APEX Solutions


Refurbishment continues

Posted by Robert Pilcher

Here are the latest photos from the rebuild of Mr Pilcher's surgery. There has been a lot of work carried out by the building team today, although most of it is unseen being first fit of all the electricals and plumbing. A top skim of plaster went on today, and the final fitting of the air conditioning.

Neat fitting of Air Con.

Hard at work


Refurbishment continues

Posted by Robert Pilcher

Another very busy day in the surgery. The services have all been laid under the floorboards, air conditioning fitted, walls had their first coat of bonded plaster.






Surgery Refurbishment starts

Posted by Robert Pilcher

The refurbishment of Mr Pilcher's surgery sarted today. I will chart the progress of the rebuild as it goes along.

Surgery before the start of day one.



Starting to dismantle the surgery


















Infection Control Training

Posted by Robert Pilcher

On the 6th, I highlighted the fact that the Department of Health had published a new Guideline on Infection Control in Primary Care Dental Practices. This came completely out of the blue, as it had not been anounced in advance. Abbey Dental Practice, decided that we would take the opportunity to implement the new guidelines as soon as possible and arranged to have a practice training afternoon from 2 - 5pm today. The practice covered all aspects of infection control, including the sources of infection, personal protection, environmental cleaning, cleaning, sterilisation and storage of instruments and auditing infection control - to ensure we are doing it correctly.

All clinical staff from both sites attended the training - nearly 30 staff.

Changes in Infection Control Regulations

Posted by Robert Pilcher

Four years ago, The Department of Health decided that it would publish a new Health Technical Memorandum on Infection Control in Dental Practices - HTM01-05 - Decontamination in primary care dental practices. Up until this point, the accepted document on decontamination was produced by the British Dental Association - Advice booklet A12. This had been produced in consultation with the Department, and had been the document I had used since the 1980s (It was reviewed and republished every couple of years).

At one swift stroke, the Department cast aside the A12, which had been produced and adapted as more evidence based advice became available, and produced it's own HTM. There was consternation within the profession at the time, as there were massive sweeping changes, and massive inconsistencies compared to the standards for other healthcare environments, and no published evidence to back-up the changes. One example was the storage of bagged sterilised instruments. In hospitals this has been set at 1 year - instruments must be used within 1 year of being sterilised, but in dental practice it was 21 days - yes hospitals have 365 days to use a bagged sterilised instrument, and we got 21 days. After 21 days, the bag has to be opened and the instrument re-sterilised and re-bagged in a new bag.

 The HTM was so suspiciously non-evidence based, the BDA and other dental organisations put pressure on them to release the evidence that had been used to make the sweeping changes. After many months, the Department finally, reluctantly, released the list of evidence they had used. Funny old thing. Hardly any published, refereed research; mostly opinions, committee decisions, and other department documents. This evidence would not have been taken seriously by anyone with an enquiring mind. The evidence was flimsy at best.

It was promised by the Chief Dental Officer that it would be reviewed after 2 years, but we would be stuck with these changes for at least 2 years, and the changes have been extensive requiring expensive changes to surgeries and procedures with no evidence it would improve patient safety.

In the meantime, research was conducted by the Scottish Department of Health (Yes there are different standards for different parts of the UK!), and others. They soon found that the assumptions made by HTM01-05 were just that - the evidence showed they were wrong, and the HTM needed re-writing.  Well 2 years came and went; Then 3 years: then 4 years; and nothing; Then very quietly, with no fanfare, no press release, NO NOTIFICATION TO DENTISTS, NO APOLOGY, they quietly published the 2013 version of the HTM on 3rd April (3 days ago). In fact the majority of Dentists will still be unaware there have been changes, as there has been no notification by the Department of Health, and it was only a partial review, but a number of important changes had been made. A full reveiw will now not happen until the end of 2014 - 6 years after to original 'living' document - if it is a living document, it must be a walking dead zombie.

