The Duchess and the French orthodontist

On Saturday the Daily Telegraph carried this article about the Duchess of Cambridge and how 'pioneering' French orthodontist Didier Fillion has used 'micro-rotations' of the teeth to produce 'harmonious asymmetry' and give her a natural look, according to Dr Fillion's friend Bernard Touati.

I do think the Duchess has a lovely smile, I'm so pleased she hasn't gone down the route of porcelain veneers and instead chose orthodontics to help her, but I do have a few problems with the way this article portrays what she has had done. Let's leave aside for now the breach of patient confidentiality (it's NOT ok to tell your friends about your clients) and read between the lines of the article.

Harmonious asymmetry
I don't see much that's asymmetric about Kate's teeth. I'm sure if you used an accurate measuring device you'd be able to pick up small differences, but it's what the eye sees that counts. I'm not sure why an orthodontist would deliberately aim to leave asymmetry but there will always be some imperfections when the natural teeth are kept. The only way to get that perfectly even, perfectly white 'American' smile is with porcelain veneers, and even with that type of treatment a natural look can still be achieved if wished.

Micro-rotations
If something is 'micro' then are we able to detect it? I would never claim to be able to align teeth perfectly, I can get close to perfect, but perfect does not exist. There will always be 'micro-rotations' (see above!)

Lingual braces
There is little information to tell us what Kate actually had done to her teeth. This is not the first article to suggest she has had treatment by Dr Fillion, who could be called a dental pioneer in lingual braces. Lingual braces are like traditional fixed braces but attached to the back of the teeth (tongue side=lingual). Put them on the back and nobody can see them. Dr Fillion runs a respected course in lingual orthodontics in Paris and has developed his own system called Orapix. However, there are orthodontists all over the UK using lingual braces and it is growing in popularity amongst orthodontists and clients who'd like straighter teeth but prefer discreet braces.
I've been using the technique for five years and about 20% of my adult clients now choose lingual braces. As an orthodontist it is a challenging technique but I now feel comfortable using it and look forward to seeing my lingual clients. Almost anyone who is suitable for standard fixed braces is suitable for lingual braces, though they require a bit more time to get used to and cost more.
Take a look at the British Lingual Orthodontic Society website (you'll see Didier Fillion is the president) for more information and to find an orthodontist near you, or have a look at my own website. You don't need to be a princess or travel to London or Paris to get a smile like Kate's.

We may never know exactly what the Duchess has had done with her teeth but they do look lovely, straight yet natural. You can certainly be sure we will be seeing a lot more of her smile!

Some you lose

Its not often that I have a 'failure' to report, but one has happened this week.

A lady in her 60's asked me to improve her crooked lower teeth. Together we decided the best option would be to remove one lower front tooth to create space and fit a ceramic fixed brace to straighten the teeth and close the space. As with everyone I treat we discussed the possible problems she could face especially discomfort during treatment. Everyone will experience some level of discomfort, from either achy teeth or the braces rubbing on the inside of the lips, but this is usually temporary. For most people it takes 1-2 weeks to get used to wearing braces, but it does vary a lot.

Mrs H came to see me several times with areas of rubbing or soreness and in most cases I could help by suggesting orthodontic products or trimming sharp ends. However this week she has decided it is all too much and asked to have the braces removed. We discussed a few options but finishing treatment now was the final decision so she is now very relieved to be free of her braces, even though she does now have a small gap at the front.

Of course, I'm disappointed that it hasn't worked out for her, but this is only the second time in 6 years as an orthodontist that I have had to end treatment for these reasons. I think this shows that for most people the discomfort is temporary and can be tolerated for the end result. My mission is to make people happy, and if wearing braces is having the opposite effect then I'm not being very effective in my mission! I will always try and work with my patients for the best outcome, and this means taking every case separately and listening to their needs.

What gumshield?

September heralds the return to school for many people and the school season for sports like hockey and rugby. You've probably got the PE kit already, but does it include a gumshield?

Gumshields are essential for anyone participating in contact sports, in the UK that mainly includes hockey, rubgy and lacrosse, plus boxing and martial arts like judo, taekwondo or karate. Usually made to cover the top teeth they offer protection to the teeth in case of a direct blow. This greatly reduce the risk of the teeth being broken or knocked out. This will reduce the need for prolonged and possibly expensive dental work.

However, the protection from a gumshield goes a long way beyond just protecting the teeth, they protect the bone supporting the teeth and the jaws too, cushioning the impact that might occur between the teeth and jaws from a blow to the chin. They can also reduce the risk of concussion from a similar blow, absorbing the impact and reducing shock to the brain.

Many schools and sports clubs now have good policies about gumshield use, you should wear one any time you are training, playing or competing. However, there is more than one type of gumshield, how do you know you have the right one that offers the best protection? A gumshield must also be comfortable to wear or the player will stop using it.

There are three main types of gumshield available.
1 Stock gumshields cost a few pounds, are preshaped and simply fit over your teeth. The likelihood is that they will not fit very well and therefore offer very little protection.
2 "Boil and bite" gumshields are adapted by the player, usually by immersing in warm water then placing in the mouth until it cools. I've tried one of these, it was difficult to get a good fit and was very uncomfortable to wear. Again, protection levels are low, but these remain popular options as they are usually less than £10.
3 Custom gumshields, which will require a dental impression of your teeth. These are the most expensive ranging from £30-£70 approximately, but as they are customised to the individual they are not only the most comfortable but they offer a very high level of protection from injury by having an even amount of material over the teeth. The cost can be off-putting, but for this you should get a choice of colours and often a storage box as well as a named gumshield. For more serious sports participants, eg adults and older teens in boxing or club rugby, the gumshields can be made of several layers to get the highest level of shock absorption possible.

