely rewarding journey. It is like losing weight; you know you need to do it for the sake of your health and wellbeing. You know all the buzzwords like cutting down on carbs, sugar, calorie intake. If you let your body guide you through the process, it may give in to temptations? But what if you deprive your body way too much, then it starts retaliating by going in starvation mode.
Sound familiar doesn’t it? If you let your team members or colleagues organically build the culture around you then your own goals and core values or those of your company take a backseat. If you take too much control and try forcing culture on others and they don’t want to be on-board with it, it flounders. The bottom line, however, remains that culture is essential; but what is more important is finding the right balance. And that is exactly what we try to look into today.
What is Culture Anyway?
Culture is the sum of everyone’s attitudes, beliefs, behaviour, traditions and skills. So culture really belongs to everyone within a team. So if you take a dental practice, culture doesn’t belong to the owner of the practice, it belongs to everybody that works in and around that practice. It is driven by the feedback from patients too, so obviously it is the sum of everybody working in, and connected to the organisation.
Seek Fulfilment, Everything Else Will Follow
As practice owners or providers of services to a practice, monetary gains are on top of our minds, which sometimes lead some to make the wrong decisions and put other interests in the backseat. This mind-set can make the work environment toxic to say the least. Research shows that people would rather work in a happy environment with great leadership for less money than in a toxic environment that pays well.
And in times of active social media and active review and ratings culture, it is very easy to get the word out if the organisation has a toxic culture. What you should be focusing on is seeking fulfilment. To make sure that your work principles and ethics are not being compromised; to make sure that you and your team members are happily proactive and always opt for organic growth that all the team members are a part of.
The Know-it-All Approach to Disaster
This mistake can at times be solely responsible for killing the culture of any team. As providers, managers and team leaders we need to understand that in order to be the smartest person in the room, you need to be the dumbest person in the room. You should be the one asking questions rather than answering them.
Allow your team members to speak to you about their expectations and ideas and they’d carry you forward to greater successes all on their own.
The Culture is Nobody’s to Own
This somehow correlates with the previous point. You need to know that you can neither claim responsibility nor ownership of the culture of your organisation. Too often we see huge banners, posters and pamphlets scattered all around screaming culture in an organizational space. Those are not interesting to look at and neither do they serve any positive purpose.
You cannot just set up some ground rules to be followed and expect it to become a culture. Just like most things great and growing, it needs to evolve. You need to constantly keep your team members on board and be proactive in order to develop and maintain a healthy culture.
Signs of a Good Culture
So how do you know you have a good thing going on? In all fairness, it is not hard to detect. Everyone deserves a grumpy day every now and then, but if your colleagues or team members continuously show up to work without a smile on their faces and a twinkle in their eyes, then know that something isn’t right.
And how do you fix it? You openly communicate. Rather than blaming them for not being productive/active/involved enough, you should try to be on their side and ask them how you can make their work more fun and interesting.
How to Get the Work Done?
‘Sweet talk doesn’t get the work done, Jesse,’ No it most definitely does not! Which is why you need to set the ground rules beforehand. You need to let team members know what is expected of them and hold them responsible for it.
Performance management is one of the best methods to ensure everyone’s on track with their responsibilities within an organisation. If the culture, or business productivity for that matter is suffering because someone isn’t doing their job properly or isn’t on-board with the culture of the company, despite warnings and emotional support, then you need to let go of that person before it gets more toxic.
The Last Word
The only way you can ensure a healthy, proactive and result oriented culture where everyone involved happily works towards similar goals is to make sure you continuously work on it from the backseat. Agreed, it is a tricky position to be in and it will take some time before you, your team members and your patients are all on board with it, but it is a process that will generate great rewards. So keep the culture alive and it will keep you in business.
Expert Q&A – June 2020
Expert Q&A with: Dr. Varun Garg
"The most focus in any discipline of dentistry should always be on diagnosis and treatment planning. If we can plan something correctly and our execution is less than ideal, we can still get a functional result but if we start with a wrong plan, even if our execution is 100% failure is inevitable."
Bio:
Dr Varun Garg is a Melbourne based and trained specialist Prosthodontist. He maintains his specialist practices in Collins Street (Prosthodontic Group) and Tullamarine (Tullamarine Prosthodontics). Dr Garg graduated from the dental school in 2007 and later received his Doctor of Clinical Dentistry in Prosthodontics from The University of Melbourne in 2017. During his postgraduate program he was awarded with the Dr. Steele Award for outstanding clinical skills. He enjoys all aspects of prosthodontics but has a keen interest in aesthetic, reconstructive and implant dentistry. During his postgraduation, he researched the use monolithic zirconia implant crown and studied their fracture resistance under cyclic loading.
He is actively involved with prosthodontic teaching as a clinical supervisor at The University of Melbourne, other continuous education programs and hands on courses. He currently holds the position of treasurer for the Australian Prosthodontic Society (Vic Branch) and is affiliated with the International Team for Implantology and the Australian Dental Association.
Outside prosthodontics he enjoys photography, playing cricket and spending time with his wife (Gazal) and three-year-old boy (Amiek).
You are involved in a lot of teaching to dentists and dental students of various levels of clinical experience. What areas of clinical dentistry do you feel that most young dentists should focus on?
I think dentistry is a speciality in itself and then there are further sub-specialities like Prosthodontics, Periodontics, Orthodontics etc. This makes dentistry a very diverse field hard to master everything. It’s difficult to answer where most young dentist should focus on in dentistry. It depends largely on their personal interest but also the type of work they are exposed to.
In general, if I was to say the most focus in any discipline of dentistry should always be on diagnosis and treatment planning. If we can plan something correctly and our execution is less than ideal, we can still get a functional result but if we start with a wrong plan, even if our execution is 100% failure is inevitable.
Adhesive dentistry and more recently biomimetic dentistry have surged in popularity. As a result, more and more reliance is being placed on “the bond” versus the more tried and tested resistance and retention form when it comes to single unit indirect restorations. Do you think this is the future of dentistry or a trend that will stop with perhaps an increase in restorative failures?
Adhesive dentistry for sure has gained popularity in the last few years and it’s for a good reason. I think the biggest advantage of adhesive dentistry is conservation of the remaining tooth structure. With advances in our understanding of bonding, specific protocols and development of newer & stronger ceramics like lithium disilicates, the predictability with our restorations has increased immensely. Dentine bonding for sure has improved, especially with techniques like immediate dentine sealing (IDS) but the golden bond is still to the enamel and for me that is still a major factor that dictates how much I can rely on the bond itself.
My advice to the young clinicians reading this will be that bonding is technique sensitive but when executed properly does give us a very predictable result. Having said that, if your bonding substrate either with or without IDS is majority on dentine and very less enamel, then plan your restorations to have some resistance and retention form as well. It’s not always a battle between using bonding or resistance/retention form but rather a subtle balance between the two to achieve an optimal long-term result for our patient. I do feel that the bond-o-dontics is here to stay but we sure will learn from our failure and make changes to our protocols as necessary.
Occlusion is a big topic that can be hard to understand and implement into daily practice. What is your advice for clinicians seeking to learn more about occlusion and how they can implement it into daily practice?
Occlusion for over a century has been a topic of confusion and anxiety for dental professions. This is because occlusion is not an exact science and there is no conclusive evidence to support superiority of one occlusal scheme over the other, so we need to understand them all and apply the most appropriate scheme dependent upon the patient requirements. One of my mentors once told me “when it comes to occlusion many times things work not because of what we do but despite of what we do.” This is true but also is a very generalized statement. I do think understanding of occlusion is important when we plan either direct or indirect restorations. Occlusion is not hard to understand/implement when we are doing confirmative dentistry like a single crown with intact neighbouring teeth but becomes a lot more critical when doing re-organisational dentistry like in patients with extensive wear or needing a full mouth rehabilitation. These are the patient that do not have forgiving occlusion and as failures in dentistry are expensive can be stressful to deal with.
If clinicians are planning to treat patients with complex occlusal wear or rehabilitation needs, make sure you firstly know how to diagnose their wear patterns and only then you can design a new occlusal scheme that can account for the patient habits that destroyed their own dentition to begin with. Talk to your mentors, take their guidance, attend continuous education programs with people who have a deeper understanding of this subject and then practice over and over, as that the only way to succeed.
What advice do you have for dentists thinking about pursuing prosthodontics as a specialty?
Of course, you are going to get a very biased answer for this question, but I also have to tell you what I honestly feel. Prosthodontics is the best thing that has happened to me. I have always been intrigued by prosthodontics even when I was a dental student and this fascination with the subject has only grown with time. I think prosthodontics is the most rapidly changing field and the advances we have made in the past few years have been phenomenal. It is really exciting time to be a prosthodontist. In the past prosthodontists have been accused of being too invasive with their treatment but that has totally changed now. Prosthodontist now have a very different view and approach to treatment planning.
Prosthodontics is the forefront of aesthetics, implants and reconstructive dentistry and it is only getting better. Each day in the office is different than the last and that is exciting for me. I won’t say that being a prosthodontist is easy or not challenging as we are dealing with quite complex situations most of the times, but it is equally rewarding as well.
For anyone who is planning to pursue prosthodontics, I would encourage them to do so. Keep that fire burning within yourself, “Stay hungry, Stay foolish!”
Speaker Spotlight: June 2020
Speaker Spotlight: Dr. Misagh Habibi
Don’t get fooled by short industry driven programs that purport to make you equipped to be a “master” of some aspect of dentistry. Attend more, learn more, and keep learning until you realise how much you have to learn!
Bio:
I finished Dentistry at UWA (Perth) in 1999 and started work in private rural practice. Dealing with everything from pros to wisdom teeth to trauma at the hospital, I had to learn quickly. I gained early mentored experience in minor oral surgery. I went onto a Grad Dip in Sedation at Sydney Uni, and sedation ended up being a major part of my daily work. I delved into a year of implantology training programs in 2008, and got hooked in that discipline. Since then I’ve focused my continued learning and practice in implants, along the way gaining an MSc (Oral Implantology) and Fellowship and Diplomate status of the ICOI. I currently practice implants and perioplastic/dentoalveolar surgery full time. As a sucker for punishment I’m also undertaking a P/T PhD focusing on a novel biomaterial development.
I teach for 3 organisations: Goethe University Germany for its Master of Oral Implantology program, The Implant Institute which is my initiative in cooperation with other colleagues in Australia, and the Cambridge Academy of Dental Implantology. We deliver a comprehensive PGCert and PGDip (Dent Imp) program (UK Award) to Australian dentists, as well as other training programs.
What made you interested in teaching and becoming a lecturer in your given area of interest?
I’ve always enjoyed teaching, talking shop and sharing skills. I’m passionate about delivering information in a way that the student can understand and become empowered to build further learning on. This stems from a desire to deliver learning in a way that I would want to learn. I find some programs speak so academically that it can be overwhelming to learn anything. At the other extreme, some programs can be naive to the complexity of what they are imparting, giving a false sense of confidence which proves harmful in clinical practice. Many fundamentals can be lost if glossed over, whilst teaching advanced details without learning “the big picture” fundamentals can also have limited outcomes. So I try to marry practical case orientation and science, taking into account pros and cons and complications of various situations.
Another motivation for me is to contribute to an open, encouraging and enjoyable dental community culture: Where we can avoid dogmatic opinions, and move away from petty motivators like competition or ego.
From a lecturer’s perspective, what can CPD Junkies do to get more out of CPD events they attend?
My advice would be that CPD Junkies should focus in on pertinent and valuable CPD opportunities rather than spread their energies too thin. It’s a great idea to keep abreast of developments in all aspects of dentistry, but ultimately you can’t master everything. At least I can’t! That’s why you see every great clinician has honed in on one or two areas of clinical practice.
In early years after graduation, it’s great to learn tips from all types of seminars and courses. But as you develop further, as there are only so many hours available in our busy professional lives, you have to pick one or two areas to try and learn in depth, and keep learning.
Don’t get fooled by short industry driven programs that purport to make you equipped to be a “master” of some aspect of dentistry. Attend more, learn more, and keep learning until you realise how much you have to learn!
What advice do you have for anyone hoping to become a speaker/lecturer?
If you have a passion for teaching that you’d like to contribute to the profession, focus first on continued learning and clinical experience. Gain postgraduate qualifications or extensive training in a given area, and get lots of clinical experience under your belt, so that your knowledge is also informed by experience. We learn most from our mistakes, but we can also learn from others’ mistakes. It generally takes about 10 years of solid clinical practice in a niche area to do that. It’s important to understand the science and benefits of different clinical methods, even those you don’t practice yourself – otherwise you become a biased educator. It’s also important to remain open to change and developments in the profession. Right now, with a plenitude of webinars and courses, many skilled clinicians almost feel pressured to be in the education game. It may not keep growing this way, as the industry may not sustain it. Think about what difference you would bring. Align yourself with good organisations, collaborate, and be a refreshing contribution to our profession by keeping your ego in check.
Letter From the Editor: May 2020
Letter From the Editor
United Through Webinars
Omid Azami DDS, Co-Founder CPD Junkie
As we roll through the second month of the Covid-19 Pandemic, so much of our daily lives have changed. With the easing of restrictions back to level 2 and 1, a lot of our colleagues are cautiously returning to work to serve their patients and their dental needs.
One amazing trend to emerge during this period of isolation and social distancing has been the rise in dental webinars. Our nights have been filled with content from speakers from around the world sharing their lectures, cases and lessons to dentists sitting in the comfort on their own living rooms, for free!
At CPD Junkie we have been working hard over the past few weeks to try and list all the available webinars in one place to make them easier to find and keep track of. We hope that you have made the most of your down time and really taken advantage of these webinars to learn something new. The delivery of CPD may change in response to this Covid Pandemic and our commitment to our CPD Junkie community is to remove as many barriers between you and finding quality CPD.
Enjoy the second edition of the CPD Junkie Newsletter and be sure to sign up for an account if you haven’t already to receive all the benefits of the website including the free “How to Get the Most out of CPD” E-book.
Expert Q&A: May 2020
Expert Q&A with: Dr Mehrnoosh (Nu) Dastaran OMFS
MBChB BDS MPhil DOHNS (RCS Eng) FRACDS (OMS)
"OMFS is indeed a broad scoped speciality, but it is important to remember that our roots still lie firmly in dentistry."
Bio:
Dr. Mehrnoosh (Nu) Dastaran is a Victorian-trained Specialist Oral and Maxillofacial Surgeon, who graduated in Medicine in 2005 from the University of Bristol and Dentistry in 2010 from King’s College London, as the highest achieving candidate in both degrees. She has undergone sub-speciality fellowships in craniofacial and skull base surgery, corrective jaw surgery and craniofacial trauma at the Royal Melbourne and King’s College Hospitals.
Dr. Nu plays an active role in undergraduate and postgraduate surgical and dental education at the University of Melbourne and is a senior lecturer at Charles Sturt University. She has researched collaboratively with the Victorian branch of the Australian Dental Association (eviDent Foundation) and has completed a Master of Philosophy in Dental Science by Research in the field of Implantology at the University of Melbourne Dental School.
Dr. Nu works as a specialist at The Royal Melbourne Hospital, Royal Dental Hospital of Melbourne, and in private practice in Melbourne and regional Victoria. Her special interests include corrective jaw surgery, craniofacial trauma, dentoalveolar surgery, implantology, minimally invasive salivary gland surgery and facial aesthetics.
In her spare time Dr. Nu finds it hard to sit still. She relishes musicality and movement through dance, and in particular, enjoys classical ballet and pole dancing. She also loves to explore the outdoors, whether on foot or by bicycle.
Oral and Maxillofacial Surgery is a very broad scoped specialty. What procedure(s) can an OMFS provide patients that referring dentists may not be aware of?
OMFS is indeed a broad scoped speciality, but it is important to remember that our roots still lie firmly in dentistry.
We are trained specifically in oral surgery in a way that ensures thorough knowledge of its evidence base, and precision and attention to detail in its execution. Yes, we do place dental implants in the aesthetic zone, for example, and we do perform an array of soft and hard tissue augmentation procedures that can facilitate oral rehabilitation with dental implants.
Many dentists do not realise that our patients can access Medicare rebates, so surgery is a lot more affordable than it might seem. Additionally, for us, implants, graft materials and some surgical guides like MGuide® fall under the prosthesis list, which means that patients often do not have to pay for them. I see this as a huge bonus, particularly as we are in the business of helping people!
Many oral and maxillofacial surgeons have additional/subspecialty interests in cancer surgery, free flap reconstruction or paediatric cleft and craniofacial surgery. My love of facial anatomy and strong background in orthognathic surgery has grown my interest in facial cosmetic surgery.
Whatever the area, it is clear that the fine motor skills, creativity and 3-dimensional perspective required for dentistry, have given us an advantage over other surgical specialties.
A lot of dentists may not have well developed working relationships with their specialists. From your experience, how can a dentist establish a better working relationship with their specialists?
I believe in relationships that are personal, mutually beneficial, respectful, and long-term. I am a proponent of good and open communication, whether in person, over the phone or in writing. Personally, I respond best to face-to-face meetings and phone calls, because I like to put a face and/or voice to someone’s name. That is my practice style.
It works both ways though. Sometimes, specialists may seem unapproachable, and for me, sometimes, it is difficult to get beyond a receptionist when I am trying to contact a dentist or potential referrer.