So we made all these expensive changes (£1000s), with no evidence, and now it has changed again, and lots were conpletely unnecessary in the first place - and from the DH - NO APOLOGY.





MacMillan Cancer Support

Posted by Robert Pilcher

I was today going to do the blog about acid erosion of teeth from acidic food and drinks, however, recently Denplan announced the total raised for MacMillan Cancer Support in 2012 - £26 888.55.  A great total raised by Dental Practices and their HQ Staff in Winchester.

Abbey Dental Practice had 9 members of staff take part in the Denplan Organised 18 mile walk in London during the summer.

 The chief organiser was one of our Dental Nurses - Abbie. The Practice is very proud of the effort put in by all the staff, and the fantastic generosity of all the patients who donated to bring our total to £2788.16 - more than 10% of the total of the amount raised by everyone else.

They will be preparing for the next event this summer very soon.


Reducing Decay

Posted by Robert Pilcher

A couple of days ago, we broached the subject of fluoride (29th). This contained some advice for toothpaste and mouthwashes, however fluoride is only one means of reducing decay. The approach must also tackle diet.

Dental decay remains at high levels in the UK.  Recent studies show 40% of 4 – 6 year olds and 67% of 14 – 18 year olds have decay.  A number of factors are involved in the development of decay, including composition of the teeth, presence or absence of fluoride and type and quantity of oral bacteria.  It is recognised that by far the most important factor is diet, and that sugars are undoubtedly the most important dietary factor in causing dental decay.  

The sugars associated with decay are the refined sugars e.g. sucrose, glucose and fructose.  The sugar found in milk (lactose) has a low potential for causing decay.   

Raw starch has a low potential for causing decay, but most starch is cooked or refined for consumption, and in this form it has the potential to cause decay.   

The following list shows those foods that have a high potential to cause decay.

Decay causing foods and drinks

Sugar and chocolate confectionary

Cakes and biscuits Buns, pastries, fruit pies.

Sponge puddings and other puddings

Table sugar

Sugared breakfast cereals

Jams, preserves, honey.

Ice cream

Fruit in syrup

Fresh fruit juices

Sugared soft drinks

Sugared, milk-based beverages

Sugar-containing alcoholic beverages (Alcopops)

There are a number of non-decay causing, non-sugar sweeteners that are permitted for use in the UK e.g Sorbitol, Mannitol, Xylitol, Hydrogenated glucose syrup (Lycasin), saccharin and Aspartame (Nutrasweet, canderel).  However sorbitol, Mannitol and Xylitol have only a limited use due to their laxative effect.

Foods and drinks with a low risk of causing decay are those with low sugar or have starch that is not highly refined or cooked.  The following list gives example of these food and drinks.  

Foods and drinks with low potential for dental decay

Low/No caries risk

Bread (sandwiches, toast, crumpets and pitta bread)

Pasta, rice and starchy staple foods.

Unsweetened or artificially sweetened yogurt.

Low-sugar breakfast cereals (e.g. shredded wheat)

Fresh fruit (whole and not juices)


Sugar-free drinks

Unsweetened popcorn

Some foods even have a potential to counteract the effects of dietary sugars.  These can help by neutralising the acids produced, or stimulating saliva production.  The following list has some of these foods and drinks.

Possible anti-cariogenic effect  




Sugar-free chewing gum

Fibrous foods (e.g. raw vegetables)

Xylitol sweeteners, gum and mints

Tea (unsweetened) – contains fluoride.  


The following are KEY dietary recommendations to control dental decay and dental erosion.


Key dietary recommendations to safeguard dental health

ü      Reduce the frequency and amount of sugary and acidic food and drinks and try to limit these to mealtimes.

ü      When a structured meal plan is not followed, limit the consumption of sugary foods to 3-4 times a day.

ü      Avoid sugary and acidic foods and drinks close to bedtime.

ü      Consume foods and drinks that do not cause, or are known to protect against, dental decay and erosion.

ü      Consumption of some sugar-free products may help achieve these goals in practice.

ü      Avoid brushing immediately after consuming acidic food and drinks.