Custom gumshields are also ideal if you are wearing fixed braces, they can be made to fit over the brace and also to allow some space for the teeth to move. I find they generally last a season. Dealing with injuries to teeth while wearing braces can seriously compromise the teeth and the orthodontic treatment as well as prolonging the total time wearing braces.

A lot of schools arrange for a company to come to school at the beginning of term to take impressions for custom gumshields, if this is not available ask your dentist or orthodontist about having one made. If it does not fit or is not comfortable return to your dentist as it may be able to be adjusted. It may seem like a lot of money for a small piece of sportskit, but how much do you value your front teeth, your jaw and your brain?

It's not always about braces

I guess the common perception of an orthodontist is that we fit braces. Of course that is a big part of what I do but I don't advise braces for every patient I see. Take two cases that I have seen this week.

S is 12 and not bothered by the appearance of his teeth. He is pretty adamant that he doesn't want braces, he has thought about this and lists several very valid reasons why. His teeth are a bit crooked, but not too bad and the main reason for doing treatment would be aesthetic. That's not to say appearance isn't important, but in S's case he was happy with his appearance. In his case treatment will still be possible if he changes his mind when he gets a bit older, even when he is an adult.

In this situation the patient's opinion is key. Wearing braces is a big responsibility and is not without risks. I need patients to be on my side to make the treatment easier for all of us. Apart from a few specific situations (for example where treatment timing is critical or dental health is an issue) I will never persuade people into treatment they don't want.

C is also 12 and has a very different situation. Her teeth aren't very crooked either but four of her adult teeth have failed to develop and one is in a poor position, that's her x-ray above showing the milk teeth remaining in position. Orthodontic assessment in a case like this is essential to plan what to do. If her teeth were really crowded we would remove the milk teeth and use the space to straighten the front teeth so that there won't be long term spaces, but in C's case this would be too complicated and wouldn't actually improve the position of her teeth by much, in fact she'd probably end up in a worse situation. So I didn't suggest braces for C either, she needs to take care of all her teeth, including the milk teeth that remain as they can sometimes last for years. Her dentist can plan how to replace these teeth when they are eventually lost but orthodontics can't really offer much to her.

So just because you need to see an orthodontist it doesn't mean that braces is the immediate or obvious solution. As an orthodontist I am trained to understand the development of the teeth, the jaws and the face, as well as knowing how to correct problems that can occur. So be honest with me about how you feel, listen carefully to my advice and don't be afraid to ask questions.

"Why is your Invisalign more expensive?"

That's a question I often get asked, and it's usually specifically about Invisalign rather than other type of orthodontic treatment I provide.

Do a quick internet search and you will see lots of offers for Invisalign treatment, some significantly cheaper than others. Have a look at your local orthodontic specialist and they will probably charge more than the general dentist down the road. In areas of high competition like London the price differences are even bigger and there may well be aggressive marketing on the internet or in magazines.

So why has this happened and why is a specialist more expensive than a general dentist? Have a read of this article by American orthodontist Ted Rothstein to see a bit of the background.

To summarise, Invisalign is one of a few orthodontic treatments that are easy for any dentist to start using, requiring a one day course to become certified and able to provide treatment (though there are now other similar treatments like ClearStep and Inman Aligner with similar issues to Invisalign). If you were a dentist who could now offer the treatment direct to your patients then why not, rather than referring to a specialist who will take the fees that could otherwise come to you? Why subject your patients to treatment with fixed braces when they can wear invisible removable braces instead? If you are the consumer why should you pay more to see a specialist when the same treatment can be bought for less?

Here's a quote from the article; "Dr. Rothstein reports that he is seeing in recent years a growing number of patients on consultation in treatment with Invisalign by the generalist who simply lacked an understanding of the limitations of the Invisalign appliance. General dentists are not fully trained to recognize the many nuances associated with effective treatment, or even foresee the potential problems lying in wait as they proceed. Training and experience really do make a difference.
There are also cases in mid-course where the general dentist had no idea how to handle the problem that the patient was encountering and cases where the end result of the Invisalign treatment were so lacking that the only recourse was to finish the case with fixed braces."

I'm sure there are some general dentists who get comparable results to a specialist, but only with the right experience and attention to detail, and how do you know who these are? Be sure to ask questions about your potential treatment and also about what is included. Does that cheap fee include hidden extras like refinements and retainers and how often will you be reviewed? What sort of customer service do you get and do you enjoy your visits?

It's a bit like getting your hair cut. Do you prefer to go to the small salon that has out of date magazines and faded decor, see the junior stylist at a medium salon or pay the extra to see the senior stylist at the best known salon in town? The end result is important but so is the experience you receive.

You should know that Invisalign offers significant discounts to providers who commit to providing a large number of treatments per year, they have to get the numbers in or risk paying large penalties. Even with these discounts some offers I've seen are so low it must be costing the practice money instead of making it. As a small practice and a specialist offering many types of treatment my numbers are relatively low so I can't always take advantage of this, or do "extras" like tooth whitening, hygiene or veneers to gain extra revenue.