So, send an email to your local specialist, and ask for a coffee date, or time for a catchup. Discuss complex cases in person or virtually (technology and Covid-19 have helped to expedite this), so that you can nut-out a treatment plan when you have all the information in one place and at your fingertips. And, importantly, if you are sending a potentially difficult referral their way, forewarn them so that they have time to prepare!
You have been involved in a lot of teaching lately. When it comes to dentoalveolar surgery, what 3 practical tips do you have for dentists to perform extractions safer and more predictably?
- Have the right equipment open and ready. For this, you need to plan for all eventualities. That way you will not have to stop-start, because it can be stressful trying to find equipment during a procedure.
- Communicate with your nurse. Active assistance is invaluable. This includes teaching them how to support the head, support the jaw, retract the tongue and adjust the light if it is not on target etc. without you having to ask.
- If you can get forceps on a tooth, always deliver it with forceps and do not be tempted to complete the extraction with an elevator. This will avoid complications like root fractures, and tuberosity and cortical plate fracture. Push, never pull.
What advice do you have for any dentists thinking of specialising in OMFS? How do you see the future relationship between dentists and specialists evolving?
If you want to specialise in oral and maxillofacial surgery, get both degrees (medicine and dentistry) completed and out of the way as soon as possible. There are no prizes for taking a lifetime to become eligible to apply for training. Generally, to specialise, you need to do things that make you stand out from others and excel, like research and work experience.
Do not underestimate the value of general dentistry, however. There is also so much quality CPD available to general dentists now, that you can focus your attention on a few areas of interest without having to specialise.
It is important, nevertheless, to know your limitations, be able to manage your complications, and to establish relationships with specialists around you. I think that as dentistry advances, specialists and general dentists will increasingly lean on each other. Ultimately, we must not lose sight of our common goal, which is to provide the safest and best level of care for our patients.
Blog Post: May 2020
CPD Junkie Blog
"Many a times, people stop themselves from making big decisions because they are unsure/scared/financially weak yet unhappy. They continue to lead those unfulfilling lives rather than take action to do things differently. The moment you decide not to do something about your current situation, you’ve made a decision there and then!"
Speaker Spotlight: May 2020
Speaker Spotlight: Dr. Sam Koh
"Find the courses that excite you and interest you, so then when you’re there you’ll be truly excited and willing to learn."
Bio:
I graduated from the University of Melbourne in 2011 with First Class Honours in Bachelor of Dental Sciences. Since, then, I’ve completed the Progressive Orthodontic Seminars (POS) 2-year orthodontic program as well as several other shorter format courses in various disciplines. My area of interest and passion lies in the multidisciplinary approach to aesthetic dentistry and smile rehabilitation. I also enjoy all aspects as orthodontics – both fixed and clear aligner therapy. I run a group called the Young Dentist Hub, which offers quality CPD to younger clinicians at affordable prices, and also lecture on topics such as resin composites and clear aligners.
What made you interested in teaching and becoming a lecturer in your given area of interest?
It was actually all a bit of a lucky coincidence as to how it all unfolded. Back in 2015, me and a good friend decided we were fed up of the lack of affordable courses for younger dentists, especially from the bigger companies and organisations. We threw our first Young Dentist Hub conference, and the rest is history! There are so many amazing course providers out there now dedicating events to younger dentists and I really hope we played a huge part in making that all happen. In terms of lecturing, well that all came pretty spontaneously and naturally as I never even imagined I would ever do something like teaching and speaking to other clinicians and lecture internationally! I think people and companies could just see how enthusiastic and passionate I was to teach others, as I feel the way I present topics is relatable to the common clinician. I’ve been told the way I present topics is practical, simple and easy to understand, which I think a lot of dentists hopefully enjoy.
From a lecturer’s perspective, what can CPD Junkies do to get more out of CPD events they attend?
I think you should really consider beforehand what disciplines or topics you want to delve deeper into to continue your ongoing journey. Find the courses that excite you and interest you, so then when you’re there you’ll be truly excited and willing to learn. Actively seek out clinicians that you want to hear and learn from, those whose work you admire and respect, and those that their way of teaching resonates with you. Once you’re at the event – don’t just be a passenger. Instead, make sure you go prepared to take notes and are curious to ask questions and participate. I’ve always found that the ones who take away the most from courses are those who are active and ask lots of questions. We’re all here to learn and there’s no shame in putting a hand up and asking a question if it means you can consolidate your learning.
What advice do you have for anyone hoping to become a speaker/lecturer?
Run your own race. I never reached out for anything or anyone, and I think companies and organisations really see and understand that. I personally don’t think you should ever actively approach someone or try to force their hand to get them to have you lecture or speak. Otherwise, when you start lecturing, people can see right through you as the person who is just there for pure publicity or is egocentric and your speaking career will be over before you know it as that will surely come across in the way you present too. Instead, put your head down, plug away and do quality work, continue to network and become the best clinician you can be and opportunities will surely come your way. You do you Boo.
Blog Post
CPD Junkie Blog
"The moments you feel some sort of excuse or avoidance you need to lean on and confront it. Because when you are trying to avoid something, you start making excuses or start justifying why you aren’t doing it"
How to Bounce Back from a Setback
By: Dr. Jesse Green
We all have setbacks; it is part of living on this beautiful planet. Listen to anyone’s success story and they’d tell you about how they moved forward against the odds; how they fought back against forces to be where they are. And it all sounds inspirational, amazing and impossible to achieve!
‘Thomas Edison may have done 1800 experiments before inventing the light bulb, I don’t think I have that kind of willpower’. But how do you know you don’t? Resilience is one word that is often misrepresented. And resilience is one trait, which when achieved can make all the difference in how you approach work, life and more importantly setbacks in general.
The True Definition of Resilience
So what is the true definition of resilience?
Letter From the Editor
Letter From the Editor
The Importance of Community in Times of Crisis
Omid Azami DDS, Co-Founder CPD Junkie
We are all feeling the ripples of this COVID-19 global pandemic. Our personal, social and professional lives have come to halt and we are all dealing with the far stretching consequences. The next few months will be challenging for all of us and we at CPD Junkie hope to be there to help as much as we can.
We hope this monthly newsletter will provide you with some high quality content from some of the leaders in Dentistry from Australia and abroad. Our is to make newsletter education and filled with value for our CPD Junkie community.
Thanks to technology, isolation should not mean isolated. Stay connected with your dental community and peers via social media and video conferencing apps such as Skype, Zoom and FaceTime. Use your downtime to catch up with friends and family, exercise and start those projects you have been thinking about and just never really got around to.
Educate yourself. No better time than now with so many online resources available. CPD Junkie has started listing online CPD and webinars to its directory, have a browse and get learning.
Expert Q&A
Expert Q&A with: Dr. Bruce Freeman
"Parts of our toolbox of life-skills needs to be the ability to receive feedback fearlessly"
Bio:
Dr. Bruce Freeman is a native of Toronto. He is an honours graduate of the Faculty of Dentistry at the University of Toronto where he was recognized with numerous awards for his clinical and academic achievements. He then completed the Advanced Education in General Dentistry program at the Eastman Dental Center in Rochester, New York. Dr. Freeman then returned to the University of Toronto where he received his Diploma in Orthodontics. Subsequent to this he completed his Master’s of Science degree in the field of temporomandibular disorders and orofacial pain.
Dr. Freeman is Co-Director of the Facial Pain Unit within the department of Dentistry at Mount Sinai Hospital where he is responsible for the management of patients with complex facial pain disorders in addition to participating in the education of the hospital dental residents and specialty dental residents from the University of Toronto dental faculty. He also participates in research initiatives within the department which have yielded publications in the European Journal of Neuroscience, Pain, Brain Research and Neuroimage and lectures internationally on the topics of clinical orthodontics, facial pain, patient experience and mindful communication, and virtual surgical planning.
Bruce is a certified yoga instructor with additional training in breathing techniques, meditation, and trauma informed movement. He directs the Wellness Program for Hospital Dental Residents at Mt. Sinai Hospital in Toronto emphasizing how self-care leads to the best patient care.
You lecture throughout North America on the patient experience. What are three simple to implement tips that dentists can implement to improve the experience of their patients?
BF: With patient experience techniques you will often try and say something I may suggest or you hear a colleague say and when you say it the patient they look at you like you have three heads! There needs to be a lot of good ol’ trial and error to see what works for you, particularly in these trying times when both the typical stresses patients have will be compounded by mental fatigue, worry, and financial strain. Three tips you can make your own that will be more critical moving are as follows:
- Listen to the story patients have to tell and never acknowledge an emotion, such as “I am afraid of having a tooth out”, with a fact, such as “I have done this a thousand times”. Listen and HEAR the patient’s concerns and ask a lot of questions starting with “why”.
- Draw flow charts about treatment options and have the patient teach back the plan and always ask them if it makes sense to them.
- Ask if you missed anything that they wanted to discuss and always thank them for letting you look after them. A phrase that will mean so much more in the future.
A lot of young dentists are facing burnout, stress and overall dissatisfaction, with some even seeking alternate careers. What advice do you have for a dentist struggling with these issues in the early part of their career?
BF: These are issues that will become even more prominent as we navigate the “new normal” of dentistry after the significant strain the world must now endure. The toolbox needs to be filled with strategies that bolster resilience. Breathing, movement (yoga, qi gong etc), and a regular meditation practice help people learn to look inward and name their emotions so they can observe the feeling and not be controlled by it. At present we have the time to learn for free from experts in the field and becoming proactive helps mitigate fear and worry as we, like our patients, like to know we have a plan. Mentors are critical in life and it is best to find different ones for both your professional and personal worlds. These things need to be taught early on in school, so they become second nature. There are NO easy answers but ignoring how we feel and not addressing the worry and stresses in our lives will not make them go away.
Imposter syndrome and the Dunning-Kruger Effect are two popular concepts about the struggles we all face in our abilities as clinicians. You work closely with a lot of residents and mentor a lot of dentists. What strategies can we deploy in times of self-doubt to get past this challenge?
BF: “Fake it until you ARE it” is a popular phase but it does ring true. Dunning-Kruger occurs when people lack the insight to realize they are not great at something and look at you oddly when you suggest otherwise (eg: karoke night). Parts of our toolbox of life-skills needs to be the ability to receive feedback fearlessly. The delivery of this feedback may not always be ideal but the kernel of truth still resides in what is said. Dental school can take serious knocks at your self-esteem. It is tricky but we need to focus on providing a positive emotional experience for patients and nudge our ego out of the way and realize we will never be good at everything. Recognizing there are things in dentistry and life “we don’t know we don’t know” is the first step. Take lots of courses but in areas you want to focus and figure out what you can do best to serve your patients as you will never be able to do-it-all with a high-level of skill.
What do you see as the main pros and cons of social media use for dentists?
BF: Wow. We are learning first-hand the power of social medial to be a positive force in bringing people together and sharing information. The world is now united in an unprecedented struggle and knowing we can chat with our friends and colleagues and band together to offer support is incredible. One however, must be mindful of thinking what we see with regard to people’s work and lives is just a snapshot and what they want the world to see. Our brains however react in interesting ways and suddenly we feel inadequate, despite telling ourselves “oh, I know it’s just Instagram” and it’s not reality. We all must be mindful of what we post and how young professionals and students deal with the content. If less than positive profiles don’t have an audience, they will fall into the shadows. Educational and motivational profiles, of which there are many, should be where people focus and we must always remember to communicate professionally and collegially as now, more than ever, we need to lift each other up.
Speaker Spotlight
Speaker Spotlight: Dr. Clarence Tam
"To get the most from CPD events, I feel that one needs to ask questions, and that will come if you engage with the material"
Bio:
I went to the University of Western Ontario for both my undergraduate degree in Honors Microbiology and Immunology (thesis: Site-Directed Mutagenesis of recombinant bone sialoprotein in enamel formation) as well as my Doctor of Dental Surgery. I completed a General Practice Residency with the University of Toronto and Hospital for Sick Children following graduation. I attained Accredited status with the American Academy of Cosmetic Dentistry in 2017 and have been working through the Kois Center curriculum. My area of interest is orofacially-driven smile rehabilitations with interdisciplinary elements, laser-assisted therapeutics as well as naturomimetic direct and indirect restorative procedures that are minimally invasive.
What made you interested in teaching and becoming a lecturer in your given area of interest?
CT: I started by trialing and reviewing certain dental products with the goal of seeing how they could improve both my esthetic and patient function outcomes. This drove me to study and focus on techniques that optimized bonding microtensile shear bond strengths in conjunction with material features in a goal to try to reproduce the respective layers of missing tooth substrates with minimal failures. I believe my strength is that I am able to explain and demonstrate something seemingly complex to any person in a simple, efficient, easy-to-relate-to and accessible manner all whilst getting their passion levels pumped up. I believe that even if you weren’t interested that I could make you not only become interested in the topic but also plant the seed of desire to master it. I’m an optimist, obviously.
From a lecturer’s perspective, what can CPD junkies do to get more out of CPD events they attend?
CT: To get the most from CPD events, I feel that one needs to ask questions, and that will come if you engage with the material. I really like how the JCD (Journal of Cosmetic Dentistry) issues are organized, all by theme or topic. For example, orofacially-driven smile design can encompass multiple areas of white and pink modification and the techniques to achieve them, often with novel combinations. After you have finished one lecture or topic, actively search out more on the same topic and really delve into it to gain maximal benefit. Don’t chop and change until you truly exhaust your interest. For example, if one is speaking about soft tissue augmentation and customized emergence profiles on immediate placement implant provisional crowns, some will focus on a pure digital workflow and what is achievable. It is similarly important to search out resources on the analog workflow to understand what combination of techniques is possible if something didn’t work out with one or the other. A blended technique often works well, but it is up to us to know as the bartender “what to blend” to create the drink.
What advice do you have for anyone hoping to become a speaker/lecturer?
CT: I would say that stage fright is often only an early deterrent. It is true that the more you do, the better you get at it. It is important not to look to others, or to have preconceived ideas as your ideals. Instead, desire to express your full personality in conveying your message. If you’re into avocados, have a lot of avocados on the slides, and use avocado flesh (sorry, flesh is a gross word) as an analogy for how for example very soft caries might feel (sorry, now I’ve tainted your image of avocados). The bottom line is to find an area of interest and really delve into it. Everybody has experience that is valuable, experience that they can share. Being a lecturer stems from how you wish to help others in raising the bar of possibility and outcomes in clinical practice. Try to generate emotion in the crowd.
What Dental Courses Are Right For You?
How to Decide What CPD is Right For You?
We have all heard and been told that our dental degrees are just the licence to start learning and while we have to do some CPD to fulfill our requirements for registration, dentists who want to excel and want to continue to learn and improve will always seek out CPD.
There are many reasons for taking CPD and this reflects in the huge variety of courses you see listed on CPD Junkie. The obvious reason for taking CPD is to learn. Learn a new clinical skill, learn to communicate, and learn to run a dental practice.
Beyond the obvious, CPD connects us with a community of dentists, serves to motivate and can even offer up a chance to travel.
How to Choose What Dental Courses are right for you?
As with most things, it is easy to get overwhelmed when it comes to choosing the right CPD. So how do you decide what course is right for you? This is a big topic and if there was one distinct and clear answer then we would all simply follow that path. In general there are two main schools of thought when it comes to this; the doubling down on your strengths school of thought and the expanding your clinical scope school of thought. Both of these approaches have merit and both of these approaches are superior to the alternative which would be taking CPD without a plan just to fill your requirements.
In general there are two main schools of thought when it comes to this; the doubling down on your strengths school of thought and the expanding your clinical scope school of thought.
The doubling down approach involves taking courses in areas of strength to expand skill within these disciplines to allow you to take on exceedingly more challenging cases. Over time, an approach like this would translate to you becoming a dentist with a special interest in these areas. For example you are in general practice and notice that you really enjoy and are good at root canals and so you decide to focus most of your CPD investment into endodontic courses.
Conversely, the expanding your clinical scope approach involves reflection about your current clinical abilities and determining the areas where you are weakest and deciding to take CPD in these areas to improve. This approach would make you a better generalist and allow you to be quite well rounded in terms of your clinical skills. A jack of all trades, master of none approach.
When it comes to deciding what CPD to take there are several factors you should consider and before making any big investment it would be wise to have thought these through:
- What types of procedures do I enjoy and want to get better at?
- What procedures do I find challenging and want to become better at?
- What types of procedures would serve my patients’ needs the best?
- What are my long term plans clinically?
- How do I plan on implementing what I learn at the CPD event back into my day to day practice?
The more I read, the more I acquire, the more certain I am that I know nothing.
Interested in Learning More and Using the CPD Junkie CPD Planner Cheat Sheet?
Blog Post: June 2021
CPD Junkie Blog
It’s best to use the DiSC behavioural system as a basic framework to help you present your treatment plan based on your patient’s “behavioural type” and their priorities."
Motivating Different Personality Types using the DiSC Behavioural System
Ever take a personality test and wonder how accurate the results are? More importantly, what can we gain from these different “personality types?” Communication. Particularly, how to communicate effectively with people who may be ‘wired’ differently. Dentists are always striving to motivate patients to adopt better dental hygiene regimes and accept treatment plans. However, the real challenge arises in tailoring these difficult conversations in a way that the patient is motivated to get something done and actually pay for it!