ü      Chew sugar-free gum for 20 minutes immediately after meals. (Adults and older children only)

ü      Use a straw for drinking any acidic drinks.

ü      Read manufacturers labels to identify hidden sugars and acids and follow recommendations on the dilution of squashes and the use of products.

ü      Do not add any drink or food to a baby’s bottle, except formula milk, expressed breast milk, cow’s milk or water.

ü      Provide all drinks (including formula) in a cup or beaker to infants from the age of 6 months and cease bottle-feeding by 1 year.

Castellini 8

Posted by Robert Pilcher

Just before Christmas, Mr Pilcher had a new Chair and delivery unit fitted to his surgery as phase 1 of his surgery rebuild. Phase 2 happens in a few months, when the surgery is being stripped back to the walls, and new services, cabinets and floors are being installed.

The Unit installed is a Castellini Skema 8. This is Castellini's top of the range model and is a joy to use.


I have included a few photos of it being installed.

Marie Cleaning after the old Unit removed.


 Parts coming in with Simon


Starting to go in.

You can see how complicated the electronics are



More parts attached and more electronics!


Nearly complete



Installed, only took 6 hours.




Good Housekeeping Advice on Toothpaste

Posted by Robert Pilcher

The most recent issue of 'Good Housekeeping Magazine' contained the following advice on the 'Health News' page.

'Swallow, don't spit out, your toothpaste. This prevents you washing away fluoride that helps strengthen enamel and fight decay. Fluoride in large quantities can be poisonous - but you'd need to swallow a whole tube to suffer ill effects.'
This goes directly against the Department of Health publication 'Delivering Better Oral Health'. The DH advice is to not rinse, but spit out only. We can only hope 'Good Housekeeping' actually meant, 'don't rinse, only spit out'. I would agree with this advice entirely. Too much fluoride can be as bad as not enough. Suffolk does not have a large amount of fluoride in the water about 0.3 parts per million. To find out your area use this link:
Just type in your postcode hit return, then click on fluoride. The ideal concentration of fluoride for the prevention of tooth decay is 1ppm (so Most of Suffolk is only 1/3 the recommended concentration).  However if there are multiple sources of fluoride:- Water, toothpaste, topical varnishes, mouthwashes, then it is very difficult to control how much fluoride is absorbed. Of course the biggest question is 'How much water do children drink?'. If they added it to soft drinks, we might be sure that fluoride was getting in!
If too much fluoride is absorbed, this can actually cause damage to the teeth. This can be seen in the variations of fluorosis - from small amounts of white spots or mottling, to brown mottling, which is very unsightly.
So brush for 2 minutes twice per day - actually allow the fluoride time to act on the teeth, and 2 minutes brushing might clean them! - spit out, but do not rinse.  You will swallow the remaining small amout of paste, whilst it is still acting on the tooth surface.   If you want to use a fluoride mouthwash, use it at a different time to brushing, otherwise it is effectively only one application. Use it at lunchtime, tea-time, any time except brushing time. You will then get a seperate application of fluoride.
Which toothpaste? Well in respect of fluoride content for reducing decay it is pretty straight forward.
Up to 6th Birthday use a childrens toothpaste (600 parts per million of fluoride). If your under 6 year old develops decay, then use an adult toothpaste (over 1000 parts per million of fluoride - most are now 1300+), but encourage spitting out. Your dentist may well also start applying fluoride varnishes 3 or 6 monthly.
Over 6 years old - Use an adult toothpaste (makes a cheap 6th birthday present!!) Again if caries has been present, your dentist may apply fluoride varnish or fissure seal adult molars as they erupt.

The reason for age 6 is simple. Up to age 6, the crowns of the front teeth are developing, so if too much fluoride is swallowed and incorporated into the teeth, there will be a reduced risk of fluorosis on these very visible front teeth.

If you want a toothpaste for something else e.g. sensitivity, that is a subject for another day.

I'll write about other measures to reduce decay in another blog.