2  Page 1 “BADN” whether we could use fans. During that time, we received many calls at the BADN head offi ce from dental nurses who asked about what they could do because they were suff ering great discomfort from having to wear per- sonal protective equipment (PPE) in combination with the heat and were afraid of passing out. Many people announced that they were leaving the profession. Dental nurses in particular had had enough. They are paid poorly in pri- mary dental care in the UK, and on top of that, they had to put up with the additional stress of wearing PPE. Considering that dental nurses are predominantly female, we decided to raise awareness about the meno- pause and its impact on dental nurses in order to help practices understand how we might retain more of our workforce in practice. Menopausal symptoms surely vary from person to person, but what are some of the typical symptoms that menopausal women experience? And how do these symptoms aff ect them in relation to working in a dental offi ce? I’m going through the meno- pause myself, so I can off er insight from a personal point of view. Symp- toms do vary, and some colleagues of mine, who are in the same age group and are going through the meno- pause, have not experienced a hot fl ush or a sleepless night once. How- ever, for me, it has not been an easy ride. The fl ushes are a problem not only because you feel very hot but also because you sweat a great deal. As a result, you are afraid of body odour while working in close contact with the patient and other staff members, and this makes it neces- sary for you to apply toiletries often or change your working clothes. I’ve even fainted once. I was travelling on a train, commuting to work, and I needed to get off because it was so hot. And as I got off the train, I passed out on the platform. Another really important issue is insomnia. I fi nd myself wide awake in the middle of the night, and I’m lucky if I can string two hours of sleep to- gether. With a sleepless night comes fatigue in the day and the inability to concentrate, which makes you rather irritable at work. Brain fog is another symptom. Sometimes I fi nd myself in the middle of a sentence, and I just forget what I wanted to say. This brain fog can really make you think you are going mad. IMPRINT INTERNATIONAL HEADQUARTERS Publisher and Chief Executive Offi cer: Torsten OEMUS Chief Content Offi cer: Claudia Duschek UK NEWS Dental Tribune United Kingdom Edition | 1/2022 Those are some of the physical symptoms but there are also psycho- logical symptoms. I haven’t suff ered from depression, which is known to be a possible problem; however, I do sometimes feel a bit low and fed up with it. Some people even suff er panic attacks. What measures can practices take to make working life easier for meno- pausal staff ? There are quite a few things that I can think of. We put together an overview in our advice sheet, and we also created a policy. during perimenopause, it can happen that you miss one or more periods, and then you just fl ood and have a pe- riod for about two weeks. When this happens, working in a dental practice where your uniform is white is the last place you want to be. Other measures include off ering staff members who suff er from in- somnia the option of coming in later or working the afternoon shifts, if the practice schedule allows this. Also, air conditioning or fans can be really helpful in order to control the room temperature. you demonstrate that you do have a menopause policy in place, it might make the diff erence of having ten applicants for a post compared with two applicants. I’m 57 now, and I’m still struggling with the meno- pause. I started to work as a den- tal nurse when I was 17, so I have 40 years of experience. I’m not say- ing that I have all the knowledge in the world about dentistry and dental nursing, but I have a fair amount, and so do my colleagues. If we all decide that this is enough and leave, then there’s an entire cohort of dental nurses with a considerable m m o o c c . . k k c c o o t t s s r r e e t t t t u u h h S S / / n n o o i i t t a a r r e e n n e e G G l l a a u u s s i i V V © © In order to educate the dental community about the challenges that menopausal women face in the workplace, the British Association of Dental Nurses launched a menopause policy at the beginning of this year. I suppose the most important thing would be to allow open commu- nication within the practice. Employ- ers should have conversations with employees who often phone in or who do not seem to feel comfortable at the workplace in order to fi nd out the reason. And employees should feel able to actually bring up the topic with their employer. We hope that our advice sheet and the specimen policy will help encourage these con- versations. Regarding the style of the uni- form, there are diff erent aspects to consider. To make it more comfort- able for people who experience hot fl ushes, you may choose lightweight cotton instead of heavyweight cot- ton. Also, some employees might not want to wear trousers, as they can be restrictive, so give them diff erent options. The colour of the uniform is another crucial factor. Because, I think it is really important for employers to understand what is being experienced. If an employee feels that she is listened to and under- stood it makes a great diff erence, and she will do everything she can to perform her work in the best possible way. Those of us who are going through the menopause don’t want to be lying in bed during the day to catch up on our sleep, we want to act in a normal way. I am sure menopause-friendly mea- sures benefi t not only the staff but also the practice. Could you highlight some of the advantages for those dental practices which are willing to adapt? As you said, most dental nurses are female, and if the majority decide to stop working, this could turn into a real problem for the profession? Yes, it could, that’s exactly right. I think in terms of recruitment, if amount of knowledge and experi- ence that will be lost, when there is, perhaps, a simple solution to avoid this happening. In a BADN press release, you stated that legal cases related to the meno- pause have doubled in recent years. What is the current legal situation? Are there any laws in place that reg- ulate working conditions for meno- pausal employees? Although the menopause isn’t a disability in itself, it can be consid- ered as such if it has a sustained eff ect on a woman’s ability to com- plete daily activities for more than 12 months. Under the Equality Act 2010, employers are required to make reasonable adjustments to an em- ployee’s role or working conditions if they have