The DiSC behavioural system, originally developed by William Mouton Marston, broadly describes four different observable tendencies/ behavioural types and the personality traits often associated with them. In turn, this can give us a better insight of their everyday decision making process, personal preferences and communication style.
Dominance (D)
This type of patient needs to see results. There is no time for small chit-chat. They want you to get straight to the point and provide a solution. “There’s hole in your tooth, so let’s fill it.” Time is valuable and by respecting what they value, you are more likely to resonate well with them.
Influence (I)
Similar to the Instagram Influencer, this patient likes to socialise and build relationships. Don’t worry about the nit-picky details and focus your energy on carrying a conversation centred around their concerns. These patients are naturally enthusiastic and optimistic and will likely be keen to get treatment started. Get them involved in an effective oral hygiene regime and they will likely follow through.
Steadiness (S)
The quiet patient. This patient is described to be tactful, even-tempered and focuses on cooperation, consistency, and security. Their quiet nature may be due to anxiety, so it’s it best to provide them with enough information to inform them but abstain from bombarding them with too much. Small, gentle steps work best, similar to teaching someone. For example: To place a crown on a tooth, it usually takes two visits. One visit will be used to prep the tooth and place a temporary crown on it. The second visit is when we take off the temporary crown and place the actual crown on the tooth.
Conscientiousness (C)
Finally, this is the reserved, analytical, and systematic patient that highlights the importance of quality, competency and precision. These patients tend to ask a lot of questions and expect detailed responses. It’s best to provide the relevant information with pamphlets (when possible) and guide the conversation, otherwise you may end up on a tangent. That way they can do their own research after the appointment.
Although this is may seem rather simplistic as patients are more complex and can be a combination of various traits. It’s best to use the DiSC behavioural system as a basic framework to help you present your treatment plan based on your patient’s “behavioural type” and their priorities. However, it should also be adjusted according to the individual’s needs and not be used as a substitute to build meaningful relationships.
Expert Q&A – June 2021
Expert Q&A with: Dr. Geeta Perks
"Digital marketing is the most powerful way to get your brand in front of prospect patients, getting yourself and your team out in-front of prospect patients and building trust with prospect and existing patients."
Bio:
Dr Geeta Perks is a dentist with 20 years clinical experience having worked in prestigious practices and family dental practices, in both the UK and Australia.
Geeta has consulted for Dental Focus UK/Ireland for many years, helping dentists grow their businesses by attracting their ideal new patients. Dental Focus is founded by her brother, Krishan Joshi in 2001, in London during the dot com boom, and today is the leading dental digital marketing agency in the UK & Ireland.
Since moving to Australia, Geeta started the sister agency called Dental Focus Marketing It specialises in helping dental practices in Australia and New Zealand grow exponentially, by attracting their ideal new patients. This is achieved through integrated services: state-of-the art dental websites, Google Domination with Page 1 rankings through SEO and Pay per click advertising, and social media marketing to help to build PR and Brand Awareness online in local communities.
They provide clients with guidance and direction on aspects such as AHPRA compliance, and marketing strategies through consultation services using successful, proven strategies for dental practice growth. They are proud to have created over 1000 dental practice websites globally and have grown through word-of-mouth.
Coming from a family background in dentistry, Geeta understands the strategies needed for successful practice growth in this highly competitive consumer market. As a family, she’s helped to co-found of The Mouth Cancer Foundation Charity, which helps to spread the awareness of early detection of mouth cancer in the public, as this helps to save lives. Every year the MCF holds a free 10 km walk around London’s Hyde Park where survivors, carers, their families, dentists and the dental industry can join in.
Geeta understands how to find and grow a niche market, best strategies for ethical dentistry and how the power of social media can really grow your dental business. In 2019, she was awarded Fellowship of the Pierre Fauchard Academy for her contributions to dentistry.
Having practiced in both the UK and Australia, what’s one thing you wish you could implement in Australian dentistry that you’ve picked up in the UK?
I think the way that private dentistry is practiced in the UK and Australia is very similar. I think we’re very fortunate to live in an age where training and education is available online and dentists have easy access to further education, making practicing more uniform. And that’s certainly the case in the UK and Australia, where the differences in practice are small.
When I left the UK, ten years ago, dentistry was perceived as being much more accessible and affordable to the general public when compared to dentistry in Australia. Admittedly, the intervening years has seen this perception change somewhat. So, I’m all for making dentistry as accessible as possible. I’d love to see more accessibility to dental services across Australia, and we have the tools available to make this possible.
Was marketing something that you always wanted to get into, or did practicing dentistry and realizing the importance of marketing get you intrigued? How did you get started with creating Dental Focus Marketing?
Yes, I’ve always had a special interest in dental marketing. At the time I graduated from Manchester University my brother Krishan Joshi created Dental Focus in London. This was during the dot com boom. Through working in practice and helping Krishan with his business, I learnt a lot about dental digital marketing and how to grow dental practices. I’ve consulted for Dental Focus for many years. Today, Dental Focus is the market leader in dental digital marketing in the UK and Ireland.
After moving to Australia, I created the sister company called Dental Focus Marketing. I had experience in working for multiple practices, prestigious and family dental practices, in Australia and I soon realised that there was a real need for a digital marketing agency to help dentists grow their businesses here. I found most practices are doing ad-hoc marketing and using marketing companies that don’t know the dental industry. There was, therefore, a niche for a dental focused marketing company to help dental practices think more strategically about their marketing.
The main vision, when I started Dental Focus Marketing, was to create a digital marketing agency that would help dental practices grow their businesses by attracting their ideal new patients through integrated services: compliant websites that are bespoke, Google Domination strategies to be found at the top of Page 1 through SEO and PPC (pay per click) and social media marketing for PR and brand awareness for practices in their local communities. Giving clients guidance and direction on aspects like AHPRA compliance was also very important.
Today, dentists come to us because they want to engage digital marketing experts that genuinely care. We care about the dentist, their team and most importantly their ROI for practice growth. And the main reason why we care is because I’m a dentist. I’m also from a family background in dentistry, so we genuinely understand where dentists are coming from and the day-to-day running of their business.
So, coming back to the question, for me, it was all about creating freedom for the dentists to be able to save them time so that they could spend their time on things they enjoy: treating their ideal patients, or spending time working on their business and spending time with their families for instance. For me it was all about creating that ideal dental digital marketing agency for dentists.
When do you suggest dentists implement Google Ads (PPC)?
Google Ads are a way to get your practice name out there on Google by renting out advertising space. It works by someone clicking on the ad (the ad is typically a one liner offer which links to your website or a focused site called a ‘squeeze’ or ‘landing’ page). Google Ads are known as pay-per-click PPC advertising. How much is spent depends on the competition for keywords and location. Spending money on Google Ads leads is a quick way of getting in front of prospective patients, but it may not necessarily the best way. The patients who come through Google Ads are typically cold leads, and they may not be ready for treatment like those who have done more research.
I remember a dentist approached me for a consultation and we soon found out that he was doing his own marketing. He was spending a lot of money (>$3k/month) and, perhaps more importantly, spending is own time managing his practice’s Google Ads. He was only getting 1-2 leads a month. Firstly, he didn’t understand the best way to use and maximise Google Ads so wasn’t getting the results he should have. Google Ads is something you can start very quickly, but you need to understand the best strategies to get the results you want. Secondly, he didn’t realise that his website was not converting those leads and he was continuing to spend the money like a leaking tap. I always say that all roads lead to Rome, where Rome is your website. If you do decide to run ads, you need to make sure that you have highly converting website in order to convert these patient leads. Otherwise, most people will bounce off the website and you won’t see any return on that advertising spend.
Google Ads are a short-term strategy, typically recommended for practices that urgently need patients to fill up their books. They are also recommended for those practices who are investing in SEO and are waiting for their website to dominate in the top two spots on Google organically. Once the practice is dominating organically, they typically stop advertising as they don’t need it anymore.
If you’re not investing in digital marketing, then your competitors certainly are, and they’re steeling a march on you. Whether you know it or not, your competitors could be hoovering up your prospect patients.
Digital marketing is the most powerful way to get your brand in front of prospect patients, getting yourself and your team out in-front of prospect patients and building trust with prospect and existing patients. There are people out there who want your services, but they might not know you exist! They can’t find you in Google searches, have never heard of you or don’t trust you or don’t see the proof that you’re the experts at what you do. They’re going to go elsewhere where they can find the services that they need, or think that they need.
Understanding the right digital marketing strategy for your circumstances is therefore key. One size does not fit all! There are different aspects to digital marketing, and marketing strategies can as broad or as focused as they needed. For example, a new start up practice with no patients and no digital presence will require a different strategy from a practice with an existing patient list that wants to take their business to the next level and wants to attract high-end treatments such as Invisalign or Smile Makeovers. It’s also different from a specialist practice wanting to get more referrals from dentist or different to dental course providers wanting to attract more students.
For the majority of dentists out there, you really need to understand that it’s about the whole patient journey. You need to consider everything from the external marketing to the front of house to patient’s in-chair experience. All these things help determine whether patients return to your practice.
Whilst Dental Focus Marketing are typically tasked to deliver digital marketing, it’s really about making sure that the whole patient journey flows smoothly. We spend time with all of our clients adding value and consulting with them by learning about the internal processes of their practices so that their digital marketing strategy seamlessly compliments their practice’s operations. Dentists need the right guidance and direction to understand what’s the best strategy to deliver return of investment for them. This can make the difference between a practice turning over a 6-figure income or a 7-figure income
As I’ve said, all roads lead to Rome, where Rome is your website. Regardless of whether they are existing patients, new patients, or word-of-mouth patients, they will always do their research, and look you up. They will look you up on Google, they will look up your reviews, the public will look you up on social media, and everything feeds back to the website. Yes, digital marketing is not going away.
Dentists come to us for the right strategy and marketing management. We typically recommend practices to invest in their high-performance website and advanced SEO to dominate at the top of Google page 1. And invest in social media marketing for PR and brand awareness in their local community, and Google ads only if they need patients urgently.
Speaker Spotlight – June 2021
Speaker Spotlight with: Dr. Agnes Lai
The success in treatment I have learnt is beyond the clinical execution. It is, instead, about the change in the patient's attitude and commitment towards the maintenance of their teeth or prosthesis and their increased dental awareness. That is where creativity and gratitude thrive in both the clinician and patient, creating smiles in all."
Bio:
BDS USYD, DCLINDENT (Prosthodontics) USYD, MRACDS (Prosthodontics)
Dr Agnes Lai obtained her Bachelor of Dental Surgery from the University of Sydney (USYD) in 2002, during which she was awarded the G.S CAIRD Scholarship in Prosthetic Dentistry and shared Faculty Research Prize.
After practicing as an intrepid general dentist in Singapore, and metropolitan Sydney, Agnes completed her Doctorate of Clinical Dentistry in Prosthodontics at her alma mater, USYD in 2009, and was admitted as a member in the Royal Australasian College of Dental Surgeons in the same year.
Agnes had been involved with the hypodontia research in Westmead Centre for Oral Health, and has published her research in human neural adaptation related to an increase in occlusal vertical dimension using fMRI. She is also a contributor to the textbook “Oral Rehabilitation: A Case-Based Approach.”
Currently, Agnes practices prosthodontics in private practice at Sydney Prosthodontic Group, Chatswood, as well as a clinical specialist at Westmead Oral Restorative Sciences Department in the Public Sector.
Agnes had been a past Lecturer of Oral Rehabilitation at USYD where she was involved in both undergraduate and post-graduate teaching of prosthodontics and dental implants. She has been a past convener of a 5-day Continuing Education Program for Prosthodontics at USYD. She currently maintains an ongoing Clinical Educator role in the discipline of prosthodontics to Doctorate of Dental Medicine via her role at the teaching hospital. Agnes has served on the federal executive of the Australian Prosthodontic Society in the past, and is currently serving as a State Representative for the Australian and New Zealand Academy of Prosthodontics.
Her extensive experience in general and specialist practice, locally and overseas, and her friendly approach to patient-care provide our patients the highest quality specialist prosthodontic treatment in a warm, caring manner. She enjoys teamwork with her patients to rejuvenate, restore and create people’s smiles that is unique and tailored, with a comprehensive approach including mindfulness on aetiology, and recommendations on preventative strategies and risk mitigations.
Agnes is a mother of three delightful daughters and enjoys spending time with her family. She enjoys cooking, singing, theatre, travel, and playing the piano by leisure. She was born in Hong Kong and migrated to Australia in her primary years. Whilst remain fluent in Cantonese, she can also communicate in Mandarin and finds interest in Japanese and French though limited to holiday phrases only.
Publications:
Machado M, Wallace C, Austin B, Deshpande S, Lai A, Whittle T, and Klineberg. Rehabilitation of ectodermal dysplasia patients presenting with hypodontia: outcomes of implant rehabilitation part 1. Journal of Prosthodontic Research. 2018 Oct;62(4):473-478. https://doi.org/10.1016/j.jpor.2018.07.001
Lai and Klineberg. Oral stereognostic ability associated with increased vertical dimension, its relevance to satisfaction and adaptation. Professor Klineberg’s Symposium
Lai and Desai. Cracked Teeth- Cracking Problem in Dentistry (Part 1 to 5). June 2018 Australian Dental Association Online Continuing Education Videos
Lai, Korgaonkar, Gomes, Whittle, Foster, Williams and Klineberg. fMRI Study on Human Subjects with Sudden Occlusal Vertical Dimension Increase, Jacobs Journal of Dentistry and Research 2015 2(2):020. https://jacobspublishers.com/fmri-study-on-human-subjects-with-sudden-occlusal-vertical-dimension-increase/
Chapter contributor to a text book, “ Oral Rehabilitation: A Case-based Approach”, Case 10.3, Case 11.2 and Case 13.2, Wiley-Blackwell Publishing (2010)
You have managed a case where the patient had Amelogenesis Imperfecta. What did you find to be the most challenging aspect of the case and how long was the treatment planning process prior to completion?
The most challenging aspect in these type of cases is patient’s expectations and mindset. Fortunately, this patient had a very supportive family, both emotionally, psychologically and financially. He also had an excellent paediatric dentist who provided strong dental awareness and commitment to good oral maintenance of his teeth and future restorations. All of these helped to finalise our treatment goals and readiness for active treatment and maintenance. The treatment planning took one appointment, as this patient has had treatment option discussions on multiple occasions with previous dentists throughout his childhood and adolescence; therefore, he came to me with clear directions of his treatment goals. The design process until completion took 10 appointments over 3-4months.
How do you manage patients that end up needing/ wanting full conventional dentures (without implants) for the first time? Have you had a case where the patient never adapted to the dentures and if so, what did you end up doing instead?
Patients who are about to receive conventional full dentures must understand the relative advantages and disadvantages of the removable prosthesis. They must also understand how the retention and resistance form and support work, in order to embrace the limitations of function, and the maintenance required. Like learning to use any apparatus, positive mindset, skill acquisition and adaptation are important elements of the rehabilitation process. Often, by this stage of understanding, the patient will have a good idea of whether or not they will accept conventional dentures.
In cases where the patient may find adaptation challenging (associated with prosthesis retention), dental implants can be great alternative, especially in cases where patient’s lack the muscular control or coordination for a loose conventional mandibular denture. Instead, implant retained or supported prosthesis can provide a dramatic improvement in adaptation, as the skill for learning to use them is less demanding. However, when the adaptation is difficult due to mindset, or other movement disorders, then we may have to work with those challenges more specifically. The solution may not lie with the dental prosthesis design or treatment., but rather with the alignment of the patient’s or family’s expectations and their needs.
Implants are often a replacement option. However, if an implant fails, what would you do? What other replacement options would you offer for a patient who is set on getting implants (i.e., placement of a second implant, bone grafting, etc.)?
Implants or its prosthesis can have complications or fail too. If an implant fails, that is, loses osseointegration or fails to integrate, it will need to be removed. The case will have to be restarted and should consider all possible treatment options. Implant re-treatment may or may not always be possible, and often would require multiple surgical procedures with increasing treatment complexity with the risk of failing again. If the patient is set on getting implants again, it is important to identify those particular risk factors that can contribute to increase chances of failure. Where possible, those risk factors should be controlled first. To minimise the occurrence, a history of periodontitis and parafunction must be considered. Sometimes it is not as straightforward as such, the patient’s level of comprehension to appreciate the complexity of treatment and outcome expectations need to be realistic and on par. An appropriate maintenance schedule or servicing need would also have to be discussed and planned along with case selection, especially patient motivation and suitability.
What is one thing you want everyone to know about prosthodontics or something you learned during your years that you would like to share with other dental professionals?
Prosthodontics is very rewarding because you help witness the oral rehabilitation process and improvement in the quality of life in your patients. The success in treatment I have learnt is beyond the clinical execution. It is, instead, about the change in the patient’s attitude and commitment towards the maintenance of their teeth or prosthesis and their increased dental awareness. That is where creativity and gratitude thrive in both the clinician and patient, creating smiles in all.
The success in treatment I have learnt is beyond the clinical execution. It is, instead, about the change in the patient’s attitude and commitment towards the maintenance of their teeth or prosthesis and their increased dental awareness. That is where creativity and gratitude thrive in both the clinician and patient, creating smiles in all.”
Blog Post: May 2021
CPD Junkie Blog
"Social media gives you the power to share knowledge, attract new patients and grow your dental practice."
