Myth-Busting Occlusion - what's in it for me?

Myth-Busting Occlusion - what's in it for me?

S4S sponsors this annual course – and each year we come we have helped improve the lives of dentists and their patients. 

Don’t miss this opportunity!

 HAVE YOU EVER THOUGHT IF YOU JUST KNEW AS MUCH AS THOSE TMJ OR RESTORATIVE GURUS YOU COULD HELP THAT PATIENT WHO HAS JOINT PAIN OR CLICKS? HAVE YOU EVER TRIED TO DO WHAT THEY DO ... EQUILLIBRATE PERFECTLY?   AND FIND THAT THE PATIENT JUST DIDN'T RESPOND THE WAY THEY WOULD IF THE GURU DID IT? Can you say "The Emperor's New Clothes? Come learn that you are smarter than you think you are. -  and that occlusion and bruxism aren't as difficult as they make it! Learn about when occlusion matters -- and when it doesn't! Learn how to help your patients in conservative, reversible ways so that you can protect them from the forces that threaten them and the dentistry you do for them. Are you across the pond? Come to Sheffield or London in JUNE.

 

No, it won't take a series of mini courses. Just two days. The way you think of occlusion on EVERY patient will change.... and your life will be easier and less frustrating. Just sayin

On an online forum, a college professor in the UK wrote to me:

I would suggest that someone at the start of their journey, studies the established protocols of Dawson Pankey AES first and once they are proficient with them can evaluate the merits of other treatment modalities (as I assume you did?)

I responded: 

Yes, I did start what I term my “treacherous” journey studying with Niles Guichet and the Society for Occlusal Studies, which led me to work with Harold Gelb for seven years or so, and then with BioRESEARCH and ICCMO and neuromuscular concepts.  These all led to some increased conflict and confusion, and eventuality I learned that so much that was being taught was indeed empirically derived.  And thus,  each practitioner was left with their choice to pick and choose – whatever worked best in their hands(Donoff, 2000) – which is in itself problematic. 

Yes, along the way I met Peter Dawson, and yes, I was asked to lecture to his inner sanctum. This led to several of his instructors spending time in my office, a discussion of my moving my pain practice to join his.  I introduced what they named the “B splnt” to them, and then they took it back to Florida and bastaridzed the concepts to fit their agenda.  We actually use their videos in our course to demonstrate how the concepts are totally manipulated incorrectly.

 Most of the restorative agendas (as the one’s you have mentioned) are based on Travell’s Vicious Cycle Theory(Travell, 1960) which essentially suggests that interferences of some type cause hyperactivity (lateral pterygoid “spasms” which rarely if ever actually occur) leading to pain and dysfunction.  Many years ago, Lund refuted the theory showing that the “interferences” suggested to cause hyperactivity actually cause hypo-activity and proposed the Pain Adaptation theory(Lund et al., 1991).  Unfortunately, this mechanism doesn’t fit the existing agendas from the major restorative camps, which by the way, can be traced back to Ramfjord and Ash’s 1961 book which suggests that interferences “cause” bruxism, a concept that continues to be taught with zero evidence(Ramfjord, 1961).

These restorative “pioneers” created the way for us to move forward, but like with any pioneers, the maps change.  They are to be respected and yes, revered, for what they have done.  It is my impression that what they teach restoratively is nothing short of brilliant. But the connection to pain and dysfunction needs to be re-evaluated(Campbell, 1957).  But if they continue to hold onto principles and prevent science from moving us forward, this would be like not revamping a pioneer’s old map(Glassman and Malizia, 2017). 

So no.  I would NOT suggest that a dentist start down this path of essential understanding by learning a non-evidenced based agenda – a cook book of sorts teaching mechanisms as fact that are in fact not totally understood, and in some cases being taught “facts” that are in fact already demonstrated as incorrect. 

A few points:

1.      I totally understand the problem of “one size fits all” diagnosis and treatment.  I have been on a campaign to eliminate the term “TMD” from our vernacular. I have spoken to nearly every well-known lecturer and researcher in our field and while they all agree with the concept, they pronounce that it is far too embedded at this point and that it is a way to “communicate.”  I submit that it is responsible for much miscommunication(Nitzan, 2008).

2.     Therefore, we teach diagnostically driven therapy. Those diagnoses include various types of internal derangements, degenerative disease states, neuropathies, neurovascular disorders, cervicogenic disorders, ligament insertion injuries, etc.  Each of these disorders does in fact have their own specific recommended treatment considerations(Manfredini et al., 2011).

3.      That being said these treatment procedures are not necessarily “dental” as the teeth and the “occlusion” are not necessarily the key factor – and shouldn’t be considered that just because we are dentists and that is where our attention lies. 

