We're back!

Apologies for the lack of recent posts, we have been having technical issues with the blog, which I hope are now resolved.

Proper post soon, if I can remember all the things I have wanted to say since it's been down!

*Edit* I see some of the blogs I attempted to post have now published anyway, hooray!

You can't hide from me!

I live fairly close to where I work. On Friday I helped out at the community bonfire night, serving hot-dogs. Cue gaggles of teenage girls wearing braces giving me shy "hello"s as they recognised their orthodontist in an unexpected place!

Half way through the evening a group of four returned, three holding toffee apples. The fourth indicated her brace, which had just broken, asking me what to do about it. "Were you eating a toffee apple G?" I asked. She answered "no", but I knew otherwise, the red sugar round her mouth rather giving her away!

She felt suitably sheepish I think. No big problem, I can repair it, but she has now learned why the advice to avoid hard food is given to brace wearers.

Another sporting brace-wearer

Congratulations to British gymnast Beth Tweddle for her amazing gold medal for the floor exercise at the Gymnastics World Championships in London this weekend.

Not only is Beth proving that 24 year-olds are not too old to be top gymnasts, but that adults can wear braces too.

You can do anything wearing braces!

This is Shelly Ann Fraser, the fastest woman in the world (and Jamaican of course), proving that just because you wear braces you don't need to put your life on hold. This week she won the 100 metres at the Athletics World Championships, she looks pretty happy about it too!

I love "brace-spotting" on TV or in magazines. There's a Jamaican hurdler wearing braces and during the World Swimming Championships in Rome a few weeks ago I spotted at least one swimmer braced-up!

Is tooth whitening safe?

This morning I read a report about a man who unwittingly caused some severe dental damage through tooth whitening. So bad, in fact, that he will lose some teeth. Horrifying isn't it?

Before you throw away your trays and gel you need to know the full story. The person in question bought a product over the counter. It had no instructions and he used it every day for about three years. It had such a low pH that it eroded his teeth severely. It also contained levels of whitening agents higher than that permissible.

Many of my patients whiten their teeth at the end of orthodontic treatment. It's easy to do and very effective. Is it safe? YES! But...only if recommended by your dentist who can explain the advantages and disadvantages and instruct you in how to use the product. Over the counter or online products are available but in general they are much less effective than ones prescribed by your dentist or as in the case above may be dangerous.

Your options are "laser" whitening in the dental surgery or night time whitening using a mouthguard tray and gel system. I recently heard about Smilestrips as an alternative to trays/gel which should be available near here soon. Whitening is an excellent way to invest in your smile but please take time to talk to your dentist about whitening and never buy products online or in the chemist.

How to make your orthodontist happy

This is Laura showing off her smile. I think I made her week by completing her treatment in time for the school Prom. She managed to make my week too, not only did she give me some flowers and a bottle of wine (thank you!) she wrote some lovely comments which I had to share.

"Thank you so much. I know I haven't always been an easy patient but thanks for your encouragement. If it wasn't for you I would have wanted them off many a time. Worth the pain now though"

Laura's mum writes "The final smile says it all! Nearly two years of appointments, some pain, tears and laughter have all been worth it. The option of screws as an alternative to headgear was fantastic and would recommend it to anyone to reach perfection. All staff at the practice have been fantastic, particularly Megan, who has a fantastic approach with teenage girls! Dale and Anna have been great co-ordinating appointments. I can't thank you enough for this beautiful smile."

What was your first impression?

I was away on holiday when Susan Boyle made her appearance on "Britain's got talent". I have to say, I was really wondering what all the fuss was about. So last night, prompted by a friend, I watched the performance on YouTube.

WOW! What an amazing voice, I was almost crying at the end.

The thing that strikes me about this is that everyone, judges and studio audience included, made the mistake of making assumptions about her based on her appearance and her intial comments on stage.

What is the lesson here? Is it that we should look deeper than the surface? Or is it that, despite all we try, we are unable to look beyond the surface until shown otherwise? First impressions really DO count!