Why Your Dental Practice Needs To Join Instagram, And How To Get Started.
Social media has undoubtedly transformed how dental professionals can connect with patients and educate the community. It’s time for you to dedicate some of your time, or your marketing budget, to social media. Social media gives you the power to share knowledge, attract new patients and grow your dental practice. Do you really want to miss out on all that?!
So many dentists invest in innovative technologies, but they don’t advertise them enough. Think about it, if your main method of external advertisement is Google Ads and flyers in the local community, are you really able to showcase all that you offer? Of course, you can fit in “CAD/CAM same day crowns available” in a corner somewhere; but, how many people not in the dental field really understand what that means? How many will actually google it or call you to understand it? I think we can all admit, not many. However, if you showcase your CAD/CAM machine periodically through your social media pages, you’re bound to capture attention and educate potential patients.
Just recently, I had generated 4 new patients for a dental practice by posting about their DEXIS CariVu. In the post, I explained what it is, how it works, and added a picture of it being used on a patient, and the image it generates. This ensured that people could tell it was safe, and they could see how we as dentists are able to detect decay with the resultant image. My favourite part is that I made that post months ago. I know sometimes we may take our time to create something, yet it barely gets any interactions. That’s where social media is great. That information will stay on your feed for people to see months, even years later. So, for those dentists that did start up a social media page and got discouraged because it was not generating any leads, I want to assure you that one day you will enjoy the fruits of your labour. But, for that to happen, you need to be consistent, you need to interact with followers, and you need to use the right hashtags.
Be consistent
The best way to ensure this is to outsource and have somebody in charge of the social media pages. Whether you want that person to be a hired social media content creator, an existing front desk staff member, or your nephew, that’s totally up to you. However, be mindful that people like seeing people. For your account to be successful, you cannot use entirely stock images and text. You or someone at the clinic, needs to take pictures of your office, technologies you offer, staff and patients (with consent). Another way to ensure consistency is to dedicate a few days that you will post on. To figure out which day will give you the most interactions, look at your analytics. This will show you when you get the most interactions with your posts. In the beginning, experiment and post on different days and times, then look at your analytics to determine the ideal time.
Interact with followers
This is a win-win interaction. Not only will this make them feel good about themselves, it also puts you out there for their followers to see. Whenever you comment on a patient’s photo, their followers will be able to see. This is an excellent way to provide your account and practice more exposure as most likely many of their followers live in the same area, thus can be potential patients. Also, as a general give and take rule that we as humans follow, the more you interact with their content, the more inclined they will feel to return the favour.
Use the right hashtags
Hashtags will be where most of your exposure will come from as you start up. Instagram allows you to use up to 30 hashtags. I recommend using about 10 dental/ content specific, 10 general and 10 location-specific. For example, if you are posting a video of you scanning a patient’s mouth with an iTero scanner for Invisalign, utilize hashtags such as:
- #invisalign, #clearbraces (dental/ content specific)
- #videooftheday, #smile (general)
- #Townsvilledentist, #Townsvillebusiness (location specific)
These ensure you reach out to people interested in the service you offer (Invisalign), and also people in your area (Townsville). The general hashtags will help you get more interactions, which most likely won’t generate leads; but it helps the Instagram algorithm notice that users are liking your content, and Instagram will display it more to other users. This will ultimately give you more engagements in the end.
Those are the 3 main tips I recommend for running a successful dental practice instagram. It may seem overwhelming and not worth it at first, but if you are dedicated to it, it will prove itself beneficial. Of course, Instagram is not the only social media, but it is becoming increasingly popular for users to discover businesses on. So, why should you miss out on these leads? Join today on instagram.com.
Expert Q&A – May 2021
Expert Q&A with: Dr. Kalyan Voruganti
Implants are a long game – they can have issues and they are complicated and expensive to fix...they can be great and truly life changing but you have to pick your cases – make your life easy!"
Bio:
Kalyan qualified in 2005 with Merit from Cardiff University in the UK, as one of the top ten students in his year. Not long after graduating, he did further study and gained the prestigious Member of the Faculty of Dental Surgery (MFDS) in 2006 from the Royal College of surgeons of Edinburgh. With a thirst for learning, he has also completed a 2 year orthodontic diploma (with Dr Derek Mahony in 2017) which focuses on early interceptive orthodontics. This tries to prevent problems and treat them early. He has been placing Dental implants for almost 10 years and often mentors colleagues and graduate dentists to plan out their own cases. He has also worked in Liverpool Dental hospital and in Community specifically treating highly anxious patients. His focus is making his patients’ dental experience as pleasant as possible and communicating very clearly to ensure patients understand their treatment.
He is actively involved in Dental associations as well as multiple Dental forums. Training younger Dentists is something Kalyan really enjoys. He has also completed a teaching certificate in 2017 at the University of Melbourne and has been involved in training Dental Therapists and Hygienists as well as general mentoring of younger Dentists with the General Dental Residency (GDR) scheme.
You are an expert in managing anxious patients. How did you go about that and how have your techniques changed over the years?
Treating anxious patients is one of the most rewarding, yet also the hardest parts of our job. During my time as a maxillofacial senior house officer working in hospital, I would introduce myself to patients as a head and neck Doctor instead of a Dentist. The difference in patient anxiety levels vs introducing yourself as a Dentist is noticeable – you’ve all heard the phrase “It’s nothing personal but I hate Dentists”.
After graduating I went into hospital rotations doing Maxfax and general dental. This included special needs, severely phobic patients, IV sedation and GA. This allowed me to hone my skills. It’s the simple strategies that work. You’d be surprised how often these patients can be managed with conversation and comfortable Dentistry.
Technique wise, a lot of people jump to RA, IV or GA. These are options that should be provided but don’t need to be used as your first port of call. It’s important to look at the patient journey, especially as a practice owner – every little thing needs to be considered. Often these patients experience anticipatory anxiety and have been thinking about your appointment for the whole week beforehand. When they walk into your clinic (and even the phone call before), how are they greeted? What does the patient lounge look like and smell like? Are there any pictures which would increase their anxiety? When they come into the surgery, how do you greet them?
With experience, I have found that by working all these touch points out and making sure everything is set up to support anxious patients, they are getting the best experience possible. At the end of the appointment, I also ask how it went and make a note of what we can do better next time. Some patients want extra anaesthetic right from the start. By doing this, I get referrals and more anxious patients and the more you see, the better you get at treating them.
Even if you use oral sedatives or IV sedation etc the basics still apply – use topical on dry mucosa for 2 minutes, use hypnosis / distraction techniques while you are giving local, your DA can give the patient a gentle hand squeeze or a touch on the shoulder. These don’t sound like much but to a nervous patient it can make a massive difference. When I give an ID block, I check the tooth due to be worked on with ethyl chloride to make sure the patient is numb before I place dam on and start drilling. This ensures there are no shocks after you start drilling! I also check and ask how they are doing each step of the procedure as well, giving them updates e.g. “I’ve removed the decay / I’m filling it now about 20 minutes left”. This gives the patient something to look forward to as otherwise they have no idea how things are going.
Tell us more about your teaching. What do you enjoy the most and what do you find to be the most challenging aspect of it?
I’ve been very lucky to have some great mentors. They were generous with their time and very patient with their teaching and I’d like to think that I’ve picked up some of this generosity from them. Teaching is something that I genuinely enjoy, there’s a phrase “rise by lifting others”. I honestly find it so rewarding to watch people I teach gain confidence and implement things they’ve been taught. To watch newgrads go from being nervous about their first DO, their first prep, their first “big” treatment plan to then consistently doing them couldn’t make me prouder.
The most challenging aspect of it is probably the student / mentee. Mentees vary a lot and I’ve noticed in more recent times, there can be a lot more confidence (quite often misplaced) in people who are relatively newly graduated and inexperienced. They want to place implants and do big cases in their first year or two of graduation. I really do believe the first 2-3 years should be spent on mastering the basics, especially communication skills before venturing on to more complicated things.
You have worked in both Australia and the UK, did you find the transition to be smooth or what were the main differences you faced when moving here?
That’s a very interesting question. I’d been brought up and lived in the UK my whole life so it was a momentous change moving to Australia. A lot of things surprisingly fell into place. Despite a tough job market, I found a job and accommodation etc quickly and when that happens I always think it’s a good sign.
It was relatively lonely I guess when I first moved though, I lost my friends and my dental network overnight. It was daunting not knowing anyone. Thankfully, I had a great group of people at my work, including my now business partner who helped me settle in. I was introduced to the DPR facebook group when it only had maybe a thousand or so people in it and met so many people who are now my close friends.
The main differences I found are that in the UK people are happier to sue their dentists and it happens quite frequently over very minor things. The NHS also devalues dentistry in my opinion as people expect everything for free. Here in Australia, you can earn well whilst doing really good quality work. The risk of getting sued is a lot less and so you can actually enjoy your Dentistry. I love it over here and honestly don’t think I could ever go back, thanks ‘straya
After a decade of planning and placing implants, what is one thing you wish you knew back when you were first starting?
Also, a great question! This is an easy one – learn to say no. When you first start placing implants, you want to place them in every gap you see, every fractured tooth or post crown that debonds. You may also place them in places where there isn’t much occlusal room or oral hygiene isn’t quite right.
Implants are a long game – they can have issues and they are complicated and expensive to fix. Unfortunately, the longer you’ve been doing them, the more of this you see including failures. I have actually added a long section to my consent form about peri-implantitis and other complications because I want my patients to know what they are getting themselves into right from the start. Implants are great and can be truly life changing but you have to pick your cases – make your life easy!
Speaker Spotlight – May 2021
Speaker Spotlight with: Dr. Toni Surace
Practice ownership is more about managing a team than it is about clinical dentistry. Just being a good dentist is not enough to make you a good business owner."
Bio:
Dr. Toni Surace graduated from Melbourne University in Dental Science in 1995 and formed her practice, Smile Style Dental in 2000. As a Principal Dentist, Dr. Surace went through the Momentum Management Program and found by implementing procedures, protocols and systems, she could run her practice remotely and leverage her time. This enabled her to be selective in the type dentistry that she personally did and allowed her to fulfil her other passion of helping dentists run their business more effectively and efficiently. She then became a coach and trainer at Momentum Management and loved it so much that she decided to buy the company!
Today as the head of Momentum Management, Toni has become a renowned international presenter where she is able to draw on her own experiences as well as her clients to help others tackle any issue impacting their practice. As the winner of the ADIA Dental Industry Professional for the Year in 2012, she was formally acknowledged by the industry for the much-needed work she does to assist other Dentists.
To further assist dental practices, Dr. Surace has also written a book titled “Be Exceptional – 50 Dental Practice Systems to Kill Average and Wow Even Your Mother-in-Law”. Dr. Surace further assists dentists by addressing questions concerning the dental community within her Q & A column “Best Practices” in Australasian Dentist.
Toni is an enthusiastic, energetic presenter that delivers high value at every course she presents. She has formal training in team building and team management, positive psychology, digital marketing, business and leadership. Toni is passionate about people and dentistry. In her role as international presenter, coach, trainer and mentor to dental practices, she thoroughly enjoys assisting people to grow within dental practice management, marketing and communication.
Toni is changing dentist’s lives and lifestyles every day. She is passionate about people and passionate about dentistry!
Did you find that having five years experience post- graduation sufficient to start your own business? What were the benefits and challenges you faced?
Does anyone ever have enough knowledge to start their own business?! I wish I knew then what I know now! I think there comes a time when you realise that working for other practices is not right for you anymore and that it is time to take a giant leap of faith in yourself. I had got to a point where I could not find a practice to work in that shared a similar clinical philosophy to me. I am very much a preventative dentist who loves to practice biomimetic dentistry. I often found I was not able to provide clinical options that I believed were the correct ones for my patients. I was ‘encouraged’ to place crowns etc. when I believed a well-done composite would have been more beneficial for the patient and I decided that I had enough, and I would buy my own business. I was very fortunate to have an extremely supportive family and accountant by my side who made the transition into ownership relatively easy. I was also able to draw on my experience in running a practice for an absent owner when I worked in country Victoria. My 2 years in the country gave me a lot of confidence, both clinical and business. I had no one to refer to, no one to discuss cases with and I just had to learn how to do things on my own! Confidence is paramount if you want to succeed in dentistry!
One very early challenge was my first day in my own practice that I had purchased from a dentist who had been practicing for 20 years. I remember my concern about having full books of patients and not even thinking about staff. The night before I started on my first day, the DA called in sick. I had no idea what to do and didn’t even know the name of temp agencies, so I panicked until I called one of my previous bosses for support. That was not the end of it! The next day when I was seeing patients, the receptionist came and told me that unless I paid her $5 more per hour, she was leaving! I had no idea how to respond, so I panicked and said yes. What a bad move…. A year later, she was still causing issues but by then I had found my footing as a practice owner and was able to deal with the situation in a better way. Practice ownership is more about managing a team than it is about clinical dentistry. Just being a good dentist is not enough to make you a good business owner. I wish I had known this back then!
How did you transition from being an in-chair clinician to working remotely? How long was this process?
I was practicing in my own business for about 10 years before I was able to ‘autopilot’. There was a lot of water that went under the bridge during that time, and I have to say, life was not easy for me as a business owner, mum and wife. To be perfectly honest, I struggled greatly with anxiety, depression and perfectionistic tendencies that after about 5 years of trying to balance all of my hats, I had a nervous breakdown and tried to commit suicide. I was lucky, I survived but I still remember the feeling of hopelessness, the mental pain and stress that I just wanted to stop and taking my life seemed like the only answer.
Once again, I had an incredible support team by my side and once they knew there was an issue, they were there to help. I didn’t talk to anyone about my issues, didn’t ask for help and that proved to be the cause of my demise. My family wouldn’t let me go back to work without getting help. I did every practice management course under the sun in Australia and overseas, and I was able to implement systems and protocols that made the business more about my team than myself ,and that allowed me to practice 3 days a week. ‘Mummy hours’, rather than 5.5 days per week full time. After a few years of working this way, and after multiple requests for help from my colleagues, I decided to put my practice on ‘autopilot’ and run it remotely, while I helped people through my company, Momentum Management. One of the key requests I get is for help with systems and enabling owners to buy multiple practices, work less and still have a great income. I know that on average, it takes approximately 3 years from going into work full time to working exclusively remotely. It takes a lot of work and effort, but it is worth it!
You are now the Managing Director and Director at Momentum Management and Practice Entrepreneur Network, respectively. Tell us more about these businesses. What courses/ words of encouragement would recommend to others thinking of venturing into the business world/ new practice owners?
Momentum Management is a company that helps dentists become the best possible version of themselves. We teach communication skills, leadership, practice systems and processes and we help people start their own businesses and live out their dreams. We are all about life and business mastery. I am very proud of my company, which I am involved in on a hands-on level. Everyone we employ has been working in the dental profession for many years and we focus on building a support team in practices, so dentists can do more of what they really enjoy rather than being tied down by business. We give dentists freedom!
Practice Entrepreneur Network is a partnership that I own with Emanuel Recupero from Dental ED. We have combined high-end clinical education together with communication and practice management skills to help dentists grow and provide superior outcomes for their patients. Check out our Facebook Group Dental Evolution, we provide free continuing education for dental professionals.
If you are considering business ownership, I can highly recommend you attend one of our Mini Business Programs. This is a 3 day course on practice management and business ownership that will help you understand what it takes to run a dental practice in 2021! (We will be able to offer a discount to your group if you would like!)
Blog Post: April 2021
CPD Junkie Blog
Like everything good in life, there must be a balance. It is not something you find, but something you create."
Work-Life Balance–
Can we Really Have it all?
So why the imbalance? It is thought that work can provide purpose, can encourage a sense of community, boost productivity and good habits, and more importantly, provide the financial basis for living. As we all know, overhead costs are not free. Although work may provide many desirable rewards, there is a misconception that ‘more is better’, which can result in people working long hours for diminishing or even worse returns.
But why is work- life balance necessary? It can
- Prevent early burnout and reduce stress– by keeping your work and life separate, you can try to leave the stress at work and retreat home for some necessary rest and relaxation;
- Promote a healthy mind and body– the mind and body are inseparable, having a healthy mind and body can lead to higher energy levels and emotional stability;
- Increase productivity– it is about the quality of time spent not the quantity. Studies found that people work more overtime hours are less productive (Shumizu et al., 2004). Remember a fatigued mind is an unproductive mind; and
- Make you more well-rounded– it is okay to have a life outside of your job. In fact, it is encouraged. You are, above all else, a human. Try to use those outside interests to connect with others and pursue hobbies outside of the mouth.
So how do we manage to pursue your passion while still having a life at the same time?
Here are a few ways to start:
Stop and take care of yourself – burnout is not the solution
Spend some time to re-evaluate your values and prioritise interests that matter to you. Ensure you take breaks, get some daily exercise and incorporate good habits. Patients can tell when you are stressed, so instead of rushing through that last filling, use the extra time to go over treatment plans, type your notes or enjoy a quick stroll in the sun.
Live in the present
Although easier said than done, try to focus on the now. Deadlines and tomorrow’s woes will happen whether you worry about them or not. Best to direct your energy towards the task at hand and leave the worrying for tomorrow.
Set Boundaries
Establish a routine that encompasses both work and outside activities. It is okay to say “No” when situations arise outside those hours, most appointments can be rescheduled, anyways.