4.     How do “splints” work?  What is the intended mechanism?  When do they work?  Clearly muscle health is not at the forefront of most of the disorders we listed, and the preponderance of the evidence suggests that the “occlusion” is not related directly to these disorders, including the intracapsular disorders.  This, Paul, is the reason for the oversite suggestion that occlusion is not related and that it shouldn’t be changed in treatment.  I would argue that we have evidence (not confirmation bias) that there could be a relationship, but the mechanisms are not what we are being taught by our restorative gurus who have for some reason become the leaders in treatment recommendations for pain and dysfunction. This helps understand the governmental regulations – and while I understand them, I would fight for your right to treat as you feel appropriate.   That being said, what we teach is that we do not suggest that restorative treatment is required to help our patients with their pain and dysfunction, but we treat their pain and dysfunction so that they can have the restorative treatment they need or want and that we would like to give them!   The goal, then, is to provide conservative, reversible therapy when possible(Reid and Greene, 2013).  We call this the pain/dysfunction restorative “disconnect.”  This is not to suggest that occlusion can’t play a role in pain or dysfunction, but to suggest understanding what that role is and WHEN it is a factor will help explain the majority of patients who have malocclusions with no pain or dysfunction.

5.     Since it has been demonstrated that mandibular re-positional therapy is not in itself a key factor, and the preponderance of evidence suggests no direct link between occlusion and “TMD”  (Zonnenberg and Mulder, 2013, TÜRP and Schindler, 2012)(for example… many others could be listed here) and that therefore the goal of any nocturnal or diurnal appliance is to protect the patient from destructive parafunctional forces, no matter what the diagnosis, our appliance design became essentially simplified and consistent.  This was a conflict internally for me as well. There I was preaching diagnostically driven therapy, but in the end, many of the conditions could be aided by efficient parafunctional control which of course doesn’t stop parafunction but decreases destructive force vectors hopefully allowing for heading and adaptation(May and Garabadian, 2000). 

 

Whatever has been taught about splints and occlusion – I have been taught –believed – and in some cases taught myself. The biggest lesson to be learned is that our teeth are only in contact about 20 minutes a day – and that is ANY form of contact, not necessarily MIP.  And since MIP is almost never reached during function (we can have a discussion at a later time about the swallow but I think you’d find the literature interesting in this regard) occlusion itself only becomes a factor when we are “occluding” –  and that factor can be destructive forces based on force vectors magnitude, direction and duration. 

 I in no way mean to be offensive when I question what is being taught.   But the truth is much of what is taught creates “hoops” for our general dentists to jump through and teaches mechanisms that are just flat out wrong, but in many cases reinforced through confirmation bias.  Yes, we palpate muscle, but have found that most injuries are not in the muscle itself but at the enthesis, the real weak point of the musculo-skeletal system.  We as dentists tend to “stipulate” occlusion.  We tend to think of the teeth as together, and understanding rest, function and parafunction and the potential forces involved to negatively affect the components of the cervicomandibular cranial system is critically important. 

 It is my firm belief that so many of our general dentists could help so many people if they weren’t turned off by all the unnecessary controversy as our legends hold on to agendas to protect their legacy ignoring the science we need to help guide our art. 

 

CAMPBELL, J. N. 1957. Extension of the temporomandibular joint space by methods derived from general orthopedic procedures. J. Pros. Dent, 7, 386-399.

DONOFF, B. 2000. It works in my hands. Evidence-Based Dentistry, 2, 1-2.

GLASSMAN, B. H. & MALIZIA, D. L. 2017. The Curious History of Occlusion in Dentistry. DentalTown Magazine, 55-62.

LUND, J. P., DONGA, R., WIDMER, C. G. & STOHLER, C. S. 1991. The pain-adaptation model: a discussion of the relationship between chronic musculoskeletal pain and motor activity. Can J Physiol Pharmacol, 69, 683-94.

MANFREDINI, D., BUCCI, M. B., MONTAGNA, F. & GUARDA-NARDINI, L. 2011. Temporomandibular disorders assessment: medicolegal considerations in the evidence-based era. J Oral Rehabil, 38, 101-119.

MAY, B. M. & GARABADIAN, C. 2000. Reducing condylar compression in clenching patients. Crit Rev Biomed Eng, 28, 389-94.

NITZAN, D., BENOLIEL, RAFAEL, HEIR, GARY, DOLWICK, FRANKLIN 2008. Pain And Dysfunction of the Temporomandibular Joint. In: SHARAV, Y. & BENOLIEL, R. (eds.) Orofacial Pain and Headache. Edinburgh ; New York: Mosby.

RAMFJORD, S. P. 1961. Bruxism, a clinical and electromyographic study. J Am Dent Assoc, 62, 21-44.

REID, K. I. & GREENE, C. S. 2013. Diagnosis and treatment of temporomandibular disorders: an ethical analysis of current practices. Journal of Oral Rehabilitation, 40, 546-561.

TRAVELL, J. 1960. Temporomandibular joint pain referred from muscles of the head and neck,. The Journal of Prosthetic Dentistry, 10, 745-763.

TÜRP, J. C. & SCHINDLER, H. 2012. The dental occlusion as a suspected cause for TMDs: epidemiological and etiological considerations. J Oral Rehabil, online early.

ZONNENBERG, A. J. & MULDER, J. 2013. The incidence of centric slides in healthy individuals and TMD patients. Eur J Prosthodont Restor Dent, 21, 109-13.

 

 

Happy World Oral Health Day!

Happy World Oral Health Day!

5 Tips for Good Oral Health!

Tired of avoiding the camera in social situations or at those all-important family occasions? Have you ever considered how good your oral health is, and what you can do to keep it in check?

Read on to discover 5 simple tips that can help you maximise your oral health and maintain healthy teeth - and a good smile.