a disability which puts them at a disadvantage. The Health and Safety at Work Act 1974 covers working conditions for menopausal symptoms. Under the Employment Rights Act 1996, a dismissed employee can claim unfair dismissal. Employees who re- sign can claim that their employer’s behaviour and conduct led them to resign. How has the policy been received so far? We have had a good response, and some of our members took it back to their own practices to use as a conversation tool in meetings. The policy and the advice sheet have been endorsed by other dental organisations, including the College of General Dentistry, the Dental Technologists Association, the British Association of Dental Therapists, the Dental Laboratories Association, the British Dental Industry Association, the Orthodontic National Group and the British Society of Dental Hygiene and Therapy. We also received sup- port from a non-dental organisation, the British Veterinary Nursing Asso- ciation, whose members are also predominantly female and work in similar conditions. Is the menopause regarded as a taboo subject in areas other than the dental profession? It really is, it’s happening all over. Just looking at my own family, my mother belonged to a generation that never spoke about it. It was all hushed in whispers, so she never spoke about it to me either. It sounds ridiculous but, when I got the fi rst symptoms, I didn’t even know what was going on. In my parents’ generation, usu- ally the mothers were housewives and the fathers went to work. How- ever, I wanted to work because I didn’t want to be at home. And those generations coming on behind me sometimes do not have a choice— they need to work. Thus, the whole approach to work and careers for women has changed in quite a short space of time, really—in a generation. I feel it’s partly my responsibility to educate our younger generation. Of course, the younger generation is more curious and has the internet and easily accessible information. However, in spite of this, I do feel that the menopause is still a neglected topic. Editorial note: More information on the BADN, how it supports dental nurses and the benefi ts of a membership can be found at www.badn.org.uk. Tel.: +49 341 4847 4302 Fax: +49 341 4847 4173 national GmbH. Such material must be published with the permission of Dental Tribune International General requests: info@dental-tribune.com GmbH. Dental Tribune is a trademark of Dental Dental Tribune International GmbH makes every eff ort to report clinical information and manufac- turers’ product news accurately but cannot assume Sales requests: mediasales@dental-tribune.com Tribune International GmbH. responsibility for the validity of product claims or www.dental-tribune.com All rights reserved. © 2022 Dental Tribune Inter- for typographical errors. The publisher also does not national GmbH. Reproduction in any manner in any assume responsibility for product names, claims or Dental Tribune International GmbH that has been reprinted or translated and reprinted written permission of Dental Tribune International Holbeinstr. 29, 04229 Leipzig, Germany in this issue is copyrighted by Dental Tribune Inter- GmbH is expressly prohibited. Material from Dental Tribune International GmbH language, in whole or in part, without the prior statements made by advertisers. 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4  Page 1 “Evolving business systems” Twelve reasons to be miserable: 1. The continued demise of NHS den- tistry (the longest death scene in history); 2. The recruitment crisis (nobody replies to our adverts); 3. The retention crisis (my team members are leaving dentistry); 4. The poaching crisis (my team mem- bers are leaving for better money in dentistry); 5. The wages crisis (I am revising my 20-year-old key performance indi- cators [KPIs] on team wages from 17.5% to 25.0%); 6. The pricing crisis (we need to put our prices up by 25% to stand still—how are we going to do that?)—more on that later; 7. The EBITDA (earnings before in- terest, taxation, depreciation and amortisation) multiples crisis (the mergers of some of the largest dental groups in the UK, defl ates multiples, as does the increased cost of borrowing—some have predicted a 25% reduction in good- will values before year end); 8. The exit crisis (more of my clients have their practices up for sale than at any time before—hardly surprising given what I have listed so far); 9. The energy crisis; 10. The infl ation crisis (the Bank of England suggesting an infl ation rate of up to 18%); 11. The consumer confi dence crisis (when all this bad news impacts patients and leads to treatment plans being delayed or not being taken up); 12. Yet another new prime minister and cabinet whose hands are going to be full. These are enough to make an owner want to sell. I think we need some balance. Here is a list of what I see as the good news among all this doom and gloom. Twelve reasons to be cheerful: 1. Correctly utilised, the intra-oral scan- ner is the single greatest revolution in the delivery of oral health educa- tion and advice in a generation. 2. Similarly, the intra-oral scanner is the single best treatment genera- tor ever invented. 3. The training of dental nurses reg- istered with the General Dental Council (GDC) and of treatment coordinators in the use of intra-oral scanning allows greater use of the new technology to wow patients and frees up clinicians’ time to generate profi table revenue. 4. The rise of dental deserts across the UK makes compulsory dental plan membership (and conversion) easier than at any time since 1996. 5. Over the last six recessions (through which I have lived and worked), the sale of the very highest value and most complex dental treatment has remained robust—the more you focus on the dentistry that most dentists are either too scared or too unmotivated to invest in, the busier you will be. UK NEWS Dental Tribune United Kingdom Edition | 1/2022 valuations to decline. In summary, if you are looking to grow, to sell, to keep your team together or to recruit new staff members—put your prices up. I want to encourage you to take action, but I also want to remind you that there are four areas where you must be careful about price rises and (the good news) many more areas where you do not have to be. The four areas of price sensitivity in dental services and products: 1. The cost of a dental health review (check-up); 2. The cost of a hygiene visit; 3. The monthly cost of a dental mem- bership plan; and 4. Your price for Invisalign. The fi rst three are sensitive to price because they are regular repeats and the fourth is because it is a globally commoditised product, and the public are