I'll finish with a final quote from the article which puts it better than I can; "...isn't the consumer better served by the orthodontic specialist even though having to pay a higher fee? Indeed when the consumer pays more to engage the services of the specialist isn't he receiving more in the way of experience and wisdom that far outweighs the additional fees the consumer may have to pay"

Porcelain Deficiency Disease?

There is an interesting opinion article by dentist Martin Kelleher in the recent Faculty of Dental Surgery journal. He highlights what he terms "porcelain deficiency disease", a made up condition where dentists over-prescribe porcelain crowns and veneers. Unfortunately it has been taken out of context by several tabloid papers with the purpose of shocking the public about "greedy dentists", which is not really what he was trying to say. For a summary of the article click here, for the full article click here..

It's probably not escaped your notice that there is a recent trend for straight white teeth (think Simon Cowell). One way of achieving a very white, very regular smile is to place porcelain crowns or veneers on multiple teeth. A crown is a complete covering of a tooth, whereas a veneer is more like a facing glued to the front. Both are common dental treatments which are widely used for a number of purposes, mainly for restoring teeth that are decayed or broken, but they can also be used for altering the shape, size or colour of teeth. However, in order to accommodate the thickness of the porcelain the tooth is usually reshaped which often involves removing healthy tooth.

Martin Kelleher uses his article to highlight several cases where patients' dental health has suffered following extensive crownwork. The risks of crowns and veneers are well known, and include pulp death leading to root filling, fracture of the tooth underneath and gum disease due to rough edges or poor cleaning. Any responsible dentist will explain the risks to their patient and balance this against the benefits. What happens in a few cases is that the patient is prescribed crowns for EVERY tooth and sooner or later suffer dental health problem because of it. Another dentist then has to try and salvage what they can for the disappointed patient.

So why is this happening? There is certainly a pressure from patients who want to look like their favourite celebrity or their friend who has just had treatment and now looks ten years younger. But there must be a lot of pressure on dentists who perhaps see a colleague down the road doing such treatment and feel they need to keep up to survive, especially in financial terms. Whilst most dentists I know are very ethical and always have the best interests of the patient at heart there are some (like in any profession) who simply want to make money. If a patient appears in your surgery with a fat wallet and requesting complicated expensive treatment then why shouldn't you do what they ask? If you refuse will you lose out when they and all their friends go to a neighbouring dentist?

So, if you want to improve your smile what should you do and who should you believe?

Start by speaking to your dentist about your concerns. A good dentist will take time to find out exactly what your problem is and discuss the options. There will always be more than one possible treatment. Your dentist should discuss the advantages AND disadvantages of all options, but will probably guide you to one preferred option. Any comprehensive treatment should be planned out very carefully, usually with photographs, x-rays and models of your teeth, and sometimes with mockups of the predicted result. Ask to see pictures of previous cases and if you are unsure about anything get a second opinion. If you have irregular teeth has your dentist discussed the possibility of orthodontics? I accept that having treatment with braces is not for everyone, but in most cases it can mean that your natural teeth will be preserved which is much better for your long term dental health. Of course orthodontics itself is not without risks and I always discuss these with my patients before they start treatment.

Sadly there will always be rogue dentists who make headlines and there will always be journalists who will write horror stories about them. This is a very small minority of dentists and the rest are ethical, caring and well trained and would only prescribe veneers or crowns when appropriate. I will certainly be working with my referring dentists to make sure they consider orthodontics as an option.

In Praise of Patients

I treat a really wide range of patients, from about the age of 9 up to 60+. I treat boys and girls, men and women, nervous patients and confident people, housewives, teachers, business men...you get the picture.

One of the lovely things about orthodontics is that because I see my patients every 6-8 weeks over the course of one to two years I get to know them well. I've seen patients through pregnancy and love it when they bring in the babies. I like to hear about exam results, holidays, sporting results (one young girl is a national triathlete) and weddings. Sometimes I need to lend a sympathetic ear in times of bereavement, divorce or job loss. It works both ways, they ask me about my children, my holiday and my dental nurse Carly about how she's getting on with her braces.

I consider all this part of the job and one of the things that makes it interesting. I often hear "I couldn't look at teeth all day" and if as a dentist or orthodontist that's how you perceive your role then no wonder you don't enjoy it. It's the people that make it worthwhile and make no two cases alike.

I know that I make a difference by the smiles and the thank-yous I get when I finish treatment. The best way of thanking me is by recommending me to family and friends, it's not only a great compliment it's one way my practice grows. Some patients choose to show their thanks by gifts, in recent weeks I've been given wine, chocolate, running socks, a plant and some pink champagne (its a tough call as to whether the socks or the champagne are my favourite!). It's not necessary but I am really touched when people take the time to buy a gift or write a card.

So thank you to all my patients, I really couldn't do this without you!

Goodbye to the Tooth Fairy

The end of an era was reached last week as my younger daughter lost her last baby tooth.

Also known as milk teeth, or more correctly deciduous teeth, your first twenty teeth are shed to make way for the adult, or permanent teeth. Generally the first one is lost around about the age of 6, and the last one about the age of 12. However there is a large variation and two years either way is fairly normal, and as long as the normal sequence of teeth erupting is followed this is not of any concern or consequence. My daughter was particularly young, being 9 years and 7 months.