Ramsay's Kitchen Nightmares

I really enjoy this programme. If you haven't seen it (where have you been?) Gordon visits a failing restaurant and turns it around in a few days. It usually involves falling out with the owner, completely rewriting the menu and a makeover of the restaurant. Gordon is actually very good at this, he builds on their current strengths and invariably simplifies the menu at the same time as encouraging a team spirit.

Its so easy from an outsider's point of view to see where the owner is going wrong. It really highlights the need to have the "full package"; good food, lovely decor or excellent customer service are no good on their own, it has to be all together. In the same format "Mary Queen of Shops" is another excellent programme and when Mary Portas talks about "tribes" I am sure she has read Seth Godin's book on the subject.

One of the reasons I love these shows is that I can understand the processes Gordon or Mary are taking the owners through. I have been fortunate over the last few years to work with Chris Barrow, a dental business coach who helps dentists run efficient and profitable practices that patients love to visit. Not so different from a shop or a restaurant really, its not about excellent dentistry (although that is of course essential) its about the customer service, the ambiance, the team spirit and the systems that help the place run smoothly.

I am always looking for ways to improve my practice, however big or small, though sometimes it needs an outsider to point out where you are going astray. But I know we are doing something right because our patients thank us and write lovely testimonials at the end of treatment.

Another veneer article

Following on from my blog of a few weeks ago here is another article about cosmetic veneers, shorter but less biased than the previous one (its from The Times). Thanks to fellow orthodontist David Horobin who posted it on his blog.

Tooth Fairy hit by Credit Crunch!

Even the tooth fairy is not immune to the effects of the credit crunch it seems. Payments are being cut by 10%, but up to 53% in some cases.

There is even a suggestion that other incentives, such as an extra hour's TV, could replace the financial benefits. Its not the same, somehow.

I think the tooth fairy really needs to make sure her customer care is up to scratch though, in our house she often forgets to do her duty. She usually leaves a note the next night with some excuse about the weather or a sprained wing, but I'm sure she's had one too many glasses of elderflower wine...!

Veneers can damage your teeth

This article in the Daily Mail caught my eye yesterday. It details some problems patients have run into after having cosmetic veneers placed, specifically the nerves dying and needing rot-canal treatments. It makes quite horrifying reading!

Like all these things we need to look at the whole picture. Veneers are used in different circumstances to improve the appearance of the teeth, by changing the colour, shape or position of the teeth. They are usually thin porcelain laminates glued to the front of the teeth, if you watch "10 years younger" you will know what a transformation to someone's smile they can make.

It is certainly true that they are not without their potential problems. They don't last forever and will need replacing eventually. If the teeth are very irregular then some teeth will need to be reduced in size to ensure the porcelain is not too thick. Taking healthy tooth away for cosmetic purposes is obviously not suitable for everybody.

I often see patients who have rejected the idea of veneers because they do not wish to have otherwise healthy tooth tissue taken away. Orthodontic treatment can often give a similar improvement in appearance without cutting into teeth but it does take longer and obviously involves wearing braces! The picture show veneers which were inappropriately placed on crooked teeth. However, orthodontics is not without potential problems such as damage to the roots and enamel surface and relapse.

If you are considering any cosmetic treatment, whether it be veneers, tooth whitening or orthodontics, then please make sure you spend time talking to your dentist. Make sure they explain the advantages and disadvantages if treatment. If necessary, seek more than one opinion and try to see a specialist, or at least someone who is experienced in this sort of treatment and can show you examples of their work. Many of the dentists I know who do cosmetic treatment will spend several visit planning the treatment with your and will also place temporary veneers or crowns which can be adjusted until you are happy with the appearance.

Don't let this put you off treatment if you are unhappy with your teeth. But do make sure you are fully informed before committing to treatment, whatever it might be.

What's in your mouth?

That was the title of the ITV Tonight programme I have just watched. This was about the "poison" that is dental amalgam (the stuff used for filling teeth) and is a story that crops up every few years. Like previous programmes (I think Panorama did one a few years ago) it is trying to shock and sensationalise, quoting a woman who had all her amalgam fillings replaced and is now miraculously cured of all her health problems.