Why are my teeth so important?

Your teeth vary in shape and size, depending on where they are in your mouth, and also serve a number of purposes. They can help you chew and digest your food, help you talk and they give you your unique face shape.

As one of the first things we notice when meeting somebody new, having a healthy smile can be a great asset. It is therefore important that you give your teeth and gums the care that they deserve!

5 top tips

1. Brush your mouth (not just teeth) properly!

A common mistake is that people only concentrate on their teeth when brushing, when there are other important areas of the mouth you should clean too. This includes your tongue, gums, and the roof of your mouth.

When brushing, make sure you use an up & down and back & forth movement across all areas and brush your tongue to get rid of the bacteria that causes bad breath.

2. Regular flossing

Brushing is great for cleaning the surfaces of your teeth, but what about the spaces in between? Daily flossing is essential to remove food residue and other unfavourable nasties lurking in between your teeth. Not flossing can easily lead to plaque build up, increasing chances of gum disease.

3. Teeth-friendly diet

Have you ever considered what your favourite sugary snack or fizzy drinks are doing to your teeth? Foods such as nuts, apples, chicken and vegetables are teeth friendly as they cause your salivary gland to produce more saliva, which in turn neutralizes harmful acids. Limiting the amount of sugary drinks and alcohol can help improve your oral health and reduce the risk of gum disease and tooth decay.

4. Leave a little fluoride in your mouth before bed

Fluoride helps to strengthen the surface of your teeth, so why rinse it all off? It is easier said than done after you have brushed your teeth in the morning as it will more than likely be swallowed through the day. This tip is much easier to do after you have brushed your teeth before bed as the fluoride will sit on the surface of the teeth whilst you’re sleeping.

5. Visit your dentist regularly

You can only do your best when it comes to oral hygiene - leave the rest up to the experts! Therefore, it is vital you still regularly visit your dentist whilst sticking to the previous tips. Most importantly, there are dental problems you won’t be able to identify yourself. Also, visiting a dental hygienist regularly can not only allow your mouth to have a thorough clean, they can also give you some great tips on improving your oral hygiene and preventing dental problems.

Stop Snoring Week: What is snoring & OSA?

Stop Snoring Week: What is snoring & OSA?

As a highly common ailment, affecting nearly half of the population, snoring can heavily impact a person's life. Not only can it lead to a number of side effects for both sufferer and bed partner, it can also be a symptom of something more sinister - obstructive sleep apnoea (OSA) - a potentially life-threatening condition.

Thankfully, once correctly diagnosed, there are several treatment options available to patients. Before discussing these, it is first important to understand what snoring and OSA are - and their causes. 


Definitions
 

Snoring: simple snoring is the noise resulting from a partial closure of the airway during sleep. As we fall asleep, our muscles relax. For snorers, this causes the lower jaw to drop back and partially obstruct the airway.

The reduced airflow then leads to the soft tissues in the throat vibrating, causing the snoring sound. Left untreated, snoring can result in: diminished energy, reduced libido, lack of concentration, and increased risk of stress.
 

OSA: Less often, snoring can take place as part of a more serious condition - OSA. This is the medical term for the repeated collapsing of the airway during sleep, resulting in complete (apnoea) obstruction of airflow for 10 seconds or more. Simply put, a person suffering from OSA will stop breathing for periods of time during sleep.

Sufferers can be categorised as mild, moderate and severe, depending on the incidence of apnoeic episodes per night. Consequences if left untreated include: increased blood pressure, heightened risk of cardiovascular disease, strokes, diabetes, and extreme daytime sleepiness. Crucially, those suffering from OSA are often unaware that they stop breathing for periods of time.


Treatment
 

It is not uncommon for those suffering from snoring to consult their GP for advice. This typically leads to suggested lifestyle changes, including: weight loss, different sleeping positions, staying well hydrated and avoiding alcohol. Whilst these are important and will likely have a positive impact on snoring, they are unlikely to completely eradicate the problem - especially in the case of OSA. 

Many people are unaware that dentists play a crucial role in the diagnosis and treatment of snoring & OSA and can provide a number of  dental appliances to combat the problem, known as a mandibular advancement splint (MAS). Such appliances are designed to prevent the lower jaw from dropping back during relaxation (sleep), in turn keeping the airway open and oxygen saturation high.

The use of MAS has been clinically proven to have a significant impact on snoring, with many dentists throughout the UK being trained to provide these appliances to reduce snoring. As part of the screening process, your dentist will ask you to complete a short questionnaire that assesses the quality of your sleep, as well as your level of tiredness in certain scenarios.  There is also a section for your bed partner, if you have one, to complete. The results will be used to rule out OSA by determining your risk level. If you are suspected of suffering from OSA, your dentist should refer you on to your GP for further investigation - a non-invasive sleep study, which will accurately measure your sleeping patterns and oxygen saturation levels.
 

Where can I find dentists offering treatment?

To take the effort out of searching for a dentist offering MAS treatment, you can use our handy Find a Provider search tool - located here. Ensure that the Sleepwell box is selected (removing other selections), enter your postcode, and discover available clinics nearby. You can then book an initial consultation with a trained dentist. If your dentist pushed you to read this article - speak with them, they will likely have an interest themselves, or, if not, an understanding of who locally can provide such treatment for you.