I am sure you will know of the tooth-fairy tradition of leaving the tooth for the fairy to collect, who leaves money in exchange. In some countries there are variations, like a tooth-mouse, but it's a fairly popular tradition worldwide. The first visit from the tooth fairy when she was aged 5 caused much excitement. Over the years she has developed a little routine of leaving a note for the fairy, who usually replies, so we now know that our fairy is called Lilac, lives somewhere nearby under a mushroom, and has all sorts of excuses for non-attendance like a sprained wing or a trainee fairy!

This is her last letter along with the tooth and the tooth box. I did think that at the age of 9 and with an older sister she might have realised the tooth fairy secret, but she was genuinely upset that the fairy would never visit again, to the point of tears! Awww!
Thankfully this time the tooth fairy attended on time and left a lovely letter, complete with lilac ink and a picture.

The tooth fairy was good enough to let me keep the teeth, shown in the picture at the top. Three are missing, I know at least one was swallowed, not sure where the other two went! I'm pleased to report they are all healthy, thank goodness, being the daughter of two dentists would you expect anything less?

Tooth Whitening

I wrote a blog in March about cheap tooth whitening and how you should always have whitening done under the prescription of a dentist. In general it is safe and effective when used correctly and plenty have research has shown this to be the case. Although I have used whitening in the past I do not offer it to my patients but refer them back to their general dentist for the procedure.

I feel it is time to comment again, not least because there is someone locally who is offering cheap tooth whitening illegally, a situation which is being repeated around the country. There have been adverts in local magazines and makeshift billboards in the verges on the approach to Wetherby. Looking at the website they seem to have done some research and explain, along with some out-of-context quotes, that in their opinion it is not illegal, but they seem to have overlooked some pertinent points.

The General Dental Council (GDC) regulate dentists and dental professionals and are very clear about what constitutes illegal dentistry. They even have a page dedicated to the practise of tooth whitening. They say "The practice [sic] of dentistry is limited to GDC registrants. It is the Council’s view that applying materials and carrying out procedures designed to improve the aesthetic appearance of teeth amounts to the practice of dentistry. So too does the giving of clinical advice about such procedures. Therefore all tooth whitening procedures, including bleach and laser treatment, are seen as the practice of dentistry by the General Dental Council." I have now alerted the GDC to the operations of this salon but until they investigate the salon continues to operate. The GDC recently prosecuted successfully for illegal practise against a similar type of clinic.


What is concerning in particular is that illegal dental procedures are putting patient's dental and general health at risk. As dentists we train for at least five years which includes diagnosing dental disease like decay or gum disease and understanding why teeth may be discoloured. We have rafts of legislation we have to adhere to both personally and with our practices and make sure we keep up to date with current treatments and guidance. How can someone who is not a dentist (or dental professional) and has had one day of training be sure that there is no dental disease before they whiten and how can they identify fillings or crowns which will not change colour? Are they aware of cross-infection control procedures which are used to prevent spread of disease, including serious conditions like Hepatitis B and HIV? How are they cleaning equipment after use and disposing of contaminated materials like gloves? 


I should mention that there is a legal issue surrounding the use of hydrogen peroxide products to whiten teeth, due to the fact that whitening agents are classed as cosmetics (read to the lower part of the page), even when used by dentists, which is how these salons think they can get away with it and why some dentists are not offering whitening at the current time. Some illegal clinics are not using peroxide based agents, but it is unclear exactly what they are using and whether it has been correctly tested. As peroxide is the most effective agent, at the right concentrations, are the results with something else going to be satisfactory? Promising "10 shades whiter" with a single treatment is totally unrealistic as a dentist would know.


So please, if you are considering getting your teeth whitened DO NOT visit the salon offering tooth whitening at what seems like a good price. Similarly do not use that Groupon offer that seems too good to be true. At worst you could end up with damage to your teeth or even an unwanted infection, at best you will probably be disappointed with the results and will have wasted your money. Please don't buy whitening gel on the internet either, it is often fake and is usually not subject to strict quality control. Go and visit your own dentist and discuss the options, and please tell your friends too and spread the word.

Treatment fit for a Queen?

Did Kate have braces to improve her smile before her wedding day?

There is a lot of speculation that the Duchess of Cambridge had treatment with lingual braces before her wedding day including reports that she visited a specialist on Harley Street and an article in Hello magazine this week. Her smile is certainly fantastic, I'm sure any bride wants to look their best on their wedding day but when you will be seen by millions around the world and the images will form part of history it's even more important!

You might know that Prince William had braces when he was a teenager, as did brother Harry and cousins Eugenie and Beatrice. This is nothing unusual, it's estimated that up to a third of children have a need for braces and there will be more that have them for cosmetic reasons.

So how did Kate manage to keep braces a secret? It's likely she wore lingual braces, braces that are fixed to the back of the teeth to keep them hidden, rather than being invisible. It's not a new treatment but this type of treatment is growing in popularity and celebrities like Myleene Klass have chosen them. I think it's highly likely Kate also had some tooth whitening as well.

The good news is you don't have to be a future queen or go to Harley Street to have this type of treatment. I have been treating patients with lingual braces for several years, from self-conscious teenagers to middle-aged business men. The thing they have in common is wanting a better smile without wearing "Ugly Betty" braces, and they are suitable for most orthodontic problems. I use a system called Incognito which is highly customised to make the braces more comfortable and more accurate. Not only do you keep your braces hidden but you get the benefits of straighter-looking teeth whilst still wearing them!

