Delivering bad news.....

I had quite a stressful day today. We had two new patients booked in this afternoon, both female, aged 34 and 55. Both had recently had examinations and already had long-term NHS Dentists.

The younger patient, let’s call her Patient A, was concerned about her gums and felt she had some tooth movement, particularly around her front teeth.

Her own Dentist had always dismissed this and just encouraged her to keep brushing twice a day. No perio advice or treatment had been suggested. She admitted she smoked and although she knew it wasn’t good for her health, she never felt the need to quit as she was not aware of just how significant the link between smoking and perio disease was. She had decided to see us for a second opinion. As soon as I started talking to her, prior to the examination, my heart sank. I thought to myself, “Oh my God, how are we going to tell her it’s this bad.” It was blatant to me that she had advanced perio disease. From talking to her, I think she thought that we would agree that she has been quite neglected but a few visits with the Hygienist would have her right as rain.

To cut a long story short, after a few x-rays and tears, the Dentist broke it to this poor lady that she required extractions UR3 to UL2. Now just imagine- she had been seeing her Dentist every 6 months since she was a child and trusted him with her oral health. As far as she was aware, yes her gums weren’t in great shape but generally her oral health was fine. And now we had just presented her with a treatment plan consisting of 5 extractions, a partial denture and a course of intense periodontal therapy at the age of 34.

Going through the treatment plan post-consult in my office was difficult as the patient was understandably very upset, angry and confused as to why the perio disease had become this advanced and not been acknowledged. I found this situation very difficult, as I too felt nothing but anger and hurt on behalf of this poor lady, also pure shock as to why her oral health had been so badly neglected.  Despite my feelings, I had to stay strong and professional and help this patient as much as I could. I offered her a supportive hug and reassured her that once we had treated the active disease, we should be able to keep her gums stable and healthy with regular 3 month maintenance visits with our Hygienist and prevent further tooth loss. Although she was still upset and shocked at the diagnosis, I think she was also relieved at knowing that we could at least prevent her from losing any more teeth. I dread to think what would have eventually happened for her if she had chosen not to seek another opinion.

Patient B was similar in the fact that she had suffered from perio for a long time, however she was starting to lose teeth and felt that now was the time to take action. She was particularly interested in fixed options such as bridgework and dental implants to give her back her teeth if at all possible. Her own Dentist however had assured her that “everybody loses their teeth eventually” and that he thought it was “unnecessary” her seeking advice from a cosmetic dentist when he can just make her some dentures. I couldn’t believe what I was hearing. After a Consultation with one of our Dentists, it turns out that we are able to restore her mouth with implants and give her what she actually wants- a healthy, well-functioning mouth. Providing she commits to hygiene maintenance and gives up smoking that is, which she is prepared to do. Patient B left the practice feeling inspired and relieved that it isn’t in her destiny to end up with no teeth and full dentures!

I still feel frustrated that there are patients being neglected and uninformed about their oral health, in both NHS and private practice, but at least there are dental practices out there that are willing to combat this and (just about) save the day!

Following the news of a registered Nurse being struck off the dental register for multiple convictions, it is a good idea to re-evaluate the meaning of 'professionalism' and what it is and isn't we should be doing not only in our working life, but also our personal life. Committing ourselves to our profession involves a standard of behaviour and if we do not follow the standards and guidelines set by the General Dental Council, we will not only lose our job, we will also lose our place on the dental register making it impossible for us to work as Dental Nurses again.

So, what do we need to be cautious of?

Our behaviour in public/

Whether it be a party, night out on the town, afternoon of retail therapy or even queuing up in our local supermarket, we have to remember that we are registered professionals and a mere, single act of verbal or physical abuse could ruin our career and let down our patients. So, if you are ever in the position where you are being confronted or antagonised, or you are one of those people who gets a bit confrontational after a few drinks, just remember- you are at risk of losing your job if you act on impulse!

Obeying the law/

Obviously, obeying the law is something everybody should be doing, regardless of whether they are a professional person or not. A criminal conviction, regardless of how small can pose a serious threat to our registration and could lead us to a hearing in front of the GDC and ultimately result in us being struck off the register. Again, we really need to think about our actions.

Using social media sensibly/

Most of us now have Facebook, Twitter, My Space etc accounts and it is now normal for us to alert the world as to what we are doing during the day, at night and at the weekend too! We also upload photos of ourselves, sometimes not in the most flattering or sensible of tastes! Make sure that you think before you act. Could that photo of you drunkenly posing or using certain body language be taken as offensive? Could it paint you in a bad light? If you come across a photo of yourself that may relate to the above points then it really isn’t worth sharing it with the world. Imagine how your boss would react or if one of your patients came across it. It really is not worth the risk. Alternatively, posting an unprofessional status update can also have the same effect. Social media is a fun way of keeping in touch with friends and family but just always keep in the back of your mind the fact that you are a registered professional with responsibilities and people have expectations of you!