savvy. In these four areas, you must exercise some caution, but what does caution mean? Up to 2021, caution meant keeping the rise to no more than 5% a year. In 2022, caution means a rise of no more than 10%–15% in my opinion. For all the other treatment areas, I ad- vise raising prices by 20%–25%. If you did not raise your prices in January, you will still be behind, but will have to catch up over the next 12 months. However, you do not need to wait until next year; nothing is going to become better or easier and more time of low profi t helps nobody in your business. Have a look at your FPI price list within the next seven days, revise the prices and start as soon as possible. If there is a price list on your website, you can change it at the start of next month. There is no need to mail your patients unless you make changes to the fi rst three points on my sensitivity list. Your fi nancial ship is leaking profi t as you read this article. Leadership requires action. Put your prices up. In my next article, I will be looking at lead generation systems and the lat- est ideas on how best to attract new patients, how to sell more to existing patients and—dare I say it—how to avoid wasting money on advertising and marketing ideas that frequently just do not work. Chris Barrow has more than 50 years of work experience and has been active as a consultant, trainer and coach to the UK dental profession for over 25 years. His main professional focus is through his Extreme Business company, providing coaching and mentorship to independent dentistry around the world via virtual con- sultancy, practice visits, a workshop programme and an online learning platform. His blog, Thinking Business, enjoys a strong following. During the COVID-19 pandemic, Barrow created the Regeneration Coaching Programme to help practices to survive lockdowns and to bounce back higher after their return to work. More informa- tion on his work can be found at www.coachbarrow.com. Dental consultant Chris Barrow is advising dental professionals to raise their treatment prices sooner rather than later in order to stay profi table in the current fi nancial situation. 6. The eff ective collection of Google reviews puts automated search en- gine optimisation within the grasp of any practice and at no cost, thus eliminating the need for the smoke and mirrors of digital advertising. 7. The GDC scope of practice for dental therapists opens up a whole new world in the provision of preventive maintenance on profi table terms and without the need for principals to be drowning in check-ups. 8. The ability to grow therapist- and associate-led businesses frees the principal from the shackles of a per- formance-related earnout on sale. 9. The eff ective and responsible use of social media generates new patients more cost-eff ectively than ever, resulting in decreased mar- keting costs. 10. The more corporates and micro- corporates emerge amid the cur- rent recruitment and retention crisis, the more the trend towards salaried clinicians and the demise of the broken percentage/hourly rate model will continue, resulting in better profi t margin manage- ment for owners. 11. The more practices are gobbled up by corporates and micro-corporates, the less competition there is for independent owners, because cor- porate dental marketing is almost always poorly designed and exe- cuted. 12. During the 2008 banking collapse, goodwill values dropped by 25% almost overnight—that lasted for 18 months before they were back and beyond their previous highest levels because there is no such thing as a crisis—there are only cycles. So now you can decide: is your glass half-empty or half-full? Nine steps to fi nancial confi dence Against this backdrop, I intend to iden- tify winning habits, trends and actions in this article series that are keeping my best clients at the top of their game, despite the challenges they are facing. This is a summary of the nine characteristics of dental practices whose fi nancial systems are excellent and their owners thus confi dent: tasising about an exodus of patients and/or declined treatment plans. FEAR is Fantasy Expressed As Reality. 1. The owners understand their profi t and loss statement, they are in receipt of updated management accounts every month (from cloud-based ac- countancy software) and set aside the time to review the numbers. 2. KPIs are monitored monthly to spot trends and compare against indus- try benchmarks. 3. ‘Every year, a 12-month budget and cash fl ow forecast are created, and progress is monitored monthly. 4. ‘The average daily production of every fee earner is closely moni- tored and compared with industry benchmarks, and fee earners are held to account. 5. The all-important operating cost per surgery per day becomes a key measure of the profi tability of each treatment room. 6. As a result of which, each fee earner has his or her own profi tability mea- sured on a rolling 90-day cycle. 7. The owners fully understand EBITDA and adjusted EBITDA when it comes to an assessment of the goodwill value of their practice. 8. The owners know the value of their goodwill and can plan their exit in a targeted manner. 9. Prices are set accurately and re- viewed regularly. I believe pricing to be the most import- ant of these nine steps in the current climate. I suggested to my clients in the fourth quarter of 2021 to increase their fee per item (FPI) prices by at least 20% in the fi rst quarter of 2022. Like usual, 20% of them went ahead and 80% increased by lower amounts of 5%–15%. Without exception, all my clients reported that their patients did not bat an eyelid. In the third quarter of 2022, I suggested to my clients to increase their FPI prices by another 20% in the fourth quarter. So far, very few of them—if any—seem to have taken the advice. My guess is that they fear the consequences, or— to put it in other words—they are fan- Let us set some context here: Before any energy bills cap, energy bills are up 50%–60% this year so far. We all know what is happening at petrol stations and on supermarket shelves. I tried to book a standard-class one-way ticket from Stockport to Plymouth in September, and it cost over £400. Last year, my wife fl ew premium economy from Manchester in the UK to New York in the US via Heathrow Airport for £750 return—the same journey this year will be £1,500. My Amazon Prime subscription re- newed last month, and it is 20% more compared with a year ago. Supply chain delays are aff ecting every sector of the economy The media are doing a fantastic mar- keting job for all of us now by high- lighting the dental deserts I men- tioned all over the UK. The demand for high-value dentistry has historically been very robust in recessions (I am thinking especially of between 2008 and 2010), and the wait- ing lists for treatment are growing longer as scarcity creates demand. I am certain that you will have similar examples of everything becoming more expensive, and as an aside, that is why your team members are either asking for more wages or looking around for better pay. To repeat, the KPI for wages has been 17.5% of sales for the last 25 years. I advise my clients that this will be at 25% by the fi rst quarter of 2023 and is likely to stay there. That is 7.5% of your profi ts gone unless you do something about it. You have two options: fi rst, increase the average daily production of all your fee earners, and second, increase your prices. These are not really options; you must do both and you must start now. Not doing so means less profi t, and less profi t does not just mean that—it also means less EBITDA in a market that now expects multiples for goodwill