We need your support!

We need your support!

Join us at the Sheffield City Hall on 29th November for our 5th Charity Ball!

Join us at the Sheffield City Hall on 29th November for our 5th Charity Ball!

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At S4S Dental and Smilelign we are passionate about helping causes where we can and as such hold a Dental Charity Ball each year. This year's ball will see us fund raise for the Sheffield Children’s Hospital Charity, where the money raised buys life-saving equipment, funds vital research and treatment for thousands of children from across the world, and helps them create a comfortable, engaging environment for patients.

The Charity Ball is a prestigious event that has attracted between 250-300 people each year from the Sheffield dental community and has raised around £10,000, split between Dentaid, Bridge 2 Aid, Mouth Cancer Trust and The Cleft Lip and Palate Association (CLAPA). This year will be the biggest to date, with our new, bigger venue, The Sheffield City Hall, allowing over 350 people to attend.

Promising to be bigger than ever before, the night includes a three-course meal, arrival drinks, a raffle, photo booth - and a live band! We are hoping to make this event bigger and better than ever before and, as a result, raise more funds for this fantastic charity. Book your table now to avoid disappointment!

We have already kicked off our fundraising events with our bake sale, which took place on Monday 4th March, raising £132! On Saturday 13th July Team S4S will be taking part in Theo’s Obstacle 5k, which we are hoping to raise a minimum of £500. We are looking for support from our friends, family and valued customers. Visit our team page to show your support for this amazing cause.

Introducing our Orthodontic Service

Introducing our Orthodontic Service

At S4S, we offer a range of specialist and exclusive dental products including orthodontic appliances, occlusal splints to help relieve symptoms of bruxism (migraines, facial pain, tooth wear, clenching and TMJ dysfunction) and anti-snoring and sleep apnoea devices. An award-winning laboratory, we pride ourselves on delivering first class service, with a passion for quality.

 

Our Orthodontic Range

Orthodontics being one of our key areas, we offer a full range including retainers (removable and fixed), functional and removable appliances. Our experienced technicians, between them boasting over 100 years of orthodontic experience, are more than happy to discuss your individual requirements to ensure we deliver the best outcome for your patient’s needs. 

 

Retention - Quick and Cost Effective Turnaround 

We understand the need for a speedy service when it comes to orthodontic retention. Our standard retainer service means retainers are produced and despatched with a 48 hour period once received in the lab. If you want retainers quicker we are able to offer an express service which includes a next day guaranteed courier service.

 

Retention For Life

We understand the need for long term retention and appreciate that retainers need to be replaced periodically. Patients are often surprised when they find out they have to pay for retainers to be remade and feel they should get them free. Despite the standard retainer materials being fairly robust, some patients can destroy them within a few hours let alone months or weeks. We have a much better offering from the standard retainer material. Our new addition to clear retainers, DURATAIN is our ultra-strength retainer that delivers enhanced strength, greater clarity, and stress relaxation resistance, DURATAIN lasts longer and stays clearer. As with a standard retainer, to order DURATAIN we simply require impressions, which we also accept digitally.

 

Post Orthodontic Whitening

It has become very common practice, particularly in adult orthodontics, to offer whitening as a post treatment option. We are also manufacture bleaching retainers, which are a new product from S4S. Not only are teeth held in position, they can be beautifully whitened too. In 2018 we partnered with Boutique Whitening to become the exclusive manufacturer of their bleaching trays.

 

Our commitment to the environment

In a drive to reduce our carbon footprint, we are continually innovating and developing our processes in order to pass these benefits on to our customers. We actively encourage our customers to provide digital impressions rather than traditional methods, by accepting scans from all providers. This reduces not only the amount of gypsum being disposed of by practices and ourselves but eliminates the need for packaging and the associated impact postage has on the environment. This reduces our carbon footprint, which in turn reduces our customer’s carbon footprint. We are also working hard to improve our packaging to ensure we are reducing our impact on the environment. For example, we have created a unique box design, which allows customers to reuse the same box reducing the amount of wastage. We are also in the process of replacing our plastic boxes to biodegradable materials and using environmentally friendly printing materials. 

To receive more information on all of our products and services, a price list, and 50% off your first appliance click here.

Meet Abbie, Smileign technician, who explains more about the service you can expect from our orthodontic technicians!

Dental Charity Ball 2018 - raising £2650 for the Cleft Lip & Palate Association!

Dental Charity Ball 2018 - raising £2650 for the Cleft Lip & Palate Association!

Last Friday saw over 260 dental professionals join together for a fantastic night of fun and festivity, all to help raise funds for a fantastic charity - the Cleft Lip & Palate Association (CLAPA).

A UK-based charity, CLAPA is a 20,000-strong community of parents, patients, healthcare professionals and more, all dedicated to raising awareness and working together to overcome any barriers caused by cleft lip and palate.

Kenny Ardouin, UK Adult Services Coordinator at CLAPA, joined us for the evening for a presentation that shed some light on this fantastic charity, and the work they do to help others.

Now in its fourth year, the ball was held at the Mercure St Paul’s Hotel in Sheffield and was enjoyed by all. New for 2018, we were also joined by Dr Milad Shadrooh (AKA The Singing Dentist), who was our co-host for the evening, along with Helen Everatt. Other highlights included a raffle, auction and interactive games - where all proceeds were donated to the charity.