Practice Time management and Make a Plan
Try to restructure and organise your schedule more efficiently. Manage your time, so you can continue doing activities outside the clinic. Work smarter (remember those “SMART” goals you wrote down at the beginning of the year? Well, it may be time to revisit them), so you don’t have to break your back while working harder. Make a schedule, pencil in those date nights and make sure you follow through. Happy spouse = happy house.
Ask for help
If you find yourself overwhelmed, try to reach out to someone. Developing a healthy work-life balance can be difficult, but help is available, even when you think you do not need it. Learn how to manage stress effectively and let go of the little things, your staff will thank you for it.
Dentistry can be demanding, but it does not have to consume your every thought. Like everything good in life, there must be a balance. It is not something you find, but something you create. We work to live rather than live to work. Try to smile and enjoy those moments when you’re not thinking about how crooked those teeth are, although difficult, it can happen.
Expert Q&A – April 2021
Expert Q&A with: Dr. Melissa Chew
I think it is important to get good mentorship. Mentorship is invaluable, especially post-graduation. "
Bio:
Dr. Melissa Chew studied Bachelors of Dental Science at the University of Melbourne, graduating in 2013.
She fervently believes that education plays a major role both in empowering clientele with oral health knowledge as well as in one’s own continuing professional development.
Melissa’s area of expertise as a 7 year long practicing dentist in Lilydale resides in cosmetic and restorative dentistry.
Aside from the technicalities, Dr Chew possesses an innate ability to connect with patients at a personal level, building long standing relationships whilst assuaging apprehensions to put their minds at ease.
Besides work, she is quite fond of escape rooms and travel.
How do you find working in community clinic vs. private and how was our transition?
Both community and private clinics have their advantages and disadvantages. As a new grad, I found community clinic to be a place where I could improve my clinical skills after graduation. I was able to enhance my techniques, increase my efficiency and develop the fundamental ‘bread and butter’ of dentistry without having the pressure to meet business demands because you are on salary. I was also fortunate enough to work with great staff and make life-long friends. Alternatively, I found that working in the public sector also had its limitations. Depending on your particular interest, you will not be able to see a lot of prosthodontic and complex multi-disciplinary cases. You will spend most of your time doing restorative work, emergency care and cleanings.
On the other hand, in private practice, there is the additional pressure of meeting targets, time management, keeping your books filled and patient retention. Communication became the biggest obstacle. In community clinic, I found that I did not have to sell my treatment plan and building rapport was not as necessary. While in private, I could not sell the treatment plans without building rapport. Dental work can be costly and patients can be very reluctant about treatment expenses, so it is imperative that you convey the information well and provide patients with appropriate options. The transition from public to private was initially difficult; however, rewarding. There are genuinely positive aspects to both, but ultimately, I felt I had more potential to grow as a clinician in private practice.
Being a few years out, what advice would you recommend to new grads?
I think it is important to get good mentorship. A mentor can be anyone who imparts knowledge like a friend, relative, peer, teacher or someone you merely meet in passing. Someone who is willing to simply listen, make suggestions/ give advice, is supportive and understands what it means to be a new grad. Look for positions that offer mentorships specifically in your field of interest. Do not be afraid to leave a company if they are not willing to teach you and facilitate your learning, particularly early on. Mentorship is invaluable, especially post-graduation.
If you are struggling with something, ask for help (online or in person), take CPD courses, watch videos, etc. Be proactive and use the resources that are available out there, e.g. dental forums, Facebook, Instagram, podcasts. We are fortunate to have the information at our fingertips.
Speaker Spotlight – April 2021
Speaker Spotlight with: Dr. Mehdi Rahimi
I always approached research with a “Can do” attitude and believed that “Persistence is the key
to success.” Although you can fail, you can learn a lot from that failure, which motivated me to go forward"
"The most important thing is to inform the patient and deliver the news in a non-inflammatory way. Often, clinicians struggle with telling their patients of the misadventure and when they do, they stumble explaining it."
Bio:
Dr. Mehdi Rahimi (Principal Endodontist)
BSc, BDS Distinction (NZ)
DClinDent (Melb), FICD, FPFA, MRACDS
Adjunct Associate Professor (CSU)
President of the Australian Society of Endodontology (ASE NSW)
Guest Lecturer (Melb & Syd)
ADA NSW Councillor
Dr. Rahimi is an Adjunct Associate Professor at Charles Sturt University (Orange). Mehdi graduated with a Bachelor in Dental Surgery with distinction from the University of Otago (New Zealand) in 2002 and received his Doctorate of Clinical Dentistry (Endo) degree from the University of Melbourne in 2008. He has been actively involved in Endodontic teaching at various continued education levels, both nationally and internationally. Mehdi is a guest lecturer at Sydney and Melbourne Universities, and a CPD mentor and Councillor for the Australian Dental Association NSW. Mehdi has obtained a number of publications in the field of forensic dentistry and Endodontics (resin based obturation material and fractured instruments). In 2000, he was awarded the Sir Allan Wilkinson award for the most worthwhile research in Medicine and Dentistry from the University of Otago, in 2001 he was awarded the International Association for Dental Research Young Researchers Award and in 2002, Mehdi received the Pierre Fauchard Academy Award of Merit.
Mehdi is the current President of the Australian Society of Endodontology (NSW branch), the immediate past-president of the Australian Asian Association of Dentists, a fellow of the International College of Dentists (FICD), a fellow of the Pierre Fauchard Academy, a member of the Australian Dental Association (NSW) Education & Research Committee, a member of the Royal Australian College of Dental Surgeons in Endodontics, and a member of the Australian and New Zealand Academy of Endodontists.
You have published some articles on forensic dentistry. Tell us more about that and what you think all dentists should know.
My background, before dentistry, was in research, and I continued to pursue dental research during dental school through summer studentships. I was fortunate enough to start a project with a world-renowned researcher who had an interest in forensics and bite marks at a molecular level, precisely what bite marks left behind – bacteria.
Having had experience from my previous degree in genotypic analysis, I looked at the bacteria to determine what constituted the dominant strain in a bite mark. This can then be used to determine the perpetrator’s identification, so if it is speculated that the perpetrator is a male, e.g., the stepdad of the child, you can swab his teeth and the bite mark and compare the dominant strains. This is particularly important in the first 12 hours, where you can recover enough bacteria to determine the dominant strain and then match it to the possible perpetrator.
After I left, this research went further, and another colleague of mine looked into the dominant strain between twins and found this to be an objective method that can be used at the crime scene after rape or child abuse. Before, they compared the imprint bitemarks left on the skin, which can be subjective and difficult to match.
Once I got into post-grad training, I found research to be more rewarding. I genuinely enjoy having a project where you might do something repetitive whilst searching for an answer. Unfortunately, I did not have enough time to take on a PhD type research, but I continue doing a little research with students. One of the research projects I supervised the Sydney University students through is about to be published in the Australian endodontic journal in May.
If a file fractures, what is one thing you wish you had known as a new graduate or something you advise to all dental professionals when this happens.
I think the most crucial thing when these things happen is communication and management. Try to think about it in three parts:
- Did you inform the patient of the possible complications of treatment, and did you mention how it will be managed? If so,
- Did you do so in a non-inflammatory way, and
- Will a fractured instrument change the treatment outcome?
From the literature, we know that if most of the chemo-mechanical disinfection was completed before a file fracture, the patient would likely heal. It makes no difference whether the fractured file is left or not. It’s all about the communication beforehand, which many people tend to skip or do in a hurry because of the urgency of the situation: getting the patient out of pain. Often, clinicians forget that it is not until the second or third visit when the full instrumentation occurs, so I always recommend giving the patient the information before they leave so that they can read about it before the next visit. That’s how you make sure they are fully informed!
Being on the Dental Council, I have seen a lot of people dig their own holes. We find that complaints arise when patients are unaware of a file fracture because the dentist fails to inform them. Dentists refrain from telling the patient; they assume no one will find out, or they do not fully disclose the situation as soon as it happens. The most important thing is to inform the patient and deliver the news in a non-inflammatory way. Often, clinicians struggle with telling their patients of the misadventure and when they do, they stumble explaining it. What most clinicians often forget is that these file fractures do not impart a significant impact on the overall treatment outcome. An instrument fracture is a part of treatment and is something that we must accept as a misadventure rather than medical negligence. Many of us will say, “Oh, I feel terrible, I feel so bad. I’ll pay for the treatment,” and that’s when things start to go wrong; clinicians begin to take responsibility for an unfortunate mishap wrongfully. What happens if the case goes pear-shaped and turns into a root fracture and eventual tooth loss? These are the cases where the patient never leaves the dentist alone. They keep blaming the dentist, and before you know it, no one is happy.
How do you overcome ‘hot pulp?’
“Hot pulp” commonly occurs in lower molars, specifically in the 6-7 area and less commonly in the upper region. This could be due to the lower region’s complexity, so whenever you are giving a block, you might be aiming a little lower than you should because you got the anatomy wrong. Also, the tooth is probably located in an inflamed area, meaning there are more tetrodotoxin (TTX) sensitive channels present and the c- fibres are highly resistant to local anaesthetic, meaning you likely require more anaesthetic.
So, I recommend having a good plan, remembering your anatomy, giving the block higher up, similar to a Gow Gates version of the block, together with a higher volume, doing supplementary infiltrations and giving more time for the local anaesthetic to work before the commencement of treatment. Older patients might have more dense structures, so it might take longer to get to those cells and anaesthetize the region entirely. My first block is an ordinary block with a lignocaine. Then I give a Gow Gates, higher up, aspirate, and deposit Scandonest and although this may be seemingly insignificant, what I have done is mixed the drugs. When you look at the pharmacology, when you combine drugs, they become more effective, especially in the local anaesthetic delivery. Anxiety can also play a role, particularly in a patient who has not slept and is inflamed. Sometimes you need more time to get them comfortable and into a relaxed state. Nitrous oxide can also be effective in accomplishing this. It gives you a state of euphoria, especially in patients that have been under stress, and when patients feel less stressed, they are less likely to feel pain.
You have accomplished a lot during your career. How did you get into research, and how did you overcome all the challenges that involved?
As I mentioned, I have a background in research. My graduate-entry was in gene therapy, and I had an honours degree in the field of pharmacology and physiology. When I entered dentistry, I had time to do further research and spent my summers doing projects.
I always approached research with a “Can do” attitude and believed that “Persistence is the key to success.”
Although you can fail, you can learn a lot from that failure, which motivated me to go forward. Not every paper or article is going to be revolutionary. If your research is not successful and does not yield results, it can be used as a methodology paper to discuss the shortcomings. Research can pose a lot of challenges, but you can still learn a lot from it. At the end of the day, I think it is not about making a difference; it is about understanding what research entails, especially if you are doing a doctorate, like a Master’s. What you are trying to achieve is an overall understanding and, quite possibly, make a difference, albeit small, to the scientific field. It can be challenging and has its downsides but understanding the purpose and the process is the important part. If it were not for research, the COVID vaccine would not exist, and they would not be able to improve on it from vaccine to vaccine. There had to be some research or some science to do this. Some people go, “I’ll never do another research project again”, but they still look up and respect the researchers that get a lot of articles published and make a contribution. In the way we practice, the equipment we use and the technology behind it, this all stemmed from research. For example, Nickel-titanium or the more flexible files would not exist. We would still be limited to manual filing and would be having the same sort of procedural problems as we used to have 20-30 years ago if we did not have research.
Blog Post: March 2021
CPD Junkie Blog
How high you go in unconscious incompetence and how low the realisation that follows is up to you. Check yourself, your patients will thank you."
The Unconsciously Competent Dentist
During my undergraduate degree I spent a lot of time studying. The thing was, most of that time was spent studying poker.
Along with the game itself I dove into psychology, learning, emotional control and meditation. A lesson that stuck with me long after hanging up the poker hat was about the four stages of competence, first described by Noel Burch during the 1970’s. The concept is to move skills to the unconscious competence state, where even the most emotionally frustrating situation (losing a ‘bad beat’, analogous to treating an unreasonably difficult patient) would not affect the core skill. It is unconsciously working.
Unconscious Incompetence
“You don’t know what you don’t know” is one of my favourite sayings. And this is unconscious incompetence, a time where we don’t know that we can’t do something. This is actually a dangerous time where we can get into trouble and not even know it. The aligner case that has more to it than meets the eye or the guy who wants to have his teeth built up from attrition yet not understanding his square jaw and sleep apnoea impact this. Be wary.
Conscious incompetence
You realise that you don’t know it all. A humbling yet important realisation that perhaps this case has more to it or should be referred off. Perhaps you didn’t graduate ready for ortho, implants and full mouth rehabilitation. While a safer zone for you and your patients, you might find yourself a bit unmotivated, I felt this at 18 months post-graduation. When you find yourself here, you need to shift your perception. Allow this to intensify your learning and progression in the areas you now realise you’re deficient. It’s a goal. And you’ve done many years of study, you don’t struggle with hitting clear goals.
Consciously competent
You’re competent at what you do but it takes focused ongoing effort. Crown preps once you’ve done your first 50. You can do them fairly easily and sufficiently well. But not with your eyes closed. You’re on your way there.
Unconsciously competent
Turn the car on, handbrake off, put it in gear. Driving was once a stressful endeavour but now it can pass without you even registering any of the decisions it took to get there. Perhaps, all you consciously noticed the whole way was the (DHS) podcast you were listening to! Some aspects of your dentistry may get there (so I hear!) but perhaps not all.
How high you go in unconscious incompetence and how low the realisation that follows is up to you. Check yourself, your patients will thank you.
Expert Q&A – March 2021
Expert Q&A with: Dr. Vy Phan
"I find that in this competitive climate, patients want to get to know you and your practice before even stepping into the surgery."
Bio:
What led you to the decision to return back to university for the Master of Health/Medical Law program? What’s one thing you’ve learnt from the program that you think is valuable as a dentist?
Have you seen any direct benefits from having social media pages dedicated for your dental office? Do you curate posts yourself or outsource?
How did you go on about beginning to offer cosmetic procedures, such as lip fillers? Do you recommend any CPD? Did you launch marketing campaigns to advertise and get it running or just informed existing patients of it?
Speaker Spotlight – March 2021
Speaker Spotlight with: Dr. Clarence Tam
"Everyone is so concerned about how the “face” or buccal surface looks in a reconstruction... The most critical angle of view is actually the incisal or occlusal - if you are fastidious in recreating primary, secondary and sometimes even tertiary anatomy from this view, the “face” will take care of itself."
Bio:
Clarence Tam, HBSC, DDS, AAACD, FIADFE
Dr. Clarence Tam is originally from Toronto, Canada, where she completed her Doctor of Dental Surgery and General Practice Residency in Pediatric Dentistry at the University of Western Ontario and the University of Toronto, respectively. Clarence’s practice has a focus on restorative and cosmetic dentistry, and she strives to provide consistently exceptional care with each patient. She is well-published in both the local and international dental press, writing articles, reviewing submissions, and developing prototype products and techniques in clinical dentistry. She frequently and continually lectures internationally.
Clarence has multi-faceted dentistry experience that extends across multiple tiers of leadership. She is the immediate past Chairperson and Director of the New Zealand Academy of Cosmetic Dentistry. She is one of merely two dentists in Australasia who are Board-Certified Accredited Members of the American Academy of Cosmetic Dentistry (AACD). Moreover, Clarence maintains Fellowship status with the International Academy for DentoFacial Esthetics. She sits on the Advisory Board for Dental Asia, and is part of the Restorative Advisory Panel for Henry Schein Dental New Zealand. Aside from the professional organizations she belongs to, Clarence is a Key Opinion leader for an array of global dental companies, including Triodent, Coltene,Kuraray Noritake, Hu-Friedy, J Morita Corp, Henry Schein, Ivoclar Vivadent,Kerr, GC Australasia, SDI, and DentsplySirona. Moreover, she is the sole Voco Fellow in New Zealand and Australia.
Clarence participates in a number of charitable endeavors and takes great pride in achieving beautiful smiles for patients in and around her community. She sits on the board of Smiles For the Pacific, an educational trust and charity that aims to expand professional dentistry services across the entire South Pacific region. She is involved with Delta Gamma Sorority and aims to spearhead projects harmonious with Service for Sight in the South Pacific.
What is one thing you want everyone to know about aesthetic dentistry or something you learned during your years that you would like to share with other dental professionals?
Everyone is so concerned about how the “face” or buccal surface looks in a reconstruction, whether limited to one tooth or 10 teeth. The most critical angle of view is actually the incisal or occlusal – if you are fastidious in recreating primary, secondary and sometimes even tertiary anatomy from this view, the “face” will take care of itself. This applies to both anterior and posterior teeth. Photography is your greatest critic and ally – take photographs of everything and evaluate them afterwards – it will continually humble us as we strive to make our creations more and more like Mother Nature each day.
You are originally from Canada, what is it like studying in there and then making a big move to New Zealand? Do you notice any difference in values/ priorities between Canadian and New Zealand practices?
You have developed prototype products and clinical techniques. Tell us more about that and how you got into it.
What did you do to enhance your clinical skills? (Did you find certain CPD courses to be helpful, watched videos, carved soap?) and during this COVID era where new graduates may be stuck at home, what would you encourage them to do to refine their skills?