6 UK NEWS Dental Tribune United Kingdom Edition | 1/2022 The practice of self-compassion among dental professionals Promoting well-being among dental professionals: How to practise self-compassion In this article, Victoria Wilson explores ways in which dental professionals can understand the value of practising self-compassion. © tannikart/Shutterstock.com By Victoria Wilson, UK Kindness to oneself and self-love are concepts that are often spoken about in the context of looking after oneself and supporting personal well-being. According to the UK’s National Health Service, “well-being is about feeling good and functioning well and comprises an individual’s experience of their life; and a comparison of life circumstances with social norms and values”.1 Dental pro- fessionals widely recognise the impor- tance of patients’ well-being and their mental health, and it is an ethical re- quirement that we always act in the best interest of all of our patients. We have to be accountable for this. Yet, are we acting in the best interest of ourselves so that we can always thrive as dental professionals? Are we accountable for doing so? Self-compassion could have a signifi cant role for dental professionals. The topic of well-being and mental health is complex. This article will explore how self-compassion can support the well-being of dental pro- fessionals. In addition, it will identify opportunities for dental professionals to utilise self-compassion practically as a tool to enhance their well-being and ways they can become account- able for practising self-compassion. Stress factors dental professionals experience There are many stress factors expe- rienced by dental professionals that have been identifi ed throughout literature.2–4 All individuals deal with diff erent stress factors to varying degrees. Common stress factors that dental professionals experience in a clinical setting include: Fear of litigation; Running late for patients; Diffi cult or demanding patients; Musculoskeletal pain; and Working without a nurse. fection, and such self-imposed pres- sure can lead to a spiral of self-criticism if perfection is not achieved. It is important for dental profes- sionals to consciously recognise the stress factors that aff ect them on an individual basis. It is furthermore im- portant to acknowledge that the extent to which they are aff ected by similar stress factors varies at diff erent times. Example of how the same stress factor can aff ect the individual diff erently Dental hygienist—Scenario 1: The dental hygienist goes to work, and the surgery has not been left and restocked by the previous clinician as it usually is. The hygienist feels slightly agitated, but proceeds to reorganise the surgery in preparation for the day ahead. Dental hygienist—Scenario 2: The den- tal hygienist goes to work feeling tired, and the surgery has not been left and restocked by the previous clinician as it usually is. The hygienist is agitated and bursts into tears before starting the day. Dentist—Scenario 1: The dentist is at work and receives a call from the recep- tion while in surgery that a patient who received treatment the day before would like to make a complaint. The dentist asks some more questions regarding the situ- ation, takes a deep breath and accepts that it is not possible to please every patient even though he or she is always trying to deliver the best possible treat- ment. The dentist stays calm, carries on with the next appointment and sched- ules an appointment to call the patient. Dentist—Scenario 2: The dentist is at work and receives a call from the reception while in surgery that a patient who received treatment the day before would like to make a complaint. The dentist starts to feel extremely agitated by the news and is very abrupt with the nurse and begins to feel stressed. such as self-compassion, could help limit the impact of certain stressors. Thus, self-compassion could have the poten- tial to build resilience in the dental pro- fessional to ongoing stressors. What is self-compassion? Self-compassion involves treating oneself with kindness and acceptance using words and thoughts that are contextually logical to oneself, like one would address a friend who is suff er- ing. In doing so, one can help to ease the pressure often confl icted on one- self, which in turn can limit one’s ability to function well and thrive. The practice of self-compassion, avoiding self-criticism and self-comparison, has the potential to motivate one to reach one’s own capabilities while cultivat- ing self-awareness and seeing oneself clearly and honestly with acceptance. What are common misinterpretations of self-compassion? Frequently, individuals have re- ported in conversation fi nding the topic of self-compassion challenging to implement. They may feel slightly uncomfortable with the thought of self-compassion being self-love, as it may feel fake and not real, or narcissis- tic. This common misconception may prevent individuals from practising it. It has been discussed that self- compassion may be diffi cult to compre- hend and practise. An unclear under- standing of self-compassion and how it can be comfortably practised on a daily basis will in turn limit dental professionals’ exploration of how self-compassion can bring potential value to their lives. How can self-compassion be cul- tivated and implemented by dental professionals? Recognition A common trait exhibited by den- tal professionals is the commitment to meet the high standards that are required of them. This can result in a consistent desire to achieve per- This example shows how similar perceived stress factors in the same scenario can aff ect that same individual diff erently on a diff erent day. Finding