We would like to say a huge thank you to those that joined us on the evening and donated money to the Cleft Lip & Palate Association, and we are happy to share that we raised a grand total of £2650!

We would also like to thank those who donated raffle prizes for the evening, and we invite you to take a look the images taken at the event. Taken by Ben Elliott, from Social We Talk, the entire collection can be viewed here. Please do tag yourself and your colleagues in these!

We are also happy to unveil the video from the evening, shot by Mike Sims and edited by Ben at Social We Talk! See below.

Plans are already underway for our 2019 Dental Charity Ball. Moving to our brand new venue - Sheffield City Hall - the event promises to be bigger than ever before and we have a number of surprises waiting for you! If you would like to join us, please register your interest here.

 
 
 
 
 

S4S Launch NEW PuraDent - disinfecting tablets

S4S Launch NEW PuraDent - disinfecting tablets

Millions of people across the UK wear oral appliances such as clear orthodontic aligners, a night guard or dentures all of which serve a very important function. These can be a significant investment in the person’s health, appearance and well-being, therefore protecting this investment by taking proper care of it is imperative. It also ensures the appliance works to its maximum potential and prolongs the lifespan.  Wearing an unhygienic dental appliance can lead to unsightly and costly oral disease, therefore good oral hygiene standards are of equal importance.

In a study by Glass et al (2007), it was suggested that bacteria found on dental appliances can lead to further disease. In one example there were five different species of mould present on a mouthguard, believed to have exacerbated an asthma attack that couldn’t be controlled by inhaler use. It is of great importance that disinfection and effective maintenance of dental appliances is undertaken to reduce the risks of contracting oral infections leading to unnecessary use of topical or anti-fungal drugs. A cross-over randomised clinical trial carried out amongst denture wearers found that storing a dental appliance in water with a disinfecting tablet significantly reduced the total bacterial count than leaving it in water alone.(1)

PuraDent rapid disinfecting tablets are suitable for the cleaning of removable dental appliances, killing 99.9% of bacteria. The non-corrosive hard working formula fights against microorganisms such as Candida albicans, Pseudomonas aeruginosa and Staphylococcus aureus. Using 1 tablet, twice a week helps to keep your dental appliance clean and bacteria free. The tablet can be used safely on all types of removable dental appliance without the fear of discolouring or altering the materials of the dental appliance, including the metallic parts.

Order Now!

 (1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4701668/

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Inside our MacMillan Coffee Morning!

Inside our MacMillan Coffee Morning!

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On Friday the 28th of September, the S4S team came together to host our first ever MacMillan Coffee Morning.

A highly successful event, we had over 10 members of staff bake an array of different sweet treats - all for us to buy and donate to this excellent cause.

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Treats included:

  • Orange & Pistachio cake

  • Chocolate Cake

  • Millionaire Shortbread

  • Gluten-free Ginger Biscuits

  • Vegan Brownies

  • Gluten-free Brownies

  • Guinness Chocolate Cake

  • Banana Muffins

  • Vanilla Muffins

  • Cherry Loaf

  • Fresh Fruit Tart

The treats were available all day and we managed to raise a grand total of £82.30!

Also up for grabs on the day was the award for Star Baker. Judged by our Marketing Team, our Star Bakers were Kelly and Chris! Baking a Chocolate Guinness Cake and an Orange and Pistachio cake respectively, these were the favourites amongst our staff!

Roll on the next Coffee Morning!

Jaw pain or migraines on waking?

Jaw pain or migraines on waking?

A condition that impacts 80% of the population, those suffering from migraines or jaw pain on waking are often unaware that the cause could likely be the clenching and grinding of their teeth in sleep.

Bruxism, the medical term for the repeated clenching and grinding motion, can lead to wide reaching side effects for the sufferer,  most of which are often painful in nature. Though daytime bruxing can occur in some patients, the majority of sufferers are affected in sleep, where they can exert as much as four times the usual amount of pressure onto their teeth than they would when conscious.

Common side effects of bruxism include:

  • migraines & headaches on waking
  • stiff neck & jaw
  • ear ache
  • poor sleep quality
  • damage to teeth

With the exception of the latter, there is nothing about the above list of symptoms that suggests that bruxism is at the root of the problem. This is often the reason that it remains one of the most overlooked conditions in the UK.


Causes

What causes bruxism is not always clear, though there are a number of contributing factors that could suggest why a person may be clenching or grinding:

Stress: The most predominant cause, sufferers of stress & anxiety are often unaware that they are bruxing. These conditions, whether job or lifestyle related, can lead to disrupted sleep patterns and restlessness.

Lifestyle: Substances such as tobacco, alcohol and caffeine have all been linked as co-factors of bruxism. Known to affect sleep, bruxism rates are significantly higher for individuals who use these psychoactive substances.

Sleep disorders: Snorers, and those suffering from obstructive sleep apnoea or sleep paralysis are more likely to suffer from bruxism. OSA seems to be the highest risk factor, as the snoring and gasping can result in clenching & grinding. 

 

Diagnosis & treatment

A lack of awareness amongst the general public means that those showing side effects of bruxism often consult their GP for advice. Typically, this leads to ineffective treatments that do not stop the pain from occurring. 