I made the decision to undertake one of the most challenging and life-changing ventures in gaining Accreditation with the American Academy of Cosmetic Dentistry in 2017. It is a structured, board-certified protocol that will hone your hand and eye towards creating predictable nature. One of the people I look up to re: direct anterior esthetics is no other than Accredited Fellow, Dr. Marshall Hanson. His ability to nail cases every time whilst being non-or-minimally invasive is something we all strive to do. Attending the annual Scientific Sessions for me (pre-COVID of course) were a fantastic way to learn both in and out of the classroom. With myriad course subjects and workshops to whet the appetite of even the most seasoned esthetic dentist, that is the playground from which my passion was seeded and drive ignited. Something I heard years ago that I still holds true to every speaker: “You can always learn something new.” We just have to pay attention.
Thanks for reading and thanks for the opportunity to share with you all. Looking forward to seeing you in the vaccinated era to come.
Blog Post: February 2021
CPD Junkie Blog
"The possibilities to continue learning (and enjoying it) are endless."
What Continuing Professional Development (CPD) Stage Are You On?
Written by Ibaadat Sidhu
How many times have you heard, “learning is lifelong”? Well, I’m here to tell you once again! As Stephen Mitchell said, “Education is no longer thought of as a preparation for adult life, but as a continuing process of growth and development from birth until death.” As dental professionals, we go through years and years of learning, only to finally get into a clinic and realize we still don’t know a lot. In dental school you don’t learn much about practice management, dental photography, or the latest dental trends such as clear aligners or digital scanners. That’s where Continuing Professional Development courses come in to save the day! Although it is mandatory to complete 60 hours of CPD activities over a three-year CPD cycle, we have the freedom and resources to learn about anything we desire.
During different stages as a dental professional, you’ll have different CPD aims and interests. Continue reading to determine which stage you’re at now!
Stage 1: The Student
Most dental students are focused on university lectures (and the occasional Osmosis or Khan Academy video) for gaining knowledge. However, starting to attend CPD while you’re a student can really give you a head start on your career. Attending a variety of CPD on different disciplines is a good way of testing the waters and figuring out what interests you. For instance, university lectures may make oral surgery seem boring, but seeing a live surgery during a CPD event can really change your perspective. Of course as students, we need to save all the money we can but that shouldn’t stop you from registering for CPD. With CPD Junkie not only can you get discount codes for CPD, but can also browse free CPD as well. If you know you want to specialize or open your own practice soon after dental school, CPD is a great way to gain more knowledge and experience before you commit.
Stage 2: New Grad
You may think after years of school your dental education was complete. But, this is just the beginning! Once you’re out in the real world practicing, you begin to notice areas you can improve on, and areas that you want to advance on. You can chose to take courses in areas of strength to enhance skills and take on more challenging cases over time. Or, take courses to improve clinical skills in areas you are weakest in. Attending CPD at this stage can also help you network and connect with other dentists that could potentially become mentors, dental associates or lifelong friends!
Stage 3: Gaining Expertise
By this stage, you’ve gotten experienced performing your day-to-day procedures. Now is when you’re going to want more. More cases, more patients, more variety in your day. This is the perfect stage to really explore and experiment with different CPD, considering you’ve got greater funds and knowledge now. Venture out and attempt some courses on botox and fillers or various orthodontic options. At this point it may also be possible for you to dive into digital dentistry and invest in a digital scanner or 3D printer. Of course, to perfect and maximize the benefits of these investments, you should attend CPD courses. At this stage, taking CPD courses with your co-workers is a fun, interactive way of not only team building, but also enhancing the skills and knowledge of your practice. Whether it’s going to events together, or doing Lunch and Learns in the office, this is something that can give team members the chance to grow together.
Stage 4: Getting Comfortable
At this stage, you’ve gained the dental knowledge and skills you strived for. Although some dentists begin viewing CPD as a mundane task that must be completed at this point, it doesn’t have to be this way. If you’re interested in travelling, look into CPD events across the world. If you’re ready to begin relaxing, try attending continuing education courses on a cruise. If you want to dress up and go out with friends, try and attend a CPD event together and go out for dinner after. The possibilities to continue learning (and enjoying it) are endless.
As a busy dentist you may not have the time to search for the perfect CPD for you. You may just register for that random event you’re not really even interested in, but it popped up on your FaceBook someday and gets you those CPD Points. It’s time you start discovering the courses you truly want to attend, rather than signing up for something “good enough”. The team at CPD Junkie wants you to gain the knowledge and skills to become the best practitioner you can, all while truly enjoying what you’re doing. We do the searching for you so you just have to take a few minutes out of your day to find the perfect course from our comprehensive selection. I want to end off on a quote by Gary Takacs to inspire you to go register for your next CPD: “I have yet to meet a world-class dentist who isn’t also deeply committed to ongoing continuing education and has taken a massive amount of continuing education.”
Keep aiming high and learning so we can continue to change the world, one smile at a time.
Expert Q&A – February 2021
Expert Q&A with: Dr. Damian Teo
"The reality is, most of the treatment us dentists can offer our patients for TMD is a splint. The design, and bite registration of the splint is important, but end of the day, the splint can only do so much, and if we become too dependent on the splint, we’ll limit the amount we can help our patient."
Bio:
- Sleep & TMJ Dentist in Melbourne
- Bachelor of Health Science (Dentistry) – Latrobe University
- Masters of Dentistry – Latrobe University
- Post Graduate Diploma Dental Sleep Medicine – University of Western Australia
Damian is a holistic dentist with a focused interest in snoring, sleep disorders, teeth grinding, TMJ disorders and airway focused orthodontics. In his dentistry, Damian is passionate about looking “beyond the mouth” and treating the body as a whole. He believes dentists play an important role in being able to recognise airway/breathing issues, sleeping problems, and craniofacial pain (such as headaches, neck pain, and TMJ disorders). This led him to undergo extensive postgraduate training with world renowned specialists in the field of sleep medicine and TMJ disorders, and achieving his Post Graduate Diploma in Dental Sleep Medicine with the University of Western Australia. Damian also previously worked in Darwin’s first official TMJ & Sleep Therapy Centre, where he exclusively treated patients for snoring, sleep apnoea, teeth grinding and TMD.
Damian has setup his own specialised TMD and Sleep clinics: Melbourne Dental Sleep Clinic. Damian understands the value in working with skilled allied health practitioners outside of dentistry. He currently consults with the sleep respiratory physician team at Lung And Sleep Victoria, and the specialised TMJ physiotherapy team at the Melbourne TMJ & Facial Pain Centre. He has presented lectures and held seminars to medical and dental professionals to spread the knowledge that dentists can help one’s health and quality of life “beyond the mouth.” You can find free online lectures presented by Damian on https://sleeptmjstudyclub.teachable.com/ and he also has a Facebook dentist group: Sleep & TMJ Study Club where he uploads cases and tips for dentists treating TMD, bruxism and sleep disorders.
What do you think is the most common misconception about TMD?
I believe the biggest misconception is: “I can treat the TMJ alone.” This doesn’t apply just to dentists, this applies to any health professional that delves into treating TMD (e.g. physiotherapists, chiropractors, surgeons etc). When I first started my TMD journey, I was so amazed by the knowledge I was exposed to. I was taught not just about the TMJ, but I was taught about head/neck posture, chronic pain neurology, sleep apnoea, proper sleep, proper nasal breathing, myofunctional therapy, nutrition and more (and this was all from just one TMD residency).
This made me understand that I alone, as a dentist, can only do so much. The reality is, most of the treatment us dentists can offer our patients for TMD is a splint (sometimes surgery or orthodontics). The design, and bite registration of the splint is important, but end of the day, the splint can only do so much, and if we become too dependent on the splint, we’ll limit the amount we can help our patient. A splint won’t fix all our patient’s postural issues, or improve their diet, or unblock their nose. A splint may be able to “help” these issues, but very likely, we will need to work with a team of other health professionals to properly help our patients. I send 80-90% of my TMD splint patients to a properly trained TMD physiotherapist, chiropractor, or osteopath. I currently work a few days in a TMD physiotherapy clinic, and the recovery rate in my patients has improved rapidly, compared to when I was treating with only a splint. My treatment modality has changed to the point, some of my patients; don’t even need a splint.
What do general dentists/ specialists often miss when diagnosing and or managing TMD?
The first thing I learnt about properly treating TMD, is to look at the sleep and breathing. There is a huge link between TMD and sleep breathing disorders such as snoring and obstructive sleep apnoea (OSA). Proper quality sleep is so important in the maintenance of many bodily functions we use daily. For example, if we are sleep deprived, our body’s immune system and healing rate decreases, and our sensitivity to pain increases. Many chronic pain patients (which include TMD sufferers) are sleep deprived, which will contribute to their TMD pain.
Many of my TMD patients have undiagnosed OSA (and vice versa), and sometimes the key to treating them, is focusing on their sleep. During my other work days, I consult in a specialist sleep physician clinic and I see many OSA patients with undiagnosed TMD and bruxism everyday. The relationship I see joining these OSA and TMD patients is sleep bruxism. One theory in the literature relating to sleep bruxism, is the tensing of the orofacial musculature (bruxism) is a sympathetic nervous system response to help the person breathe when they are choking (e.g. experiencing snoring or apnoea). If you ever see a TMD or bruxism patient in your clinic, before you shove a splint in their mouth, first assess their breathing and sleep.
In your experience, what did you find to be the most interesting thing you have learned about the field?
Learning about TMD opened my eyes to look into the health of humans as a whole. I was really fascinated to learn how a healthy human body works, and how sometimes innocuous things such as changing our diet, can “fix” a person’s TMD. In these chronic pain patients, some people say the body is in a chronic “fight-flight” state. We should only be in a fight-flight state when we are in danger. We shouldn’t be in a fight-flight state watching TV at home. E.g. At home, we want our smoke alarm to go off while there’s a fire. We do not want it to go off when we’re cooking. A person in chronic pain, has a ‘smoke alarm’ that goes off whenever we’re cooking. Their senses are constantly ‘fighting/flighting’ to protect itself.
The fight-flight response involves activation of the sympathetic nervous system. Activation of the sympathetic nervous system triggers a number of bodily responses such as increased ventilation (breathing issues), increase in adrenaline/noradrenaline (disturbs our sleep), increase in cortisol (increase stress- bruxism), inhibits bladder contraction and reduction in digestion (diet/stomach issues). If our body is constantly performing the above actions 24/7, our overall health will gradually decline, and a piece of acrylic in the mouth is only going to help so much. I believe our role as health practitioners in this field, is to recognise these people are suffering many bodily changes, and our goal should be to try guide them from a sympathetic ‘fight-flight’ state towards a parasympathetic relaxed state. Treating their TMD will help start them down this path of healing, though dentists may only be a small piece of the puzzle.
Some of the most interesting things I have learnt in this field are from my own patients. I have seen patients suffering from debilitating TMD for years, and I was able to eliminate 90% of their pain with a splint. However, the last 10% still lingers. Then, these same patients were able to completely eliminate their pain by starting a gluten free diet, or starting personal training to strengthen their core muscles and posture, or sometimes learning to breathe properly through their nose using their diaphragm. These encounters fascinate me, because it goes to show how amazing and complex our bodies are.
Speaker Spotlight – February 2021
Speaker Spotlight with: Dr. Desmond Ong
"A patient’s psychology, compliance and perception of their treatment can all change significantly over time, which may ultimately affect the actual treatment outcome or their satisfaction with the outcome!"
Bio:
Desmond Ong BDSc (Hons), MDSc (Ortho), MOrthRCS (Ed), MRACDS (Ortho)
Desmond Ong is currently a Clinical Academic in the Discipline of Orthodontics at the University of Queensland School of Dentistry, where he is involved in both the Undergraduate and Postgraduate Orthodontic Programs.
Desmond is also in full-time specialist orthodontic private practice in Townsville.
Desmond received the Raj Prasad Award from the Australian Society of Orthodontists (SA) in 2016 and is a past winner of the Young Lecturer Award from the Royal Australasian College of Dental Surgeons.
What is one thing you wish you knew before getting into orthodontics? What do you find the most challenging aspect of orthodontics?
One thing I wish I knew in advance was that theoretical ideals are not always possible to achieve or maintain indefinitely. Despite the planning and biomechanical process of orthodontics being highly logical and generally predictable, the teeth being moved are part of a real-life patient. We all know that some patients can be highly unpredictable! A patient’s psychology, compliance and perception of their treatment can all change significantly over time, which may ultimately affect the actual treatment outcome or their satisfaction with the outcome!
Probably the most challenging aspect of orthodontics is managing retention and relapse. In 1934, Oppenheim stated “Retention is one of the most difficult problems in orthodontia; in fact, it is the problem.” Almost 90 years later, clinicians continue to struggle with the same issue. Even the most well-treated orthodontic case can demonstrate undesirable tooth changes without long-term retention.
Robert Pickron, a well-known and successful orthodontist from the USA, stated that “Relapse happens. No matter what you do or how well you treat, you will have to deal with this important part of the orthodontic practice, or move to a new town every 5 years!”
Littlewood et al (2017) concluded: Relapse after orthodontic treatment is the result of teeth moving back towards the original malocclusion, but changes in tooth position may also occur as a normal part of the growth and aging process. Relapse is also unpredictable, and so it should be presumed that every patient has the potential for long- term changes. As part of the informed consent process for orthodontic treatment, patients need to be fully aware of their commitment to wear retainers for as long as they want to keep their teeth in their corrected positions.
The formation of ‘black triangles’ may be a consequence of orthodontic treatment, when this happens, what do you recommend to your patients?
The formal terminology for a ‘black triangle’ is an open gingival embrasure space. Such spaces can be a significant source of patient concern or dissatisfaction. To a certain extent, the likelihood of developing black triangles during treatment can be predicted prior to commencing orthodontic treatment. Fortunately, the majority of mild to moderately sized black triangles can be effectively reduced or eliminated with judicious interproximal enamel reduction and appropriate root positioning.
Kandasamy et al (2007) noted that black triangles are more likely to develop following labial movement of imbricated or palatally displaced incisors and closure of a diastema. In contrast, black triangles are less likely to develop following the palatal movement of labially placed or imbricated teeth and the intrusion of one tooth relative to another. Kimura et al (2003) investigated various factors associated with the development of black triangles following orthodontic treatment. In summary, black triangles were more frequently found in patients over 20 years of age and were associated with resorption of the alveolar crest. Therefore, clinicians should be alert to the possibility of black triangles developing as a result of specific orthodontic tooth movements and also with increasing age.
From a personal perspective, I have found that diagnosing the pre-treatment periodontal condition and discussing the potential (or relative likelihood) for black triangle development during orthodontic tooth alignment as part of the pre-treatment informed consent process very helpful to avoid (or alleviate) patient concerns when such spaces become apparent. It is also important to discuss the potential impact of long-term periodontal changes (e.g. alveolar bone loss and changes in the anatomy of the gingival papillae) with all patients, particularly adult patients.
How do you prevent root resorption during orthodontic treatment? What do you do if you notice root resorption following orthodontic treatment?
External apical root resorption (EARR) is a potential problem associated with orthodontic tooth movement, which results in the permanent loss of the dental root structure. Orthodontically induced root resorption can affect any tooth, although the maxillary central and lateral incisors are generally considered to be the most susceptible to resorption. From the available literature, it appears that increased force levels and increased active treatment duration may be associated with an increased risk of root resorption. A history of incisor trauma may also increase the risk of severe resorption. Therefore, careful treatment planning for each individual case and the use of sensible force levels remains of paramount importance. There is probably no plausible means to truly avoid orthodontically induced root resorption other than to not provide any orthodontic treatment! This again highlights the need for appropriate informed consent prior to commencing any orthodontic treatment.
Thankfully, only 2% to 5% of the orthodontically treated patients experience severe root resorption (more than a quarter of the pre-treatment root length) as severe loss of root structure may threaten the function and longevity of the affected teeth. For the vast majority of orthodontic patients, the extent of any root resorption during treatment is very minor and not of clinical significance.
I was fortunate (or unfortunate!) enough to write my orthodontic postgraduate thesis on severe root resorption cases. From this research, it would seem that the difference between minor and severe resorption cases is unlikely to be associated with the treatment that is received, but instead inextricably linked to the genetic makeup of the patient. This could explain why most patients show very little resorption regardless of the treatment technique, whereas the unfortunate few that experience severe root resorption, do so despite receiving a virtually identical treatment. A family history of root resorption and/or pre-existing root resorption prior to any orthodontic treatment are also important warning signs.
Should significant root resorption be noted during treatment (progress radiographs are highly recommended), a pause in the orthodontic tooth movement is recommended to reduce the risk of further root resorption, as ceasing active treatment allows the resorbed cementum to heal. Should significant resorption continue despite the suspension, the active orthodontic treatment should be finished as soon as possible (or immediately), which often involves a need to knowingly accept an incomplete treatment outcome. Post-treatment physiologic splinting with fixed wire retainers may be beneficial depending upon the extent of the clinical tooth mobility.
Blog Post: January 2021
CPD Junkie Blog
"New Year’s resolutions are vague and outcome-driven, goals provide you with structure and the means to reach your destination"
Know the Difference – Resolutions vs. Goals
Written by Jennifer Truong
New Year… New Year’s resolutions… new you! It’s generally accepted that a new year is a perfect time for new beginnings, greater productivity, and an unyielding effort to be better than your former self.