re- sources that can be used on a daily basis, Self-compassion can be practised by fi rst recognising when self-criticism and self-frustrations occur and what the known trigger is. Imagination It can be helpful to imagine how a close friend is feeling about a particular stress factor and imagine how one would talk to him or her to reassure him or her and reduce the pain he or she is feeling. Practice Regular practice of self-compassion can improve the neural pathways for using this helpful resource. At times when we strive for perfectionism and fail to achieve it, a natural relapse into self-frustration can be the usual default response. However, when perfectionism is not achieved, in- stead of self-frustration or self-criticism, kind thoughts like “I did my best at this mo- ment, this is all I can do and I acknowledge that” or “I continue to learn every day and accept this wonderful quality that I have” could be a positive alternative. Through repetition and regular practice, it will be- come easier, and allow us to default to positive self-compassion more regularly. How can dental professionals become accountable become accountable for implementing for implementing self-compassion? self-compassion? Every time a dental Every time a dental professional resorts professional resorts to negative inner words to negative inner words of self-frustration, of self-frustration, self-criticism, self- judgement, he or judgement, he or she should recog- she should recog- nise the opportunity nise the opportunity to automatically shift to automatically shift to positive words of self- to positive words of self- compassion, self-love, self- compassion, self-love, self- acceptance and self-appreciation, like acceptance and self-appreciation, like he or she would do for a friend. However, it is diffi cult to hold ourselves accountable. Recognising this and using a tool like the HabitShare app or simply keeping a diary or holding yourself ac- countable at work or with a colleague, friend or family member might help. The future of cultivating automated self-compassion among dental professionals Changing the stigma and miscon- ceptions of self-compassion and be- ginning conversations in dental schools and among dental teams will allow the practice of self-compassion to become more mainstream. The poet Rumi wrote “Our task is not to seek for love, but merely to seek and fi nd all the barriers within yourself that you have built against it”, and learning the skill of self-compassion can help to break down the barriers to love, both for oneself and others. Dental professionals should seek and fi nd the barriers they have built within themselves, reduce these and practise self-compassion in order to maintain a mindset of being consistently kind to themselves amid the constant changes in the world and to increase their ability to thrive. Imagine what could come into your life when you become as good at being kind to yourself as you are kind to the people that surround you. References: 1. UK Department of Health. Wellbeing: Why it matters to health policy. 2014 Jan [cited 2022 Oct 26]. Available from: https://assets.publishing.service.gov.uk/ government/uploads/ system/uploads/attachment_data/ fi le/277566/Narrative__January_2014_.pdf. 2. Collin V, Toon M, O’Selmo E, Reynolds L, Whitehead P. A survey of stress, burnout and well-being in UK dentists. Br Dent J. 2019 Jan 11; 226(1):40–9. doi: 10.1038/sj.bdj.2019.6. 3. Gorter RC. Work stress and burnout among dental hygienists. Int J Dent Hyg. 2005 May; 3(2):88–92. doi: 10.1111/j.1601-5037.2005.00130.x. 4. Harris M, Wilson JC, Hughes S, Radford DR. Stress and well-being in dental hygiene and dental therapy students. BDJ Team. 2017 Sep 1; 4:17136. doi: 10.1038/bdjteam.2017.136 Victoria Wilson holds a BSc and a diploma in dental therapy and diploma in dental hy- giene awarded by the Royal College of Surgeons of England in the UK. of Surgeons of England in the UK. She has over ten years of She has over ten years of experience as a dental experience as a dental hygienist and the- hygienist and the- rapist, beginning rapist, beginning in the National in the National Health Service Health Service and private and private sector in the sector in the UK and pro- UK and pro- gressing to the gressing to the private sector private sector in the UAE. She in the UAE. She is passionate about is passionate about her work and fully her work and fully committed to oral health committed to oral health promotion around the world. She founded the Smile Revolution and Smile Revolution Growth Hub, driving innovations in oral health promotion and leadership. In 2019, she launched the Smile Revolution podcast, which has over 13,000 listeners around the world, and developed the Smile Revo- lution Thrive, the first subscription- based platform dedicated to enhancing the well-being of dental professionals daily. In addition, she is a qualified yoga instructor and mental health first-aider. More information can be found at www.smile-revolution.net.

8 SUSTAINABILITY SUSTAINABILITY Dental Tribune United Kingdom Edition | 1/2022 Building a sustainable dental practice How to reduce emissions, ensure sustainable procurement and manage clinical waste staff travel are the largest emitters of greenhouse gases within dentistry. Since dental appointments accumu- late over a patient’s lifetime, total emissions end up being extremely high compared with those resulting from other healthcare treatments. In order to decrease emissions, FDI World Dental Federation pro- motes source reduction through good oral health or prevention. This is because preventive dentistry results in fewer appointments, fewer recall visits, a reduction in materials and, consequently, less clinical waste. Dental diseases that are preventable or are in the early stages of progression should be targeted using individual- ised maintenance plans where home care should be the centre of attention. For example, switching to green energy leads to a great impact, re- quires little eff ort and minimises interruption to day-to-day practice. To make sustainable procurement more manageable, it can be divided into buying less, wasting less and switching to products and services with a lower carbon footprint. Clinical waste is defi ned as “any waste which consists wholly or partly of human or animal tissue, blood or other body fl uids, excretions, drugs or other pharmaceutical products, swabs or dressings, syringes, needles or other sharp instruments”. It is also classifi ed as hazardous and should be incinerated. Healthcare waste— a major problem The four Rs in dentistry Medical and dental care generate substantial waste. The healthcare sector is responsible