Habitual bruxing will affect the physical appearance of teeth, with worn down incisors often present. Whilst most dentists will be trained to detect these sort abnormalities, a GP would not. Therefore, if you are exhibiting any of the side effects above, it may be a good idea to book an appointment with your dentist to determine or rule out bruxism as the cause.

For sufferers of bruxism, there are a number of different treatment options available. Due to a high percentage of cases being caused by stress or anxiety, behavioural therapy may play an important role for some sufferers. Other treatment options include: botox, muscle relaxants, as well as medications.

However, for habitual bruxers, a dental appliance called an occlusal splint may be the only viable option. This type of splint functions as a barrier between the two dental arches, preventing the teeth from contacting, therefore inhibiting the clenching and grinding. 
 

The SCi

The SCi - Sleep Clench Inhibitor - is a type of occlusal splint that is typically placed on the lower front teeth during sleep. FDA-approved for the treatment TMJ & medically-diagnosed migraines, the SCi is available from a number of dentists throughout the UK. 

 

Where to go 

If you suspect that you may be suffering from bruxism, the best thing to do is to book in for a consultation with your dentist. They should be able to determine, from the shape of your teeth alone, whether you are a habitual bruxer. 

As it is a private treatment option, it may be that your current dentist does not supply this treatment. If this is the case, there is an easy way to locate a dentist who does. Our Find a Provider search function allows you simply enter your postcode to discover SCi providers in your area. To find your nearest SCi provider and to book a consultation, click here.

‘Selling the Invisible’ – increase your clear aligner sales numbers

‘Selling the Invisible’ – increase your clear aligner sales numbers

Dr Barry J Oulton, founder of The Confident Dentist Academy Ltd and creator of the 2-day Communication & Sales training course ‘Influencing Smiles’, discusses his personal approach and recommendations to discussing the clear aligner system ‘Smilelign’ with patients.

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Discussing treatments, such as orthodontics, can be a concern for some dentists and team members. Most find it easier to discuss treatment that is needed, rather than that which may be cosmetic in nature and therefore elective.

When I was younger, if I thought of a salesperson, I had a negative image and was influenced as a child to believe that selling was an unwanted, pushy transaction undertaken by manipulative, self-satisfying individuals.

Having grown up a bit and attended several sales training courses and then learnt about NLP and human needs psychology, my beliefs are completely different from those from my childhood. I believe that I am selling all of the time. Whether it’s to influence my children to make the best choices or my patients, selling is at the heart of all our personal interactions and relationships.

The word ‘sell’ comes from the Norwegian word ‘selje’ which means, ‘To Serve’. I truly believe that in all my interpersonal interactions, I am doing my best to serve the other person. This has led me to teaching the methodologies and strategies that have enabled me to build a successful ‘single-handed’ dental practice with a £million turnover.

In my course, ‘Influencing Smiles’, I teach a simple 7-step process to increase your sales of all types of dentistry - especially that which patients want, rather than need. You can learn this process during a fun, enjoyable and interactive 2-days with me, and before you do, here’s a look at a couple of the steps to ‘selling the invisible’: 

 

Step 1 – Mindset

 

Your mindset contains the subconscious assumptions you make about the world as you go about your business. Most people are completely unaware of these assumptions, even though there is usually nothing that influences their decisions and quality of life more than their mindset. Your own mindset is the most important one of all when interacting with patients.

For example, if you have a mindset that ‘the economy is broken’, or, ‘my patients can’t afford my dental treatment’, do you agree that your approach to ‘selling’ your treatment options will be different than if you had a positively stated mindset such as ‘people are resourceful and will find the money for the things they really want’? (this is important for later in this article, because people don’t buy stuff or things because they want them, they buy things that they believe will give them a ‘feeling’ that they want – confidence, love, acceptance, recognition).

So, let’s develop some positive, helpful mindsets:

To Sell is to Serve,

In your mind, think – ‘I’m going to work with you to find out what you need and why, then I’m going to communicate in your model of the world and provide solutions for you that enable you to choose the best result for you. This will be a WIN:WIN relationship.’

This means you must sell something that:

A. You absolutely believe in.

B. You are congruent that the price is worth the value.

If you are coming from a frame of serving and providing true value to your patients, sales becomes nearly automatic.

Other positive mindsets include –

  • The world is full of abundance
  • People can afford the things that they really want
  • I am worth the fees that I charge
     

Step 2 - Establish Rapport 

 

There are a number of definitions of rapport

  • ‘People who are like each other, like each other’
  • ‘a process of responsiveness whereby the client’s unconscious mind uncritically accepts suggestions offered to it’

Essentially, rapport is about a relationship of trust with another person.

20 years ago, I thought that rapport was built by finding common ground, similar interests and by showing genuine interest in the other person. Undeniably, these are important to the process of building rapport, but we are now aware that it’s only about 7% of the process. Not only is the 93% really easy to learn, it’s really easy to implement because you already do it, every day, without realising it. Once you learn the simple skill of building rapport and practice it, it gains deep unconscious liking with your patient within minutes or seconds.

Practice being more like the other person both physically – posture, gestures, expressions and in language – words, tonality, pitch, speed of speech. The more you are like them, the more they will ‘like you’ and we prefer to buy off people we like.