If you are interested in having treatment fit for a queen then please give us a call and book an appointment for an assessment, and soon you can be smiling like Kate and William on their wedding day.

Virgin London Marathon 2011

I'm not entirely sure where to start on this blog. Its been a long journey including recovering from a running injury a year ago which put me out of running for several months. I've trained through snow and ice and wind, and finally sun and warmth. I've avoided lurgy and falling ill or injured. So on Sunday April 17th 2011 I found myself on the start line at the Virgin London Marathon for my first marathon.

Running with me was Chris Barrow, a dental business coach I have known for some years. He's a veteran of 14 previous marathons and we'd talked each other into running this year over a bottle of wine! Also with us was his son Josh running his first marathon. I have to admit to being nervous about running with other people in a race, most of my training has been done solo, but we made a pact to stick together.

I've got so much I could say about this race. Overall it was just amazing, I had a fantastic day. To me it didn't feel as far as I thought it would nor as difficult as I expected, perhaps because I have trained well. Running with others was great to keep pointing out the landmarks and the mile markers. We all suffered tough sections, Chris more than me and Josh, and focusing on bringing him through that meant I stopped worrying about my own running. Seeing my family at several points around the course was a real boost and the last few miles with spectators cheering and shouting was fantastic. I ran almost all the way, and every step of the last 6 miles to finish in 5 hours 34 minutes with the biggest grin on my face, and I almost kissed the lady who gave me my medal!

I can honestly say that I really enjoyed it, and far more than I thought I would. It was wonderful to share the experience and to relive it with Chris and Josh afterwards, my thanks to them for keeping me company. I am so proud of my medal and it has been hanging next to my dental chair this week. Apart from one blister and slightly achy legs I feel pretty good and am still buzzing with the excitement several days later!

This is not the end of my running career and at some point I will be back in London to run the race again. If you have any thoughts of running in London Marathon I'd really recommend it, although tiring and time consuming the training is really worth it. I know I shall be entering the ballot for next year when it opens next Tuesday.

I have already raised about £1500 for Hearing Dogs for Deaf People and have just £500 more to reach my target of £2000. If you'd like to donate please visit my fundraising page. 

The photo above was taken by Rich Kennington at about mile 22, many thanks to him for capturing the flavour of the day so well in his pictures.

Orthodontic Tourism

You've probably heard of dental tourism, going overseas to have complex dental treatment done because it's cheaper and it can be combined with a holiday. Whilst it seems like a good idea you have to consider who will maintain your dental treatment and what would happen if you had any problems. It is difficult enough to assess the competence of a dentist but even more so if you are unable to visit the clinic in advance or talk to other clients.

Today I had a call from a patient with a request I am hearing more and more frequently, and I know my colleagues are too; "If I have my braces fitted abroad will you monitor and adjust them for me?" In this case the patient wanted to go to Poland to have the braces fitted then have me adjust them.

Orthodontics is a complex treatment and ideally should be carried out by a specialist or someone who has had additional training and experience. Each orthodontist may approach the same case in very different ways, for example some may extract teeth and some may not. There are many different treatment systems out there (brackets, wires, ways of moving teeth) which may require a different skill-set. The most important part of the treatment is the planning stage, so wherever possible treatment should be planned and carried out by the same person (or at least supervised by the same person or in the same clinic).  Therefore, if someone is hoping to save money by having braces fitted elsewhere then I am not willing to treat them, the treatment should be carried through from start to finish at the same place.

Of course, occasionally people do move or emigrate part-way through their treatment, I've had patients who have moved to Australia and Northern Ireland. In these cases the treatment should be formally transferred to a new orthodontist. I always send a letter detailing the treatment plan and the progress in treatment so far together with copies of x-rays, study models and photographs. I'd expect the same if patients transfer to me, in fact I have taken on patients from Brazil and London and successfully completed treatment. I'd also see someone who might be temporarily in the area if they have a problem during treatment, but usually only to make the brace safe so as not to interfere with a colleague's treatment.

So please don't consider "orthodontic tourism". By all means get more than one opinion if you have several orthodontists in your area, realising you may well get different treatment plans and different costs, and be prepared to consider ALL the factors, not just the financial cost of treatment. Remember your treatment will take many months and require regular visits and you will need to have a good rapport with your orthodontist and their team.

Success at the Smile Awards 2011

The 2011 Smile Awards were held on Friday and I travelled down to London with dental nurses Carly-Ann and Lisa. We got glammed up for the ceremony at the posh Royal Garden Hotel (I met Carol Vorderman while checking in!), have a look at the pictures on Facebook to see our frocks.

Although there are several dental industry awards over the course of the year these are the only ones to judge treated cases, they do this anonymously and reward true clinical excellence. Just making the shortlist is an achievement in itself, I was shortlisted for two categories, Orthodontic Smile Fixed Appliances and Orthodontic Smile Removable Appliances, along with some well known orthodontists and dentists.

Although I didn't get an award for the Fixed Braces category I was awarded Highly Commended for my Removable Appliance entry. In a later blog I'll share the pictures of Katherine who I treated using Invisalign. I always do my best to get not just a good-looking result but a technically great orthodontic result as well, so I am delighted to have this recognised in such prestigious awards.

There really was an amazing array of smile transformations on display, from orthodontics to veneers and implants to a full facial reconstruction following severe trauma. There are some talented dentists, surgeons and and technicians out there and I was delighted to see some fellow northern dentists getting awards, congratulations to all my shortlisted and winning colleagues.