But what exactly are resolutions? More importantly, what is the difference between resolutions and goals? A resolution is the decision to either do or not do something. It is tied to an outcome or an end result. For instance, consider the New Year’s resolution: “I want to increase patient rapport.” Solution: Improve communication skills. Resolution: Build stronger patient rapport.
So how do resolutions differ from goals? A goal is the means to a desired result. Contrary to resolutions, an effective goal encompasses both the solution and resolution. In other words, a goal considers the steps you should take to achieve a resolution. Consider the previous example. An effective goal for the same resolution might be: “I plan to enrol in communication courses to improve patient rapport, which can be measured by an increase in treatment plan acceptance rates”.
This discussion begs the question: which is more effective, a goal or a resolution? If you have ever (or already!) succeeded in achieving your New Year’s resolutions, take pride and congratulate yourself, because this is a rare feat. According to U.S. News and World Report, approximately 80% of New Year’s resolutions fail within 30 days. But why do so many fail?
Well, resolutions are based on the end goal, rather than the process. The expectations for resolutions are often too high, and we go in with an all-or-nothing attitude, resulting in disappointment and demotivation when we don’t instantly obtain our ‘perfect’ results. Often, resolutions lack real commitment and are probably the result of some heavy-duty procrastination, “I’ll start tomorrow! No, I’ll start next week. Well, maybe I’ll start next year.”
Alternatively, effective goals require preparation, thorough planning, an aim, and appropriate execution. What, then, makes a goal “effective?”
Types of goals
The three main types of goals are: process, performance, and outcome goals.
- Process goals are the ‘how to’ or the processes involved in obtaining your outcome, and they are entirely within your control. For example, if your resolution is to get a new job, your goal might be to apply to three clinics a week.
- Performance goals are based on performing to a certain level/standard. Using the previous example, your goal might be to secure at least three job interviews in the next month. Process goals are mostly within your control.
- Outcome goals are the ultimate goal, or “winning” aspect. Again, using the previous example, your outcome goal might be to get hired to work at your dream practice. Unlike process and performance goals, outcome goals may be outside your control due to uncontrollable factors (e.g. the performance of other job applicants).
Process, performance, and outcome goals are linearly dependent. Achieving your process goals will likely help you achieve your performance goals, which will then help you obtain your outcome goals.
Make SMART goals
To help formulate effective goals, the “SMART” approach deconstructs goals into five components:
Specific
- Make sure your goals are clear and tailored to your needs. Avoid vague goals by keeping in mind the five ‘W’s’ (what, when, where, why and who).
Measurable
- Set a goal that will allow you to objectively track your progression and determine how far you are from obtaining your desired results.
Achievable
- Be realistic and ensure that your goals are attainable. However, your goals should still be moderately challenging—that makes it more satisfying when you reach them!
Relevant
- Your goal should be specifically tailored to you and your needs.
Timely
- Set a realistic time frame to achieve your goals. Doing so allows you to measure your progress, ensures that you are on track to complete them, and keeps you from becoming discouraged.
Consider another example where ‘increasing productivity’ is your New Year’s resolution. A SMART goal might be to increase the number of patients you see at clinic by 5% annually.
Whereas New Year’s resolutions are vague and outcome-driven, goals provide you with structure and the means to reach your destination. I’m not trying to say New Year’s resolutions are doomed to fail, but if you find yourself struggling with yours and feeling defeated prior to the year’s end, then you may want to consider rephrasing the resolution as a goal (or series of goals) that lead to the resolution. After all, a goal without a plan is merely a dream.
Expert Q&A – January 2021
Expert Q&A with: Dr. Mikaela Chinotti
"For young dentists that are looking to make connections and seek mentorship and/or support as they begin their career, attending ADA branch meetings and meeting colleagues who practice in the local area is a great start."
Bio:
Dr Mikaela Chinotti is a Sydney based general dentist. She graduated as part of the inaugural cohort of dentists from James Cook University (JCU) in 2013, having grown up in North Queensland. Mikaela returned to JCU to complete a Master’s in Public Health majoring in health promotion in 2018 before moving to Sydney, taking up the role of Oral Health Promoter at the Australian Dental Association as well as continuing to practice general dentistry.
As the ADA Oral Health Promoter, Mikaela works within advocacy and health promotion. One of her main roles is the organising of the ADA’s annual oral health campaign, Dental Health Week, but jobs range from creating the ADA’s new oral health education podcast for the Australian public and facilitating the creation of the ADA Consensus Statement on Ankyloglossia and Oral Frena to creating resources for ADA members to easily download-and-go when looking to partake in oral health promotion activities within their local community.
Mikaela is also a founding member of the Colgate Advocates for Oral Health: Editorial Community where she has written articles on discussing nutrition in the dental practice, the importance of oral health literacy as well as decision making and knowing your limits. Her articles can be found here.
Once you graduated, how did you go on about seeking a mentor? Do you wish you did anything differently after graduation?
I grew up in Ingham, North Queensland and being a small town, decided to undertake my mandatory year 10 school-based work experience at one of the local dental clinics which had recently been purchased by two recent graduate dentists. I continued to return of my own accord in years 11 and 12 and then throughout my dental degree. When graduating in 2013, I was offered a job at the dental practice which I accepted, not because I had the strong desire to return to my hometown because location wise, I was interested in living and practicing in the Atherton Tablelands; it was the mentorship and support that I sought. Unfortunately, I moved on from the job after 1.5 years as another dental practice opened, oversaturating the small population, however it was a great first job and if I were to have my time over, I would take the job again.
You became involved with Colgate and ADA soon after graduating, do you have any tips for new graduates on how they can get involved with such associations?
I have been an ADA member since university and have always valued the support and provision of information that associations can provide; however, I did not get involved until making the move from Townsville to Sydney in 2018 when I began as staff at the Australian Dental Association. For young dentists that are looking to make connections and seek mentorship and/or support as they begin their career, attending ADA branch meetings and meeting colleagues who practice in the local area is a great start.
Additionally, the ADA has a volunteer committee called the Recent Dental Graduates Committee where members can have input and influence in the new graduate space and in supporting their colleagues who are no doubt experiencing similar situations.
As an oral health promoter, do you have any recommendations for dentists on how they can efficiently convey the value of regular hygiene appointments to their patients who only visit in case of emergencies?
This is not always easy and for individuals who only see oral health as the absence of pain, this can require significant changes to behaviour and mindset, but it is possible to turn a problem-based attender to a regular patient. Conveying the value of regular dental care and hygiene appointments is associated with health literacy, which is an individuals’ ability to access, understand and use health information to make health decisions as well as the ability to access and navigate the health care system.
During an emergency appointment, while you are waiting for the anaesthetic to take effect, have a squiz around the mouth…does the patient have any other signs of oral disease such as gingivitis, carious lesions or calculus built up? Plant the idea of returning by showing them an intra-oral image or radiograph if the one you potentially took during the emergency shows this. Create concern and motivation to return.
Speaker Spotlight – January 2021
Speaker Spotlight with: Dr. Ahmad Al-Hassiny
"Digital dentistry is more than just hype. When implemented properly you can expect an excellent return on investment, increased joy in practicing dentistry, and better care for your patients."
Bio:
Dr Ahmad Al–Hassiny is the Founder and Director of the Institute of Digital Dentistry (iDD), which is a leading and future focused online training academy, with a mission to ensure dentists globally have easy and affordable access to the best digital dentistry training possible.
Having graduated from the University of Otago with First Class Honours and being awarded many clinical and research prizes, Dr Ahmad has continued his pursuit of excellence in dentistry. He has seen first-hand through his own work how CAD/CAM and digital dentistry can positively change daily dental practice. He has carried out many aspects of complex digital dentistry including CAD/CAM full mouth rehabilitation and smile design.
Dr Ahmad is a global leader in digital dentistry and intraoral scanners, carrying out lectures for many companies and industry. He is one of the few in the world who personally owns and uses all mainstream scanners and CAD/CAM systems in his clinic. Through iDD he is happy to see dentists around the world develop the confidence and perspective of adopting modern techniques and reap the many benefits that CAD/CAM and digital dentistry can have on their career/practice.
Having used numerous digital scanners, which one do you recommend a new dentist invests in? What advantages does it have over the others?
This is a question I get asked almost everyday online and it is something that will entirely depend on the practice and what you want to get a scanner for. There is a huge range now available and the best way to decide is to first understand what procedures you want to carry out and your budget.
For instance, for those wanting to carry out in-house CAD/CAM, there are few systems that can compete with CEREC in terms of efficiency and ease of use. This is not an entire reflection of the scanner per say but the whole workflow, software, and milling machine. For those who have no interest in CAD/CAM and do not intend to produce restorations in-house, it does not make sense to spend big on something like this.
Rather, for those on tight budgets or just want a low cost scanner to get rid of impression material in their practice, the Medit i500 should be on your radar as this is one of the most cost-effective scanner options on the market right now. It is relatively cheap, works well and has no subscription costs. The downside being that it does not inherently come with a CAD software, and although it can be integrated with exocad and a 3rd party mill, this can feel a bit piecemeal, compared to more complete systems.
There are other factors to consider as well, for instance, those who have built their practices around Invisalign, it makes sense to seriously consider the Itero scanners as these are the only latest generation scanners that are accepted for Invisalign treatments. And so forth and so forth.
It seems the market has spoken and the leading scanners seem to CEREC, TRIOS, Medit and Itero. In our practice, I routinely use CEREC Primescan, a absolutely fantastic scanner, for all in-house work, TRIOS for anything not to be produced on the same-day (implant guides, splints, dentures, full mouth rehab) and Medit as a back-up.
What is one digital dentistry investment you made that you wish you had done sooner?
It would have to be intraoral scanners. Even though we got into it over 10 years ago, I still wish we did it sooner and our main hesitation was the unknown. It is a complete game-changer in dentistry. Everyone without a doubt should be investing in one.
Second to that would be 3D printing, which we got into 4 years ago. This is another one of those things you do not know how you practiced without before. 3D printing is a complete game-changer for clinics and really revolutionised how we practice dentistry. The handy thing about 3D Printers is, for the most part, it does not matter what scanner you have. They are all open and can communicate with any scanner via STL files. They are also relatively cheap compared to the investment cost of a scanner. 3D Printing for us has opened a lot of different possibilities including most recently printing dentures and being able to offer a turn around of about 2-3 days for most denture cases (especially immediate ones). The other benefits are being able to quickly design a smile design/wax-up and print it ready to try-in for the patient in aesthetic cases. An easy way of boosting case acceptance for cosmetic procedures.
Again, with 3D printers there are a whole lot on the market now and its best to do your research. I can recommend Formlabs for its ease of use and NextDent 5100 for its blazingly fast printing speed.
What are some resources you recommend for dentists interested in stepping foot into the digital world?
I run the Institute of Digital Dentistry which provides CPD courses focused on all things related to the digital workflow. We have also launched an online training platform in the past 12 months, which is one of the most comprehensive in the world right now and covers all topics from the basics of intra-oral scanning, 3D printing, digital implantology, to expert masterclasses and everything in-between. Right now, the digital dentistry industry is being led by the suppliers of the technology which have a conflict of interest – we exist to provide knowledge that is up to date, impartial and based on clinical experience.
Our goal has always been to provide the highest quality CPD courses that are engaging and well-structured. For those interested you can learn more about us and check out our courses at https://instituteofdigitaldentistry.com/
Another incredible resource is social media. Depending on your scanner of choice you will find several different Facebook groups, with fantastic communities to learn from. This includes the likes of the “Keep CERECing”, “3Shape Study Group” and “Medit Users – i500, T-series”. These groups are priceless with tens of thousands of users all sharing cases, information, advice etc. One of the most important factors before jumping into the digital world is support. Make sure you have adequate support both online and locally through your sales reps. It will make your experience a lot better. Digital dentistry is more than just hype. When implemented properly you can expect an excellent return on investment, increased joy in practicing dentistry, and better care for your patients.
Blog Post: December 2020
CPD Junkie Blog
"Think positive, be positive, and positive things will happen”
Positive thinking: A tool to becoming better
Written by Jennifer Truong
Being a dentist is a demanding career.
You spend so many hours studying as a student, followed by many more hours working in the field. It’s not all sunshine and rainbows. Days can be either gratifying or absolutely chaotic having to deal with complication after complication. Hence, it’s very important for dentists to not only focus on their hand skills, but on their mental health as well.
You probably think this is not a new concept, but yet it’s estimated that, on average, 80% of our thoughts are negative. “I should have done… I wish I could have… if only I had more time…” sound familiar?
So, what’s a simple way we can go about changing this?
“Think positive, be positive, and positive things will happen.”
One emerging area of research in mental health is on positive thinking, which is a set of techniques aimed to replace negative thoughts with more positive ones. Positive thinking is based on the theory that our thoughts, emotions and behaviours are all causally related. Changing our thoughts should therefore change both our emotions and behaviour. Thankfully, positive thinking is a skill that can be learned, so even those who are ‘Debbie Downers’ can benefit from these steps.
Step 1: Understand your negative thoughts
The first step to positive thinking is to recognise your negative thoughts and what triggers them. Although you’re likely aware that you have these thoughts, probably many of them, the idea here is to understand when and why they happen.
Some common types of negative thoughts are:
- Personalising. Blaming yourself when something bad happens.
- Polarising. Seeing things as either good or bad. You either succeed or completely fail.
- Filtering. You focus on the negative aspects of the situation, despite all the positive aspects.
- Catastrophising. You expect the worst possible outcome for a situation.
- Should statements. You attempt to force yourself with should and shouldn’t statements and punish yourself when you don’t comply.
Try to spend some time and effort being familiar with when your negative thoughts occur. You could note your negative thoughts in a diary or on your phone. This may sound over the top, but it’s important to understand the patterns of your negative thinking. For example, you may notice that you tend to rate your performance in the clinic as either entirely good or bad (polarizing). Alternatively, you may make a small mistake and then expect the patient to never see you again (catastrophising). You focus on that one negative comment someone left you on google reviews even though you have been showered with compliments in the preceding posts (filtering).
You’ll be surprised as to how many of these negative thoughts you have, and how tedious they seem to be in the grand scheme of things, I mean, we did spend most of 2020 in lockdown.
Murphy’s law states that things happen beyond our control and rather than dwelling on things you cannot control, challenge these thoughts and shift your energy to things you can control.
Step 2: Challenge your negative thoughts
The next step is to challenge your negative thoughts with a rational response. For example, if you rate your day in the clinic as either good or bad, challenge these thoughts with a rational response such as “My day was filled with wins and losses, which I call a typical Wednesday”.
Perhaps you automatically blame yourself when a patient’s restoration fails and you begin to question your skills as a clinician. A rational response could be “The restoration was likely to fail given the patient’s malocclusion”.
You could think of a rational response as being similar to what you’d say to a close friend when they’re having negative thoughts. This is not to say that you should adopt a “It’s not me, it’s you” kind of attitude and you definitely don’t want to make excuses for your behaviour. However, consider whether your negative thoughts are valid and more importantly, whether they will improve your skills in the future.
Step 3: Practice positive thinking
Along with challenging your negative thoughts, it’s important to spend some time focussing on positive thinking. Positive thinking is a skill that needs constant practice, but once you’ve become good at it, it’s easy to maintain. Here are some examples of positive thinking:
- Gratitude- think about the things in your life that you are grateful for. These will naturally bring your attention to the good things in your life. Think about your co-workers, your mentors, and your support system, and how much of your venting they had to endure.
- Think about your successes. It’s important to think about your recent and past successes and give yourself that little pat on the back from time to time.
- Imagine your best future. Instead of thinking about the worst outcome, instead, think about a future where your life is going well, which will make you excited for what’s to come.
- Focus on your strengths. Similar to your successes, think about your personal strengths and what you can achieve with them.
These techniques are best integrated with a structured time each day, perhaps first thing in the morning or just prior to bed. After some practice, all these techniques should become second nature. You should find that your negative thoughts will become less frequent and severe, while your positive thinking should increase.
“Instead of worrying about what you cannot control, shift your energy to what you can create.” – Roy T. Bennett
In dentistry, we have the luxury to create beautiful smiles, let that be our focus. I think I can, I know I can, I will, I did.
References
Burns, D. (1980). Feeling Good: The New Mood Therapy (1st ed.). William Morrow and Company.
Rood, L., Roelofs, J., Bögels, S. M., & Alloy, L. B. (2009). Dimensions of Negative Thinking and the Relations with Symptoms of Depression and Anxiety in Children and Adolescents. Cognitive Therapy and Research, 34(4), 333–342. https://doi.org/10.1007/s10608-009-9261-y
Expert Q&A – December 2020
Expert Q&A with: Dr. Amanda Phoon Nguyen
"There are limitations, but if we recognize these and work within them, Teledentistry has the power to change lives for some of our patients, especially those in remote or regional areas."
Bio:
Amanda is an Oral Medicine Specialist in Perth, Western Australia. She is also a PhD candidate and adjunct senior lecturer at the University of Western Australia. Her clinical and research interests include orofacial pain, temporomandibular joint disorders, oral mucosal disease, dental sleep medicine and paediatric oral medicine. She is Treasurer of the Australian Dental Association (WA), the Editor, and an examiner for the Royal Australasian College of Dental Surgeons (RACDS), reviews and publishes in multiple journals, and has been on the WA Dental CPD committee for many years. Amanda believes in interdisciplinary teamwork and represents her specialty at multidisciplinary groups. She is heavily involved with various professional committees, and also dedicates her energy to supporting various community and volunteer causes. In particular, she loves making children smile by volunteering as a mascot of the local children’s hospital. Dr. Nguyen has served in the Royal Australian Navy as a Dental Officer for 3 years. She is also passionate about her speciality, regularly lecturing, running oral medicine interest pages and dental forums, and teaching at the University of Western Australia.