Please remember that you are being ‘more similar to’ not mimicking your patients, subtlety is the key here.

 

Step 3 Ask Questions

 

Correct Conversations, Language and the Questions to Ask.

You need to find out specific details and speak the language of your patient to find out what the patient wants and needs, and what their outcomes are. Most importantly, if we are able to find out what our patients’ deep drivers (core values) are and identify these drivers, we can serve them better by providing solutions to their core values.

As mentioned in Step 1, people don’t buy our services for the reasons they tell us – “I want a bright white smile”, “I want straight teeth”. They don’t want these things, they want what they think these things will bring to them if they were to have them – love, connection, confidence (or remove what they have and don’t want to have – rejection, criticism).

Finding out what their core values/deep drivers are.

“I’d like straight teeth”

“Ok, you’d like straight teeth….for what purpose?”

“Uuhh, so that they are straight and look nice.”

“So, what would having nice looking teeth do for you?”

“Well it would improve my confidence”

“In what situations?”

“Ha, eerr well, when I’m talking to women”

“Ahh, ok so if we could look after your smile and improve it so that you felt more confident when talking to women, is that something you would be interested in finding out about ?”

When we now enter a discussion about treatment options, we will also talk about other cosmetic choices, such as whitening, veneers, bonding, etc, AND I will remind him of the reason he told me he wants to have treatment.

To learn more book your place on ‘Influencing Smiles’ now - prices from £299 on 28th and 29th September in Manchester or 30th November and 1st December in Farnborough. www.influencingsmiles.com or email sally@theconfidentdentist.com or call 0333 220 2447.

Suffering from your partner's snoring?

Suffering from your partner's snoring?

Whether you snore yourself, or your bed partner does, snoring can lead to a number of side effects if left untreated. Read on to discover the simple solutions available from your dentist.

Three Lyons in our lab!

Three Lyons in our lab!

With the 2018 World Cup well underway, we thought we would get in the spirit by introducing you to our very own 'three Lyons' - Will, Dan & Kirsty Lyons!

Will 

A Dental Technician for over 30 years, Will is a great asset to the S4S team - and is also Dan's dad! He has worked here since 2016 and is skilled in the production of several dental appliances. Will is one of our technicians responsible for contract review and quality assurance. He will be one of your main points of contact for technical enquiries. 

Dan

Like his dad, Dan is also a Dental Technician - qualifying in 2016 from Cardiff University. He has been with S4S a little over a year and splits his time between producing occlusal splints, as well as scanning, prepping & dealing with digital cases so that they are ready for manufacture. 

Kirsty 

One of our newest team members, Kirsty is the receptionist here at the lab. You will have probably spoken to her on the phone already, as she is the first point of contact for any incoming calls. Kirsty, our final 'Lyon' is married to Dan! 

COME ON ENGLAND!!!!!!! 

Bruxism - damaging your teeth without you knowing?

Bruxism - damaging your teeth without you knowing?

Do you often wake up in the morning with facial pain? Headache? Jaw ache?

On average, the clenching and grinding of teeth, or bruxism as it is medically known, affects 80% of the UK population and can lead to a number of painful and debilitating side effects. Sadly, most of the symptoms, such as migraines, ear ache, and a stiff neck/jaw do not overtly suggest that the clenching & grinding of teeth may be the cause - leaving bruxism one of the most overlooked and underdiagnosed conditions in the UK. 

With the 14th of May-14th of June marking National Smile Month, a campaign that stresses the importance of oral health, now is the perfect time to seek treatment - especially if you are suffering from any of the side effects above.

 

Why do we brux?

The reasons why we might clench or grind our teeth are not always clear, however, it is commonly linked to stress and sleep-related problems. In fact, almost all chronic bruxing takes place in sleep - where it has been shown that we can unconsciously exert up to four times as much pressure on our teeth than we would when awake. 

Studies have found that a high percentage of cases are caused by anxiety. Whether job or lifestyle related, anxiety can lead to disrupted sleep patterns and restlessness - increasing the likelihood of bruxing. Other factors are lifestyle choices, such as drinking alcohol, smoking, excessive consumption of caffeinated drinks, as well as recreational drugs, such as ecstasy and cocaine. These psychoactive substances have indicated significantly higher bruxism rates in comparison to those who do not use them. 

 

What are the long-term effects?

Left untreated, bruxism can wear down the suffer's teeth, causing sensitivity and, in more severe cases, tooth loss. In extreme cases, teeth grinding can lead to an increased use of the masseter muscles at the back of the lower jaw. This continued clenching can cause these muscles to bulk-up, which can give the face a wider appearance.

Grinding can also lead to enamel surface loss, making the teeth shorter, and, in some cases, more sensitive. Shorter teeth can cause the look of an over-closed mouth, which we associate with old age. As sufferers typically brux when unconscious, this often results in an unrestful night’s sleep – in some cases not just for the sufferer, but also their sleeping partner. This can take a toll on their general health and well-being if left untreated.

 

What can I do if I think I'm a bruxer?