To refresh your memory of the standards and guidelines set by the GDC, please visit http://www.gdc-uk.org/Dentalprofessionals/Standards/Pages/default.aspx

I have had a very productive day today. I have been revising our Smile Portfolio and Testimonials Books and have had a lot of fun updating them with new “before and after” photos and written testimonials for our patients, particularly new patients to view. One thing I love doing is video testimonials and I am currently in the process of uploading a few onto my new TCO Ipad (thanks boss!) which is going to be absolutely amazing once I start using it with patients.

How fantastic will it be for me to present my patient with a small, light tablet which has every ounce of information that they want or need at their fingertips? I shall keep you updated as to how it goes but I am expecting nothing but positive feedback.

Anyway, back to video testimonials! Anyone who isn’t using video for patient testimonials should consider it. Watching a video of a real-life patient sharing their experience is a lot more powerful than reading a hand-written or typed letter from an anonymous person. You can have them saved to your computer to show patients, merge them into a “Testimonials Video” which I have done or have them playing on a flat screen in Reception- there is so much potential! Not all patients will want to be filmed but there will be plenty who would be willing to. You could even take things a step further and incorporate social media into your video process. For example, we use Facebook and You Tube to upload video testimonials for patients and non-patients to view, what a great way to attract new patients!

We have also invested in an intra-oral camera for the Consultation Room which new patients can use and have a play with before seeing the Dentist. It can also be used during Smile Consultations with me as an added perk. Basically, it gives them a chance to view their teeth in a different light and get them thinking even more about the goals that they have for their mouth. We can then get as much information and feedback from them as possible in order for us to give them the perfect treatment plan. Genius!

There are so many ways you can personalise your practice and give off a modern, cutting edge vibe by using these simple yet effective tips and tricks. Why not have a think about what you can do to make your practice stand out?

To check out our You Tube channel and see for yourself what you can achieve with video, please visit Cahill Dental You Tube Channel!

Emma Lever-Pilling RDN.

Smoking cessation is the process of discontinuing the practice of inhalation of a smoked substance. More and more smokers want to give up their habit and luckily, there is lots of help available. Smoking cessation does not necessarily have to involve the use of medication or professional help- it can be achieved alone. This is personal choice.

Methods of Smoking Cessation:

Cold Turkey/

This is the process where all nicotine use is abruptly stopped. This method can be very successful for some smokers but also very unsuccessful for others.

Local NHS Stop Smoking services/

This service is available in most areas and offers help and advice for smokers to achieve their ultimate goal. Smokers aren't expected to quit straight away, they are given two weeks preparation in order to mentally and physically prepare themselves for the challenge ahead of them. It is also possible to speak to someone one-on-one.

“Smokefree Together programme”/

Another option from the NHS is this programme which is designed for busy people who find it difficult attending the meetings. This programme involves then use of texts, emails, phone calls and mail packs in order to help and inspire smokers to achieve their goal.

Nicotine Replacement Therapy (NRT)/

There are various medicines available to aid quitting. NRT works differently to cigarettes in the sense that it does not contain toxic chemicals like tar and carbon monoxide and it does not cause cancer. NRT is suitable for most people however you would need an assessment with your GP first. Pregnancy and heart conditions can affect whether you can use NRT. Products available are:

• Nicotine gum- through chewing this gum, nicotine absorbs through the oral tissue.
• Nicotine patches- can be worn around the clock or just during the day. Nicotine is released directly into the bloodstream.
• Micro tablets- these tablets are dissolved under the tongue.
• Lozenges- when sucked slowly, these lozenges provide nicotine into the system within 20-30 minutes.
• Inhalators- perfect for people who miss the hand to mouth action of smoking, these cigarette shaped Inhalators release a nicotine vapour which is absorbed through the mouth and throat.
• Nicotine nasal spray- with a quick spray up the nose, nicotine is released and absorbed through the lining of the nose.
• Zyban- this medicine changes the way your body responds to nicotine and should be taken one to two weeks before quitting. This programme lasts a couple of months. Only available on prescription.
• Champix- this medicine works by reducing the need for a cigarette and also the effects the body feels when having a cigarette. As with Zyban, Champix should be taken one to two weeks before quitting but the programme lasts 12 weeks. Only available on prescription.

The smokefree.nhs.co.uk website is a fantastic tool to use as it has more details on the above information and also has quizzes and helpful tools such as a cost calculator to help and inspire people to quit.

How can we use this information to help and advise our patients?

• We can attend training sessions in order to gain more knowledge on how to offer effective smoking cessation.
• We, as a dental team, can assess patients’ smoking status and explain the benefits of quitting.
• If the patient is responsive, we can offer advice and help on quitting and the various methods available. We can also direct them to help-lines and meetings.
• We can provide leaflets and other resources in-practice for patients to view and take away.
• We can monitor patients and offer encouragement and praise.