With stress increasing worldwide due to this pandemic, there is a correlated increase in bruxism. What advice do you offer patients to manage their teeth grinding?
From the 2018 International Consensus by Lobbezoo et al., in otherwise healthy individuals, bruxism should not be considered as a disorder, but rather as a behaviour that can be a risk (and/or protective) factor for certain clinical consequences. Not all cases will need management.
In order to manage cases of bruxism, I encourage dentists to review the current evidence-based literature, attend quality CPD and to base their practices on good scientific literature. There are many unsolved issues concerning the etiology of bruxism itself, for example, contrary to popular belief, night-time bruxism is actually not as well-correlated with psychosocial factors and stress. Bruxers with jaw muscle pain also have been shown to have LESS bruxing episodes than bruxers with pain. With my patients, taking into account their age, I explore the type of bruxism they may have, determine the predominant behaviour in their type of bruxism, for example (clenching, bracing or grinding), look at possible associations (with differentiation between associations and causation!), and then assess the behaviour of a continuum before discussing any management. With proper patient discussion, most patients then understand why management has been recommended and the potential sequelae of non-management. I think my best tip there is to think of it as education rather than “convincing” them to have a night guard. If your patients understand the “why”, they are invested in their own health outcome and are empowered to take ownership of their diagnosis. I find clinical photographs to be a really useful aid!
Unfortunately, I do not believe management of this is as simple as providing one type of occlusal splint for all cases of suspected bruxism. Management is not always innocuous either, there is some literature on how provision of a maxillary occlusal splint can worsen sleep disordered breathing, and it is clear from the literature that occlusal adjustments to treat bruxism and temporomandibular joint disorders are very outdated and should not be done for this reason.
With routine dental check-ups coming to a halt due to this pandemic, many dentists began examining patients virtually. Do you see a future for tele-dentistry? Do you think it is possible to effectively diagnose oral diseases through pictures and videos, or do you think problems can easily go unnoticed?
Yes, I do think Teledentistry will become more of a reality at some point in the future. I think it has been in the works, simmering for some time, but the COVID-19 impetus really gave people the drive to make it accessible. I think it will be good for reducing one of the barriers to care. I was lucky enough to give a TEDx talk on this topic, which is available here: https://www.youtube.com/watch?v=jZBPPBgD_MI
Our medical colleagues use it well, and I know some dentists who implement its use in their practice, both pre and post COVID. Among some of our dental specialist colleagues, it has been used successfully for a while, for example in dentomaxillofacial radiology. There are limitations, but if we recognize these and work within them, Teledentistry has the power to change lives for some of our patients, especially those in remote or regional areas.
How was your experience serving as a dental officer in the Royal Australian Navy?
One of the things I loved best about serving in the Navy were the close relationships I formed with many of my team-mates, and some of us maintain our friendships to this day. It was a really bonding experience. The Australian Defence Force was really supportive, with providing great access to additional training and dental CPD, which I appreciated. The whole 6 months of officer training in HMAS Creswell was an experience for me, to this day I detest ironing and will trade much for the condensed milk in the ration packs!
Speaker Spotlight – December 2020
Speaker Spotlight with: Dr. Omar Ikram
"To the aspiring endodontist- this is the most heart sinking feeling- to be able to locate the mb2 but then create a ledge due to this curvature or not be able to negotiate the canal it’s full length."
Bio:
Probably your most asked question as an endodontist, how do you find the MB2 canal? Any tips for increasing visibility and accessibility?
To be able to find this microscopic canal (and most of the time it is microscopic) requires a whole lot of clinical equipment to visualise it and confidently remove dentine in the right area and read what you all know is called the ‘dentine map’ or pulpal floor, without perforating! The LN bur and the Endotracer burs are fabulous. But just drilling in the right area isn’t enough. You also need to be able to visualise the canal. To do this requires at least 4 times magnification, Once you locate the canal, it is not enough to just locate it. It also requires negotiation and this is the challenging difficult part. Because Hess discovered this canal in 1920–and Weine mentioned it in 1969. But dental students weren’t really taught about it until we had the equipment to negotiate it. The canal has an acute coronal curvature in the first 2-3mm meaning that unless you are able to drill past this level the access to the apex is impeded by this acute curve. To the aspiring endodontist- this is the most heart sinking feeling- to be able to locate the mb2 but then create a ledge due to this curvature or not be able to negotiate the canal it’s full length. This acute curvature accounts for about half the referrals we receive. Negotiation usually requires opening access to the straight part of the canal using the XA rotary file and use of C pilot or C+ files to widen the canal, enough to allow instrumentation. The hand filing stage is perhaps the most treacherous stage with the acute curvature in the coronal region being a focal point for torsional fatigue and fracture of the hand file. Negotiation requires knowledge of the various tapers and different rigidity of stainless steel available.
Any recommendations on techniques for extirpation and location of calcified canals?
Use of the white dot technique where a slow speed round bur, such as the endo Tracers or LN bur create dentinal debris to plug the canal helps to locate the orifice. Magnification is essential. I work at around 10 times magnification. This is usually sufficient.
Patients can be extremely anxious about root canal treatment, how do you explain the procedure to them and do you have any advice on how to alleviate anxiety and make them comfortable?
Patients have to be on board if they want root canal treatment. We are essentially performing microsurgery of a tooth. Most of the time an explanation that the procedure will not be uncomfortable due to the use of local anaesthetics will suffice. If the patient is really nervous we can use nitrous oxide. We also have the option of IV sedation or general anaesthesia where I work. If I see nervous adults then IV sedation is usually a good way to treat the patient. General anaesthesia is usually reserved for young children or special needs patients. If in doubt give the patient time to think about the option of root canal treatment they can make that decision for themselves, given all the various options.
Featured Article – November 2020
Case Study
How to achieve a better, faster and more predictable result with aligner treatment planning
Dr. Geoff Hall Bio:
Dr Geoffrey Hall received his dental training at the University of Melbourne in 1983, and pursued his postgraduate orthodontic training at the prestigious University of Pennsylvania in 1990.
Dr Hall has an extreme passion for clinical orthodontics and orthodontic training for Dentists, specialising in adult and children treatments including early treatment, conventional adolescent therapy, short-term orthodontics (Smilefast) and cosmetic treatment options including lingual braces, Invisalign and other aligner systems, and a strong emphasis on interdisciplinary treatment, including orthognathic surgical cases.
Dr Hall has been a pioneer in modern day orthodontics and education and all backed by 27 years and over 10,000 cases of orthodontic experience.
In 2020 OrthoED has developed a Complete Aligner Treatment Planning Service (Caps) to help dentists provide optimal digital setups and allow them to treat even the most advanced of aligner cases. This service makes aligner therapy for the general dentist very predictable and profitable .This service supports Invisalign, SureSmile aligners, Smilestyler and Angelalign.
Dr Hall is a member of many associations including the Australian Dental Association, Australian Society of Orthodontists, American Association of Orthodontists, and various Lingual Orthodontic Associations. He has 2 wonderful adult children and been blessed with a gorgeous grandson.
Traditional orthodontic thinking would require a patient with severe crowding and an open bite anteriorly to be treated orthodontically with fixed appliances/braces in combination with dental extractions and more than likely a surgical approach as well.
Could aligner therapy alone (without extractions or surgery) resolve the issues of crowding and anterior open bite – quite possibly.
Case: A 15-year-old female presents with a class 1 posterior relationship with significant crowding in her upper and lower anterior region and a 7mm anterior open bite. What would you do?
From a facial perspective, the patient had a slightly retrognathic mandible. There was a dolichofacial and vertical growth pattern with a long lower facial height and demonstrated significant lip strain on closure.
Initial Digital Setup
The initial digital set up was returned and further attachments were placed, staging of treatment was modified significantly and most importantly over correction of the posterior segments was incorporated to provide the digital set up a posterior open bite. Here is the digital set up and final treatment plan for the first set of aligners.
We decided to treat the patient with Aligner Therapy. The results were extremely impressive:
Through excellent treatment planning – and with a final plan of 17 upper aligners and 15 lower aligners, the following treatment result was achieved – an excellent correction of the anterior open bite and now a further modification is required to perfect the anterior alignment and in particular the crown tip of the lower right lateral incisor and also requiring further improvement in providing a nice socked in occlusion posteriorly and adding further buccal root torque to the upper second molar teeth. In the past this type of patient – who presented with an anterior open bite and crowding – was traditionally treated with a combination of orthodontics and orthognathic surgery.and dental extractions to resolve the crowding issue. If left untreated, the patient would have significant functional problems as well as serious occlusal wear on the posterior teeth. She may also have issues with proper mastication;unable to chew and digest food properly. Not to mention the aesthetic and potential psychological issues she may suffer in her delicate teenage years and beyond as a result. However, there are a number of potential problems and challenges that many dentists face with aligner therapy, including:
• Poor case planning
• Incorrect stageing of the tooth movements
• Poor placement or use of incorrect attachments based on the biomechanical requirements
• Not providing the necessary over-corrections
• Offering an unrealistic treatment outcome; a common mistake aligner companies cause and general dentists experience frequently.
To perfect the result, a refinement is planned with a further 15 upper aligners and 10 lower aligners – making the treatment in total of 32 upper aligners and 25 lower aligners – and the patient has been changing each aligner weekly, so we expect a total treatment time to be less than nine months.
Digital Setup and Final Treatment Plan
Here is the digital set up and final treatment plan for the first set of refinement.
This case demonstrates the value of a good diagnosis, excellent treatment planning which factors in ideal staging of treatment, understanding the use and biomechanics of different attachments, when and how to over correct different tooth movements and
ensuring the set up provides predictable movements with aligners to allow a predictable outcome for your patients.
With the right team of orthodontists experienced in aligner therapy planning the treatment for you, these mistakes can be avoided and even the most difficult
cases can be managed and completed successfully with aligner therapy.
Like to learn more about how to provide high-quality orthodontic aligner treatments with predictable, profitable and positive outcomes every time?
Learn about CAPS, visit capsdental.com.au today.
Letter from the Editor – October 2020
Letter from the Editor October:Your Partner in CPD
We launched CPD Junkie at the start of 2020 with the goal of being the go to source for dentists looking to find CPD. Our aim was to create a comprehensive directory to help dentists browse, search and compare CPD in areas of interest. CPD made simple. We are proud of the our growing directory (now over 500 courses listed) and the tools and services that we are developing to help our colleagues find the CPD they are looking for. We are working with our partners to bring Junkie Deals exclusive to our members and have some exciting plans in the works for 2021. To our members, we will soon be delivering you email notifications for CPD events that you have indicated interest in. This customised and curated email will be tailor made to match your areas of interest – delivered to your inbox monthly. As we grow and bring on more partners from the CPD industry, we are focused on finding value and finding ways to help you take the guesswork out of CPD. Our monthly newsletter and the amazing resources such as the “How to get the most out of CPD” E-book and the CPD Junkie x Szabi Hant photography cheat sheet are also some of the perks we are proud to provide our members.
So we hope that you continue to check in often with CPD Junkie and trust us as your go to platform for finding CPD. If you enjoy the site and find value with what we are doing, it would be great if you could recommend us to your friends, colleagues and classmates.
Enjoy this weeks expert Q&A with Dr Aovana Timmerman!
Dr. Omid Azami
Co-Founder CPD Junkie
October Newsletter
Expert Q&A in Endodontics with Dr. Aovana Timmerman
Expert Q&A with: Dr. Aovana Timmerman
"Good communication with the patient is something that I find that most dentists struggle with. I would suggest building up rapport with senior clinicians at work, a mentor through an organisation or with the specialists that you refer to and ask them lots of questions on how they would communicate with their patients in different scenarios and learn from their experiences."
Bio:
Aovana graduated with a Bachelor of Dental Science from the University of Melbourne in 2001 and after completing her fellowship with the Royal Australasian College of Dental Surgeons (RACDS) in 2010, she continued with her specialist training obtaining a Doctor of Clinical Dentistry in Endodontics.
Aovana has been involved with endodontic education since 2011 and was awarded the Graduate Certificate in Clinical Teaching in 2019. Currently, Aovana is a clinical demonstrator for the Doctor of Dental Surgery Endodontic program at The University of Melbourne and examines dentists in the Membership (GDP) program for RACDS and Australian Dental Council.
Aovana is currently working part-time in private practice at Collins Street Specialist Centre and is also pursuing her PhD part-time at the University of Melbourne and has published research in both local and international peer-reviewed journals.
Endodontics can be quite a stressful procedure for many dentists. What advice can you give around case selection and workflow so that dentists can confidently assess and choose cases which they will be able to complete confidently?
Case difficulty assessment can help general dentists decide if they would consider proceeding with endodontic treatment or consider referral. There is a useful form published online by the American Association of Endodontists which can be downloaded on this link – https://www.aae.org/specialty/wp-content/uploads/sites/2/2019/02/19AAE_CaseDifficultyAssessmentForm.pdf.
I would suggest using the form until the clinician feels comfortable in assessing a case without using the form.
From my own experience as a general dentist, I definitely found it better to work on simpler cases at the start, before managing more challenging cases, as this approach helped me to build up my confidence and workflow as a clinician.
In addition, I often encourage general dentists to discuss their cases with their endodontists if he/she is uncertain about managing a complex case. I found that when I was a general dentist, the patients really appreciated that I have discussed their cases with the specialists before making a referral. First of all, it gave the patients reassurance that they definitely need specialist care. Secondly, it helped me to gain a deeper understanding of the case such as potential complications and risks and helped me look into alternative treatment options in managing a complex case after discussing it with the endodontist.
With workflow, it definitely becomes easier with time once you have established the way you like to work, and every practice tends to have a slightly different set up with materials, equipment and staff support. If you have just joined a practice, I would suggest observing the experienced dentist(s) at the practice and note the workflow and see if you would make any changes that would suit your needs.
As an endodontist who also educates dentists, what are some of the key aspects of endodontic treatment that you find most dentists find challenging? How can they overcome these challenges?
Good communication with the patient is something that I find that most dentists struggle with. I would suggest building up rapport with senior clinicians at work, a mentor through an organisation or with the specialists that you refer to and ask them lots of questions on how they would communicate with their patients in different scenarios and learn from their experiences.
The first aspect is communication of case difficulty with the patient. It is a good idea to clarify to the patient at the consultation visit if his/her case is simple or complex to manage. And if the case is complex, then go through with the patient what makes the treatment of their tooth/teeth complex and to provide an option of seeing an endodontist.
Second aspect is communication of complications and risks to the patient and reading the patient well enough before starting treatment. For example, when you discuss the risk of instrument fracture to the patient, have you discussed through what you plan to do if that occurs, so that the patient is prepared that he/she may require further management with a specialist afterwards?
We do manage patients with differing expectations, and it is good to understand what the patients expect before starting. For example, if I am going to discuss endodontic treatment of a tooth with poor prognosis, I often put the question back to the patient and ask, “how would you feel if this tooth would require extraction and replacement within five years?”. It gives me a clearer idea of what the patient expects me to achieve and if he/she would be disappointed if treatment does not work out in the short term.
At times, it can be useful getting the patient to sign an acknowledgement form, if he/she definitely wishes to proceed with treatment regardless of the poor prognosis of the tooth, just so that there is another level of acknowledgement and to make sure that the patient is on board with you regarding the potential short term survival of the tooth, before proceeding.
Magnification is an important tool in successful endodontic treatment. What other tools do endodontists use on a day to day basis that general dentists can benefit from using?
I definitely think it is a good idea to get a tool for transillumination to detect cracks in teeth in a clinic, such as the microlux 2 transilluminator. A lot of dentists find it hard to confirm the finding of cracked them then end up placing metal bands around cracked teeth as a result. However, there are a lot of issues with placement of metal bands. With transillumination and high magnification with a microscope, it definitely helps in confirming the location and extension of the cracks, so we can inform the patient promptly regarding the treatment options and prognoses without delay.
Second tool that I enjoy using is definitely the electronic apex locator. I hope all dentists learn how to use one well because it does help with determination of the working lengths besides relying on the radiographs. If you are uncertain about using one, definitely contact your endodontist and consider observing him/her using it.
Thirdly, I like using the WAM key crown remover. It does make removal of crowns much more efficient and could be a useful tool in have in the clinic.
Letter From the Editor: September 2020
Letter From the Editor
Looking Ahead
As we enter the last quarter of 2020 it’s time to start looking ahead. Within the new normal, dental practices, CPD organisers and dentists are all working in creative and impressive ways to excel. At CPD Junkie we have been pushing ahead as well. We have launched our new fresh website with added functionality and an improved interface to make finding CPD easier than ever. We have been bringing on new partners and starting collaborations to finish 2020 strong.
If you are new to CPD Junkie, be sure to check out the website and spend time exploring all the CPD available. Start planning to finish 2020 strong and look ahead to 2021 with a concrete plan for how you want to spend your time and money investing in yourself.
Dr. Omid Azami
Co-Founder CPD Junkie