After two years of Highly Commended I will be back next year hoping to go one better and get a trophy!

Should you be concerned about radiation from dental xrays?

With Japan and the Fukushima nuclear crisis in the news the dangers of ionising radiation have been brought to everyone's attention. You can't see radiation but most people are aware that it can be dangerous.

Radiation has several effects on the body. A large single dose (like being very close to a damaged reactor) has immediate effects that will make you ill or kill you, remember Alexander Litvinenko who was deliberately poisoned a few years ago.

For the general population it is the long term effects of an accumulated dose over many years that is more relevant, by either increasing the risk of cancer or causing birth defects, and these are the sort of effects that are seen in people living near Chernobyl where there was a nuclear disaster in 1986. Health problems are still being suffered by local residents and especially children due to the ongoing increased levels of radiation.

So how does dentistry fit into this? You might be concerned that having a dental xray will increase your radiation dose. Of course it does, but it needs to be put into perspective. You receive radiation every day from your surroundings (background radiation) and this is by far the biggest source of radiation most people receive over their lifetimes. A dental xray is roughly equivalent to the amount of background radiation you experience over the course of a day, and less than the additional amount you would get from a plane flight to Spain. Have a closer look at the clever chart above by clicking this link and you will see how insignificant the dose from a dental xray is compared to other radiation sources, including the radiation from Fukushima.

Of course that doesn't mean we don't have to be careful with medical and dental xrays. Modern technology has dramatically reduced the necessary dose to get a good xray picture and there are regulations which we, as dentists, must adhere to, as well as making sure we don't take any unnecessary xrays (for example if someone has had a recent xray elsewhere I always request a copy rather than taking a new one).

Dental xrays are an important tool for diagnosing problems and planning treatment, but they really aren't a significant problem when you consider overall radiation doses from all sources. My thoughts are with those who work or live near Fukushima and I sincerely hope the crisis can be controlled. Like Chernobyl, we may not be able to count the total human cost of the disaster for many years to come.

Brides and Braces

If you are getting married you are probably thinking about your appearance on the day, especially as it will be immortalised forever in the photos. Hair and makeup are just as important as the dress, but have you thought about your smile?

A wedding is often the factor that prompts brides into getting dental attention, whitening is probably the most frequently requested treatment but you may also be thinking about the position of your teeth. I have treated several brides-to-be (and mothers of the bride) to give them a better smile before their wedding. The limiting factor is often time, most orthodontic treatments need at least a year and the more time you have the better.

However, if you have less time don't panic, we can get a significant improvement in most people's teeth in about 6 months. We can fit the braces, progress the treatment as far as possible in the time available, then remove the braces in time for your big day. Afterwards we can reassess whether to re-fit braces to complete treatment.

Alternatively, you could pick invisible braces like lingual Incognito braces or removable Invisalign, which means your treatment can be continued without interruption, these are especially good options if time is a bit short or you don't want the additional cost and time of removing/refitting braces.

Recently one patient got married wearing her ceramic fixed braces as she was keen not to interrupt treatment. Ceramic braces are like traditional fixed braces but made of clear porcelain rather than metal so they blend with the teeth. I changed the wire for a tooth-coloured version before the wedding and she smiled with confidence all day. You can see the braces in the pictures (see above) but they are barely noticable. I know Faye herself was delighted that her teeth looked straighter and knows she made the right decision about keeping the braces on. I'd like to congratulate Faye and her husband on their wedding and wish them the best for the future.

If you would like to get your teeth straightened before your wedding please call us to arrange an appointment to discuss the options, it may be easier than you think!

Cheap Teeth Whitening

As teeth whitening becomes the new "must-have" it's not surprising that bargain treatments are springing up all over the place. I've seen various home kits advertised, beauty salons offering whitening, and offers for someone to do laser whitening in your own home.

It probably seems rather attractive to have your teeth whitened for just £50 or £99 or to buy gel on the internet rather than pay your dentist more for what appears to be the same thing.

Please think carefully before you go ahead with any sort of cheaper deal. You may not know that it is illegal for anybody who is not a registered dental professional to carry out any sort of dental treatment, including whitening. You should always have your teeth checked by a dentist before you have any treatment, including cosmetic work. Professional whitening is very safe but there are some risks which should be explained to you first, these including damage to the gums, especially if the wrong concentration of gel is used. "Laser" whitening does not exist, though very bright lights are sometimes used they are NOT lasers! If you're not sure about someone's credentials check the dentists' register on the General Dental Council website. If you're not sure if it's a legitimate business or dental practice check for a proper address, a local phone number, details of the team members and information about other dental treatment that is offered (no respectable dentist would ONLY offer whitening).

Beware of guarantees about the amount of improvement or the longevity of the result and you should always be told about potential drawbacks as well as benefits. As I said on my previous blog, if an offer seems too good to be true, then it probably is!

DIY Orthodontics?

Two slightly bizzare things happened yesterday.

I saw a lady who had braces fitted elsewhere about four years ago. Following a disagreement with her orthodontist she had not returned, so had not seen a dentist or orthodontist for about three years! Eventually she got fed up with the braces and removed most of them herself. She was unable to remove the upper ceramic braces or the remaining adhesive so had asked me to finish the job.