for 5% of all the greenhouse gas emissions in the EU. Dental waste management has been primarily focused on amalgam dis- posal, but this is no longer the main issue. Even though it is well known Waste management aims to pro- tect humans and the environment. If correctly done, it can also reduce costs since most of the waste pro- duced is clinical waste and is more expensive to dispose of than house- hold waste. A popular way to man- age waste has been to employ the Recycle in the surgery This is the most challenging area since clinical waste cannot be re- cycled. The most common materials found in clinical waste are tissues, gloves and sterilisation pouches. We should be able to establish routines that allow us to open the pouches with clean gloves, separate the plastic from the paper and recycle appropri- ately. Small actions like this can have a positive impact on the environment and save costs for dental practices. Rethink in the surgery Rethinking is the most important of the four Rs. Even though reducing, reusing and recycling are the most discussed, they do not adequately address the clini- cal reality of dentistry or medicine. In order to meet the Sustainable Development Dr Sanjay Haryana. By Dr Sanjay Haryana, Sweden Kindness to oneself and self-love are concepts that are often spoken about in the context of looking after oneself and supporting personal well-being. According to the UK’s National Health Service, “well-being is about feeling good and functioning well and comprises an individual’s experience of their life; and a comparison of life circumstances with social norms and values”.1 Dental pro- fessionals widely recognise the impor- tance of patients’ well-being and their mental health, and it is an ethical re- quirement that we always act in the best interest of all of our patients. We have to be accountable for this. Yet, are we acting in the best interest of ourselves so that we can always thrive as dental professionals? Are we accountable for doing so? Self-compassion could have a signifi cant role for dental professionals. Sustainable dentistry’s two major outcomes, namely good oral health and reduced environmental impact, could be achieved by focusing on preventive care and quality operative care. However, the large amount of waste produced by the dental offi ce daily is a problem that needs imme- diate attention. Reducing emissions— a complex task Dental caries and periodontitis are two of the most common diseases globally. Thus, the primary aim of sustainable dentistry is to improve the quality of life through preventive care and quality operative care. In order to be able to off er this to the underpriv- ileged part of the global population, increased emissions are inevitable. However, from an environmental perspective, we want the population to have immediate access to dental care, but we do not want patients to visit the dental practice too often. After the manufacturing of dental supplies and the dental waste gener- ated in daily practice, patient and m o c . k c o t s r e t t u h S / l s b a n e l e © According to Dr Sanjay Haryana, sustainable dentistry helps to make the workplace more attractive, is ethically correct and can serve as a great marketing tool. Sustainable procurement Why should dental professionals strive towards sustainable dentistry? Firstly, it is the right thing to do ethi- cally; secondly, it is a great marketing tool; and fi nally, it creates an attrac- tive workplace for new colleagues. Before taking steps towards creating a green dental practice and practis- ing green dentistry, the practitioner should understand that sustainability minimises pitfalls and simplifi es the process. To build a sustainable dental practice, it is essential to establish the coming change with management and take advantage of the trickle- down eff ect—the spreading of atti- tudes and behaviours through the core of the organisation. The team members must understand why the change is necessary, feel responsible for their roles and be inspired to take part in the sustainability journey. that dental practices generate great amounts of waste, there is limited data available on the eff ect of this on the environment. Similarly to sustain- able dentistry, dental waste manage- ment lacks a global consensus on how to tackle certain environmen- tal issues that are associated with dentistry. In the day-to-day running of a dental practice, waste is generated from all parts of the business and can be divided into three categories: household waste, hazardous waste and clinical waste. Household waste is similar to that which is generated in a residential environment and should, if possible, be recycled. Hazardous waste is considered harmful to people and/or damaging to the en- vironment and must be disposed of through the appropriate facility. It includes clinical waste, radiographic solutions, amalgam and gypsum, which generates a toxic gas during degradation in landfi lls. four Rs—reduce, reuse, recycle and rethink. Reduce in the surgery Many practices work with preset trays containing certain instruments and disposable material, such as plas- tic tray liners, gauze, cotton rolls and polishing paste. As soon as the tray has been contaminated, all materials, both used and unused, are classifi ed as clinical waste. Practices should re- view their set-up routines to minimise the waste of unused material. Reuse in the surgery Most of the waste in dentistry consists of single-use equipment de- signed to minimise cross-contamination. There is a need for the development of novel solutions allowing sterili- sation and reuse. However, practices must consider whether the equip- ment is safe for patients and person- nel and whether its production and use have a positive impact on the environment. Goals of the United Nations as set out in Agenda 2030, our suppliers must under- stand the waste management system and align their dental products and materials with the most appropriate end-of-life procedure—incineration, land- fi ll or recycling (chemical or mechanical). Moving forward All clinical waste is destined for incineration and should, therefore, be bio-based instead of fossil-based to reduce net emissions. Additionally, a consensus is needed on how to safely minimise single-use equipment. There are many diff erent types of plastics used in the healthcare system, and a circular approach will never be accom- plished if they are recycled together. Our eff orts in the clinical setting will have little impact on sustainability unless there is an alignment of equip- ment production, waste management and end-of-life procedures. Only then can good oral health and reduced environmental impact be achieved.

