February Newsletter Contents:
The CPD Junkie Newsletter Archive
CPD Junkie Blog
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 with: Dr. Damian Teo
- 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 with: Dr. Desmond Ong
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.
Featured Online CPD
197001jan1:00 am1:00 amFeaturedThe OrthoED Institute - An Online PlatformOrthodontic Education for Dentists1:00 am - 1:00 am AEST(GMT+10:00) View in my timeOnline Event Organized By: The OrthoED Institute Discipline:OrthodonticsFormat:On-Demand,Online