I later had a phone call from a man asking about using elastic bands bought over the internet to close the space between his teeth. He didn't want me to do the treatment, just to tell him if it was a good idea. You might guess my response. This was the first I had heard of self-treatment with elastics but a check on the internet shows that a lot of people have tried it.

Please don't attempt any sort of DIY orthodontics or dentistry. Dentists train for five years and orthodontists a further six at least (three of those just devoted to orthodontics) and understand all the drawbacks and risks to treatment. Orthodontics is NOT simple, it might appear so but damage to teeth, gums and bone can occur and teeth do not necessarily stay where you put them. Similarly there are a lot of "quick" options springing up that many general dentists are being encouraged to try without detailed orthodontic knowledge. If you find a cheap or quick option that seems too good to be true then it probably is!

About a year ago I introduced low cost intitial consultations for both adults and children who want to find out if treatment is possible without spending large amounts. They have proved so popular they are continuing indefinitely, £30 for age 16 and under, £40 for adults and I can usually tell you what type of treatment will be needed and an approximate cost. Please contact us if you'd like either a full consultation or a short one.

Why I love Mary Portas

I've really enjoyed watching Mary Portas' "Secret Shopper" on Channel 4 and both her previous "Queen of Shops" series for the BBC.

In "Queen of Shops" she was helping small independent retailers make the most of their shops to stand out from the competition. The makeovers of the shops were fantastic but what she really pushed was doing something different to stand out from the big chains and this often included great customer service. In "Secret Shopper" at first sight she is on the customer's side, fighting for better customer service. There have been some great examples of pushy salesmen, the sort of thing that a lot of people shy away from. The hard sell, the sales patter, the constant discounts and the formulaic shops were particularly well highlighted in the sofa shop programme. After some persuasion she got the MD and the salespeople on her side and turned around the way they did sales. A win for the customer who wasn't subjected to the hard sell any more, but also a win for the business as their sales increased and their staff got job satisfaction.

You might think this has nothing to do with dentistry or orthodontics, we are not exactly a retail or a sales business. However, I believe many of Mary's principles can be applied to dentists or indeed many other types of business. When I set up my practice I was sure I wanted to focus on great treatment and treating my patients with care and empathy. As dentists we are taught how to treat teeth, but we are not tauught how to run a business. There are two people in particular who have helped me develop in this over the years.

Ashley Latter is a sales coach for dentists. His inspiring course helped me "sell" my services without sounding like a salesperson or using pushy techniques. By talking to my patients and finding out more about them I can recommend the right sort of treatment. Think of the difference between the sofa salesmen with their standardised patter selling sofas that are too big or the wrong colour, and how Mary transformed them into people who listened to the customers and tried to understand what they wanted.

Chris Barrow is the Mary Portas of the dental world. Like Mary he can instantly see what is wrong with a dental practice and guide the owners to a better place. Like Mary's shops a dental practice might need a visual makeover, a team who care about service or behind the scenes help.

Neither Chris or Ashley are dentists and I am sure they experience the same sort of scepticism Mary faces when she first talks to the retailers about what they are doing wrong. Dentists can be stuck in the "we've always done it this way and so have our competitors" rut. I love seeing the moment of enlightenment on the faces of the retailers on Mary's programme as I can empathise with that, I've experienced it myself and seen it in other dental professionals.

I'm always trying to improve my practice, I love my job and my patients and want the best for all of us. Watching Mary's programme I've picked up a few things, visit my website and you'll see I've added my personal promise to the front page, inspired by her programme. I'm also very aware of the customer service experience wherever I go, whether it is a shop, a hotel, a restaurant or another dental practice.

More from Mary Portas please!

PS If you watched the first series of Queen of Shops you may have noticed she's had her smile improved since then, I think she looks fab!

My Marathon Challenge

Over the last few years I've done a few challenges, from walking the Edinburgh Moonwalk to running the Great North Run. I've really got the running bug now and enjoy getting outside and getting fit.

This year I am taking on my biggest challenge yet, the Virgin London Marathon on 17th April 2011. I will be running 26.2 miles which will take me about five hours! I'm currently deep into training and already running further than I ran for the Great North Run. Its hard work but I can feel myself getting fitter.

I am running for Hearing Dogs for Deaf People, a fantastic charity my parents have been involved with for several years. Mum and Dad help by "socialising" puppies and young dogs before they go for full training. The recipients not only get companionship but a dog who is trained to alert them to everyday noises like the doorbell or alarm clock, and even emergency alarms. It costs a lot to train every dog (who are often rescue dogs or otherwise without a home) so every penny will help.

Your support is greatly appreciated, please visit my Just Giving page if you'd like to donate. I shall be thinking of all the people who donate when the going gets tough on 17th April.

My Milk Toof

I tweeted this last week but couldn't resist another link.

My Milk Toof a blog of photo stories following the adventures of two teeth, Ickle and Lardee. Its not really dental related, its not promoting healthy teeth or a dentist and the stories aren't dental in nature (for example in one they go fishing!) but the characters are very cute and the photos are lovely. Go and check it out.

How to choose an orthodontist

I came across this blog from an American orthodontist on Twitter. A few years ago this would not have been relevant in the UK. You take your child to the dentist, the dentist says they need braces and refers your son or daughter to the local NHS orthodontist they have always referred to. You didn't think to question that there might be a different orthodontist you could choose to see and when the treatment is "free" why should you question it?