10 SUSTAINABILITY Dental Tribune United Kingdom Edition | 1/2022 Study examines public perceptions regarding sustainable dentistry Patients embrace sustainability in the dental practice By Brendan Day, Dental Tribune International Given the relatively high levels of material waste produced during the course of dental procedures, a more sustainable approach to dentistry has been advocated by many within the industry. A study from researchers at the University of Sheffi eld has sought to examine how the general public perceives the push for sus- tainability within the profession and to better understand what com- promises will be accepted in the name of environmentally friendly dentistry. The research team, which is spread across the university’s De- partment of Psychology and School of Clinical Dentistry, set up an online questionnaire for participants re- cruited via private dental practices and by other means. Data regarding the participants’ views about sustainable dentistry, as well as demographic data and infor- mation about the participants’ overall oral health, was collected between August 2020 and February 2021. In total, 344 adults responded to the survey. Positive attitudes towards sustainability Overall, the researchers found that participants responded quite posi- tively to sustainable dentistry and were “moderately willing to compromise time and convenience”. In addition, they were somewhat likely to agree to pay more and receive potentially less durable dental treatment if it meant that the treatment would be more en- vironmentally conscious. Respondents were least likely to accept compro- mises regarding the appearance of their teeth or their oral health status, whereas those having better self-rated AD Leading virtual orthodontic solutions Augment practice productivity and deliver outstanding patient experience. Engage more qualified patients: via AI-powered initial assessments and virtual consultations. Drive higher case acceptance: with instant ultra-realistic smile simulations. Control treatments remotely: thanks to an automated workflow and clinical goals that you set (suited for all fixed and removable appliances of all brands). Already trusted by 7,000+ practices and 1M+ patients worlwide DentalMonitoring, Smilemate and Vision are products designed and manufactured by Dental Monitoring SAS, under the DentalMind branding for Health Care Professional (HCP). They are also used by patients under the mandatory supervision of Health Care Professional (HCP). DentalMonitoring and SmileMate are designed to assist HCP in observing remotely intra-oral situations (and monitor orthodontic treatments for DentalMonitoring). Refer to your HCP and/or the Instructions for Use before use. DentalMonitoring product is a medical device (in Europe only), registered as such and holding the CE mark. Vision simulations are generated using artificial intelligence, they are not contractual and may differ from the final results of the patient’s treatment. Products availability, claims and regulatory status may differ across countries depending on local regulations. Contact your local representative for further information. d e n t a l - m o n i t o r i n g . c o m m o c . k c o t s r e t t u h S / d u B e t a K © A new study from researchers at the University of Sheffi eld has found that dental patients are likely to accept certain compromises in order for the dental treatments they receive to be more sustainable. oral health were more likely to view sustainable dentistry in a positive light. “Participants’ ethnicity, level of education and employment status were not found to be associated with their attitudes towards, or willingness to make compromises for, sustainable dentistry,” the authors noted. How- ever, they added that, similarly to the results of previous studies conducted on attitudes about sustainability, signifi cant diff erences were present in accordance with age and gender. In their discussion, the authors recognised a number of limitations regarding their study, including the relative homogeneity of respondents, the lack of measuring household in- come or socio-economic status and the focus on participants’ willingness to make compromises rather than on their actual behaviour. This focus was justifi ed by the reasoning that “there is currently little choice for the public when it comes to reducing the impact of their dental treatments on the environment”. “Women displayed more positive attitudes regarding sustainable dentistry.” Older respondents were less likely to want to compromise their time and convenience than younger respon- dents, whereas women displayed more positive attitudes regarding sustain- able dentistry than men did. Survey respondents who were reg- istered with a dentist recorded more positive attitudes towards sustainable dentistry than those who were un- registered. Whereas the frequency of dental visits did not appear to aff ect these attitudes among participants, the authors found that those who vis- ited more frequently for routine dental check-ups stated that they were more likely to pay more to reduce the ecologi- cal footprint of their visits. “[F]uture research may want to use environmental assessment (for example, Life Cycle Assessment), in order to inform which types of com- promises would have a benefi cial impact on the sustainability of dental services,” the authors stated. “Such research would inform what changes should be made, while our research can inform whether such changes would likely be accepted by the public,” they added. The study, titled “Exploring at- titudes towards more sustainable dentistry among adults living in the UK”, was published online on 26 August 2022 in the British Dental Journal. n e _ K U _ H _ d r _ 2 0 _ 9 1 0 _ D A _ P V _ D A I

12 INDUSTRY Dental Tribune United Kingdom Edition | 1/2022 Simplifi cation is the secret to success a consensus based on the latest scientifi c fi ndings and their own clinical experience. They ensured that Success Simplifi ed considers the challenges and constraints of a modern dental practice. What is it all about? Aside from the infl ux of new prod- ucts and materials, patient expectations continue to change. As a result, it is be- coming more complex to meet modern demands. Streamlining the workfl ow is thus more important now than ever be- fore. Fortunately, the answer is simple. Success Simplifi ed is a compre- hensive yet highly accessible resource that covers all seven steps of an indi- rect workfl ow, guiding dental pro- fessionals on how to simplify and standardise their prosthodontic pro- cedures. To sum up the basic prin- ciples of Success Simplifi ed, the goals of this concept are as follows: Modern dentistry provides dental professionals with plenty of oppor- tunities to enhance their work. The dental market is full of new ideas, materials, techniques and tools to help maximise treatment outcomes, patient satisfaction and practice prof- itability, but is there such a thing as too much choice? The industry’s advancements are impressive and certainly positive, but it is important that dental profession- als are not overwhelmed by the avail- able options. When it comes to indirect restorative work, which naturally can be complex, too much choice can make things even more complicated. That is why *3M Oral Care has partnered with fi ve international ex- perts to create Success Simplifi ed— a unique concept that helps dental professionals streamline their indirect restoration workfl ows for remarkable outcomes achieved with minimal stress. The faces behind Success Simplifi ed Prof. Jan-Frederik Güth and Drs Paulo Monteiro, Akit Patel, Carlos Eduardo Sabrosa and Stefan Vandeweghe have developed AD TEAMWORK FAST. WELLCOORDINATED. EFFICIENT. United in strength: for predictable and convincing results in full-arch restorations! Scan and integrate our standardised protocol. d e v r e s e r e g n a h c o t t c e b u s d n a e k a t s i j M Register now! bredent UK Ltd · Tapton Park Innovation Centre · Brimington Road · Chesterfi eld S41 0TZ · T: +44 1246 559599 · www.bredent.co.uk · @: enquiries@bredent.co.uk selecting the simplest methods that still ensure reliable results, being as minimally invasive as possible, and ensuring cost-effi ciency for the den- tal professional and the patient. A glimpse into Success Simplifi ed Success Simplifi ed covers every- thing from dental material selection to restoration maintenance, providing an enhanced understanding of each step. For instance, the fi rst step focuses on product selection—arguably the most important part of the entire treatment pathway. 