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...!