This is changing and in many cases parents are researching who might be best for their child. Why? Partly due to the NHS changes meaning that there are long waiting lists and children with milder problems will not get treated, meaning parents may need to pay for private treatment. But there is more to it than that, parents and children want to be involved in the decision making process and want to understand what will happen, and be treated as an individual, not just another patient in a busy day.

As a private only orthodontist I see patients who have chosen to visit me for a number of reasons. In many cases its because they do not qualify for NHS treatment but still want to get straighter teeth, or because they do not want to wait for a year or more. But I am seeing an increasing number of children and their parents who are visiting more than one practice before they select who they feel most comfortable with to do the treatment. Its not just about cost or whether extractions are involved, its about how they feel about entrusting the dental care of their son or daughter to the clinician. You probably only get a real feel for this by visiting the orthodontist.

I'd actually disagree with the article about "Word of Mouth". Of course if you are not a dental professional you cannot assess the quality of work that is done, but I do believe that if someone takes pride and care in looking after their patients then they will probably take pride in their clinical work. Its important to me that I get a great clinical result, but its just as important that my patients feel happy and comfortable visiting me. I get a real sense of pride when I know I have been recommended by a former or current patient.

So how do you choose an orthodontist? Research on the internet, ask your friends and ask your dentist. Weigh up the practical side like how easy the surgery is to get to and get parked, the costs and the payment plans available. Consider the type of treatment that has been recommended, whether extractions are involved and how long it might take. But overall its about how you felt when you went to the surgery, the customer service, the pleasantness of the surroundings and most of all if you got a sense of whether you can trust the orthodontist. If you're not comfortable-get a second opinion!

Invisible braces for Chris Evans

Regular visitors to Wetherby Orthodontics will know that we usually have Radio 2 playing in the background and if they're lucky Carly and I will even sing along!

I did miss Chris Evans on this morning's breakfast show talking about his new invisible braces, but it didn't take long for a patient to tell me they'd heard it. Chris is such a smiley person and I've always noticed that his teeth aren't perfectly straight, particularly the lower ones. As more and more people get straighter teeth I guess he has now decided to get something done. I'm sure it will make a big difference to his smile and I wish him well with his treatment.

From the description we think he's wearing Invisalign, clear removable braces that fit tightly against the teeth. They really are almost invisible and are very easy to get used to, they certainly won't give him any problems with his radio and TV work. Of course, if you don't want to tell people about it you don't have to. Other types of invisible braces are available too, like lingual Incognito braces, sported by Myleene Klass (see earlier blog), so there really is something for everyone, they don't have to look like Ugly Betty's braces!

If you'd like to find out more about invisible braces there's more information on our website or on the Invisalign website (linked off the title of this blog). Please get in touch if you'd like an appointment for an assessment for your own teeth.

Smile Awards 2011 Shortlisting

We are delighted to announce that Megan Hatfield has been shortlisted for two categories in the 2011 Smile Awards.

The Smile Awards are the ONLY dental awards in the UK to reward clinical excellence in dental and facial aesthetics. Megan Hatfield has been shortlisted in the Orthodontic Smile-fixed appliances category for her treatment of a teenager with crooked teeth, and the Orthodontic Smile-removable appliances category for her treatment of a young adult using Invisalign clear braces (photo above). Just making the shortlisting is a massive achievement and we are delighted that Megan's hard work is getting recognition.

The awards ceremony is in London on Friday 25th March. Megan will be hoping to improve on the 2010 awards where she was shortlisted for two categories and won Highly Commended in one of them.

Can you be too old for braces?

This is a question I often get asked.

The popular image of braces is teenagers wearing fixed braces or train tracks and this is often off-putting to older patients who feel they don't want to look like a teenager.

I see a lot of adults who didn't get orthodontic treatment when they were younger or whose teeth have changed position over the years. You may be surprised that in 2010 we started treatment for equal numbers of adults and children. From the adults who completed treatment last year half were between 30 and 44 years old, nearly 25% were over the age of 45 and our oldest patient was 63!

There is certainly a recent surge in orthodontics for adults, partly as people are realising how important it is to have a great smile and partly as a result of the modern treatments which greatly reduce the aesthetic impact compared to traditional metal fixed braces.

Last year most of the adults we treated opted for ceramic fixed braces, like the traditional ones but clear and they blend in so well with the teeth they are barely noticeable. For even better aesthetics we recommend Invisalign or lingual braces. Invisalign are removable, like a thin clear gumshield, and don't feel like fixed braces. Lingual braces (we use Incognito) are fixed to the back of the teeth (see pic above, courtesy of Incognito braces) and are suitable for almost anybody.

So if you have been considering getting your teeth straightened but are concerned about being the wrong age or wearing visible braces, don't worry, we will probably have a treatment to suit you and you will be in good company. Get in touch for your initial consultation and find out how we can help.

Beat the VAT rise!

Here at Wetherby Orthodontics we will help you beat the VAT rise!

How?

There is NO VAT on dental and orthodontic treatment, so our fees remain unaffected by the VAT rise. If you've made one of those "New Year, New You" resolutions why not come along and see us to find out how we can help you achieve a beautiful smile. You can even continue smiling during your treatment with Invisalign or Incognito braces.

However, some things we need to run the practice are affected by VAT and many of our supply companies are putting prices up, so our fees will be changing on 1st February. If you attend for an initial assessment in January you will get our 2010 fees guaranteed for three months (this extends to our young patients too)!

So don't put it off any longer, give us a call and come in for a chat to find out how we can help.