I was disappointed by the representatives of the dental profession. Peter Ward from the BDA looked a total fool in response to not unreasonable questions. Chief Dental Officer Barry Crockroft seemed woefully underprepared. Surely someone could have found him some decent studies to support the argument for dental amalgam?

OK, how about some of the things that I know about dental amalgam...
1 Mercury is poisonous but in fillings is mixed with other metals. Most mercury is released during placement and removal of fillings, but it is unlikely that the amounts are harmful.
2 Dentists do have to follow regulations regarding the disposal of amalgam to safeguard the environment (otherwise mercury would build up and get into the food-chain, potentially much more damaging).
3 Scandinavian countries have banned amalgam, but in an attempt to reduce the amount in the environment and not due to direct impact on the health of individuals.
4 It is still the best filling material in terms of cost and longevity, although dental material science is advancing all the time and will eventually catch up.
5 There has been advice for a few years to limit placement of amalgam in pregnant women, but no advice on whether pregnant dentists should avoid using it!

Please don't panic about this and immediately rush off to your dentist to get your fillings taken out. By all means, discuss the options with your dentist. In fact, many patients are choosing alternatives to amalgam, but generally for aesthetic reasons. It is also worth looking carefully at the costs involved as the cheaper white filling materials tend not to perform as well as amalgam. Gold or porcelain inlays are an excellent alternative but are more costly, so many patients tend to choose them as old fillings wear out and need replacing anyway.

As for me, I will not be rushing to get my amalgam fillings replaced and would not hesitate to have another if my dentist recommended it.

Oh, and I might consider writing to the presenter of the programme to see if he would like some orthodontics to close the gaps in his teeth...!

Dentistry in the news

I can't really let this week pass without commenting on three stories that have caught my attention and its only Monday so far!

Girl with dentist fear starves to death
An eight-year old girl died in 2005 from starving herself due to a fear of dentists and dental problems. Its a truly shocking story and one which I hope will never be repeated.

What's in your mouth?
I have just watched this TV programme about mercury in dental fillings. There's a lot to say on this so I will comment in a separate blog post.

Dentist accused of murder
I have just returned from a weekend in Northern Ireland where this story is front page news. A dentist and his ex-lover are accused of the murder of their ex-partners. This happened many years ago and was believed to be suicide until recently. The story becomes more sensational with accusations of sexual assaults by former patients and the possibility of a third murder. A "Harold Shipman" of dentistry? You may hear more of this story as talks are already underway to turn it into a film!

Three sensational news stories which do not really do much to promote dentistry in a positive light, but isn't it the case that bad news spreads faster than good news?

DIY Dentistry

Click on the title to read a news story about how millions of people are resorting to DIY efforts to fix their teeth. I am sure many people have tried temporary fixes until they can reach a dentist (I have often seen patients who have stuck a crown back in with glue or chewing gum), but it is horrifying to think that some people are doing this instead of seeing a dentist.

I guess it is partly due to the lack of NHS dentists around and the fact that many dentists have waiting lists even for emergencies. I also know there are still many people who are scared of visiting the dentist, which is a shame because most of the dentists I know are caring professionals who take their time to make their patients comfortable.

Certainly we do still have patients who are nervous or worried, but often it is fear of the unknown and I will always explain honestly what will happen during treatment. I can recall a number of patients, both adults and children, who have been nervous at the start of their orthodontic treatment but relaxed and comfortable by the time the braces are removed.

So if you are putting off that visit to the dentist or orthodontist please don't, book an appointment and you may well be surprised to find it is not as bad as you think.

Look who's got braces!

This is British singer Estelle, currently nominated for a Brit award for "American Boy" which was a massive hit last year. She is wearing some aesthetic ceramic braces and already you can see an improvement in her teeth. She says "This was a me thing. I've wanted braces since i was 20." She even says it has not affected kissing! I think it's great that she is not afraid to smile and show them off.

Our lovely staff

I love this photo, this is receptionist Dale and practice manager Anna looking radiant and in the Christmas spirit.

What makes a smile?

Click the title to link to a short article about how to tell a real smile, called a "Duchenne smile". I often notice how my patients smile more naturally on the "after" photos than the "before" photos, it can actually make their apperance quite different (not just the teeth!).