3M Oral Care has combined the very best of its portfolio and recom- mended the products that will work optimally for each step. Its ethos is underpinned by the belief that dental professionals should be able to use innovative products that truly make an impact, all the while making their lives easier. The fi ve experts who have supported and developed the Success Simplifi ed concept have also shared their defi nitions of best practice recom - mendations and protocols. Together, this is aimed at helping the dental professional achieve outstanding re- sults the fi rst time, every time! The future of dentistry Nowadays, the focus of the dental fi eld is on preservation, allowing pa- tients to enjoy their natural dentition for as long as possible. The development of minimally invasive techniques has made this a reality, and all dental treatment should be supported by this underlying principle. Success Simplifi ed is ideal for dental professionals seeking ways to harness a minimally invasive workfl ow, save time and money, and prioritise sim- plicity without compromising quality. As dentistry becomes more complex, den- tal professionals can rely on simplicity to help them keep pace. To receive your free copy of the Success Simplifi ed handbook, contact a 3M representative or request a free sample of 3M Astringent Retraction Paste at go.3M.com/susi-dt. Watch the on-demand webinar on Success Simplifi ed, hosted by Dr Stefan Vandeweghe, at 3M.co.uk/ Success-Simplifi ed. * 3M is a trademark of the 3M Company. Perio plus mouthwashes: minimum side eff ects Maximum eff ect, The Perio plus mouthwashes—also available as toothpaste and gel—are the result of many years of research with a clear objective: less chlor- hexidine and greater eff ect. Perio plus achieves a strong antibacterial eff ect thanks to a unique blend of additives. Valuable expertise and successful use of polylysine and biofl avonoids are combined in Perio plus for the ultimate eff ect. This product also owes its suc- cess to close collaboration with dental professionals who contributed exten- sive practical experience. Perio plus is a very eff ective mouthwash, proving itself anew on a daily basis against acute gingivitis, in the care of im- plants and in postoperative care. This product range is the ulti- mate showcase of Curaprox’s dental hygiene expertise. More information can be found at curaprox.co.uk.

Doing dentistry diff erently There’s never been a better time to join {my}dentist. With record investment in our people and practices, the largest clinical support team in UK dentistry, and unrivalled opportunities, you’ll have the freedom to work the way you want, build the career that’s right for you, and provide the highest level of care to your patients. Real freedom and fl exibility: We’re giving clinicians the freedom and fl exibility to grow the careers that are right for them. Clinicians won’t be chased to hit a target or work hours that don’t suit them and their families. Unrivalled support: We’ve built the largest clinical support network in the UK, with more than 50 clinical support colleagues dedicated to listening to clinicians and offering help and guidance when it is needed most. Clinicians also benefi t from an industry-leading support centre and training academy. Investment where it counts: We’re investing more than £20 million every year to ensure clinicians benefi t from the latest materials and equipment, outstanding facilities, and better-rewarded, supportive practice teams. practice teams. D A Dental Tribune United Kingdom Edition | 1/2022 “People are smiling from the bottom of their hearts” Interview with Dr Florian Obadan on the SKY fast & fi xed system. By bredent. Dr Obadan, how did you start working with the SKY fast & fi xed therapy? I fi rst heard about the SKY fast & fi xed implant therapy for immediate loading about 14 years ago; however, it is worth noting that I fi rst started as a non-believer in the system, its potential and how it would function. Then, one day, I was translating a course held by Wolfgang Lechner, currently the international sales manager of the bredent group, and he described the system in a way that captured my attention and curiosity. I started to re- search the system and to read peer reviews, but I still was not totally sold on SKY fast & fi xed. Back then, I was working in a small town and community and could not aff ord any fail- ure. Since I needed more evidence about the system, I went to visit the Swiss Dentaprime clinic in Varna in Bulgaria, where a surgeon came to do a demo surgery. It still wasn’t enough to win me over, even though I assisted during the surgery. Then, in June 2009, I went to a course in Germany, where Dr Michael Weiss also performed a live surgery using SKY fast & fi xed. Upon my return to Romania, I fi nally de- cided to give it a try after nine months of uncer- tainty. A patient of mine who I deemed suitable for the procedure agreed to be my fi rst case. The intervention was scheduled in July 2009 and was a success. August 2009 brought the next two successfully completed cases and with minimum discomfort to the patient. Fast-forward to today: even though I do not keep an exact count of the patients from my clinic, I am proud that some 2,000 to 3,000 people are smiling from the bottom of their hearts and not hiding any more, thanks to SKY fast & fi xed, the therapy that restored their smiles in just 24 hours and enabled them to continue living just like before they had any tooth issues. Has SKY fast & fi xed made a diff erence in patient satisfaction? Initially, I fi nd that patients who are suit- able for the treatment are also rather des- perate. They have lost teeth and are likely to be wearing a removable denture. Once the pro visional restoration is placed, you can see a change in these patients: they start having Dr Florian Obadan, based in Romania. new expectations about a life with greater functionality and improved aesthetics. With the SKY fast & fi xed system, you can achieve a high degree of treatment predictabil- ity and stability, which is not the case when you try to reconstruct the structures biologically. After surgery, you can see in patients’ eyes how happy you have made them, and that is really rewarding and reminds us why we are so motivated to help patients every single day. Is SKY fast & fi xed suitable for all patients? When profi ling patients, I would advise dentists not to look at the age of patients and instead to focus on their personal situation. Ready to join us? scan for more info www.mydentistcareers.co.uk Dr Florian Obadan off ers hands-on training programmes.

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