If you are suffering from any of the side effects associated with bruxism - book an appointment with your dentist as soon as possible. Habitual bruxing will affect the physical appearance of teeth, with worn down incisors often present. Your dentist will be able to detect signs of this and, if deemed in the early stages of tooth wear, can keep an eye on it at future appointments. Whilst there, your dentist will also check for tenderness in the neck, temple and shoulder muscles - a common side effect of bruxing.

The Sleep Clench Inhibitor - SCi - an example of an occlusal splint.

The Sleep Clench Inhibitor - SCi - an example of an occlusal splint.

If your dentist believes you are suffering from bruxism, there are a number of treatment options available. If stress related, your dentist may suggest a course of behavioural therapy. More commonly though, your dentist can prescribe an occlusal splint. 

A small appliance that sits on the lower front teeth, the splint works by preventing your upper and lower teeth from touching, in turn preventing the clenching and grinding from occurring. 

 

Where can I find an occlusal splint?

There are a number of dentists throughout the UK that offer treatment for bruxism with an occlusal splint. Our useful Find a Provider search allows you to simply enter your postcode and discover available clinics in your area. To search for a practice near you, click here.

Stop Snoring Week: What is snoring & OSA?

Stop Snoring Week: What is snoring & OSA?

As a highly common ailment, affecting nearly half of the population, snoring can heavily impact a person's life. Not only can it lead to a number of side effects for both sufferer and bed partner, it can also be a symptom of something more sinister - obstructive sleep apnoea (OSA) - a potentially life-threatening condition.

Thankfully, once correctly diagnosed, there are several treatment options available to patients. Before discussing these, it is first important to understand what snoring and OSA are - and their causes. 


Definitions
 

Snoring: simple snoring is the noise resulting from a partial closure of the airway during sleep. As we fall asleep, our muscles relax. For snorers, this causes the lower jaw to drop back and partially obstruct the airway.

The reduced airflow then leads to the soft tissues in the throat vibrating, causing the snoring sound. Left untreated, snoring can result in: diminished energy, reduced libido, lack of concentration, and increased risk of stress.
 

OSA: Less often, snoring can take place as part of a more serious condition - OSA. This is the medical term for the repeated collapsing of the airway during sleep, resulting in complete (apnoea) obstruction of airflow for 10 seconds or more. Simply put, a person suffering from OSA will stop breathing for periods of time during sleep.

Sufferers can be categorised as mild, moderate and severe, depending on the incidence of apnoeic episodes per night. Consequences if left untreated include: increased blood pressure, heightened risk of cardiovascular disease, strokes, diabetes, and extreme daytime sleepiness. Crucially, those suffering from OSA are often unaware that they stop breathing for periods of time.


Treatment
 

It is not uncommon for those suffering from snoring to consult their GP for advice. This typically leads to suggested lifestyle changes, including: weight loss, different sleeping positions, staying well hydrated and avoiding alcohol. Whilst these are important and will likely have a positive impact on snoring, they are unlikely to completely eradicate the problem - especially in the case of OSA. 

Many people are unaware that dentists play a crucial role in the diagnosis and treatment of snoring & OSA and can provide a number of  dental appliances to combat the problem, known as a mandibular advancement splint (MAS). Such appliances are designed to prevent the lower jaw from dropping back during relaxation (sleep), in turn keeping the airway open and oxygen saturation high.

The use of MAS has been clinically proven to have a significant impact on snoring, with many dentists throughout the UK being trained to provide these appliances to reduce snoring. As part of the screening process, your dentist will ask you to complete a short questionnaire that assesses the quality of your sleep, as well as your level of tiredness in certain scenarios.  There is also a section for your bed partner, if you have one, to complete. The results will be used to rule out OSA by determining your risk level. If you are suspected of suffering from OSA, your dentist should refer you on to your GP for further investigation - a non-invasive sleep study, which will accurately measure your sleeping patterns and oxygen saturation levels.
 

Where can I find dentists offering treatment?

To take the effort out of searching for a dentist offering MAS treatment, you can use our handy Find a Provider search tool - located here. Ensure that the Sleepwell box is selected (removing other selections), enter your postcode, and discover available clinics nearby. You can then book an initial consultation with a trained dentist. If your dentist pushed you to read this article - speak with them, they will likely have an interest themselves, or, if not, an understanding of who locally can provide such treatment for you.

Ultra-strength clear retainers

Ultra-strength clear retainers

Introducing our new ultra-strong clear aligners - Duratain! Using a material that is stronger than others in the market, Duratain offers seriously strong first-class retention whilst being comfortable to wear due to its precise fit...

We walked, we conquered...we're at it again!

We walked, we conquered...we're at it again!

As a company that takes pride in raising money for both local and international charities, we're planning to make 2018 even bigger and better than before! The list is constantly being added to, but the most recent pledge is a team member that is going to be peddling hard for a whole 200km. Read on to hear her story.

Want to stop snoring? See your dentist

Want to stop snoring? See your dentist

Want to stop snoring? As a condition that affects over 40% of the population, it is no surprise that the majority of us have been impacted by snoring in some way, shape or form. Left untreated, snoring can lead to a number of side effects....

Made in Sheffield - S4S Dental Laboratory

Made in Sheffield - S4S Dental Laboratory

With our entire workforce based in Sheffield and a long history of providing quality products, we knew there wouldn't a be an issue being awarded Made in Sheffield status. That doesn't mean, however, that we aren't proud of receiving it!