Leichtenstein Ivoclar blog day three

Saturday 16th February

Lectures started at 9am this morning, a few slightly tired eyes around the room I noticed!

What really impresses me about Ivoclar is their R&D commitment. They have a team of 80 research and development staff spending all day creating, tinkering, improving and above all, listening to the changing needs of the profession. I don't believe there's a company out there in the dental sector with this level of commitment.

Coupled with their international education departments and programme, they really do feel like partners in dentistry, almost part of the team.

One simple example of this is during one of the workshops one of our UK team came up with an idea for an enhanced product that would work synergistically with Bulk Fill. It didnt take long for that idea to reach the product development team, starting a whole load of excited beard scratching and the sound of brain cogs working.

Other ideas about surgical access aids for implant surgery were discussed over dinner and this again was quickly passed on.

It's one thing to develop products that you think people might need, it's another to develop products whilst listening to Opinion Leaders who actually know what they want and what can work. Very impressive.

After coffee we broke into workshop groups. The first workshop had all the ingredients of Bulk Fill composites laid out like a cookery program and it was incredible to see and feel these components, giving us a greater understanding of why they are used, and what happens when you omit certain things. This was a serious highlight for me.

Our second workshop was a hands on demonstration of the curing depth of bulk fill composite. It's quite impressive to see a material looking as dense as a regular composite but getting test curing depths of 7mm with only 10 seconds of curing.

Our final workshop was testing firsthand the chemical in the composite that slows down the setting in natural light, allowing us much more time to place and shape our single layer, meaning less polishing required afterwards.

It does go to show that when sales companies say "this product does X,Y and Z" we should not always respond with immediate cynicism but we can embrace the work these guys do that of course makes them profitable and successful companies, but also makes our lives so much easier and more worry free.

Thank you so much Ivoclar for inviting me to this amazing event and after spending 2 days writing copious notes, it's time to put some exciting things into place in not only my lectures but my daily practice.

Leichtenstein Ivoclar blog day two

Friday 15th February


Flu definitely subsiding now after a good nights sleep in the Hotel Residence in Vaduz. Yesterday managed to get time for a wander around the town which really didnt take very long! For a capital city in takes 15 minutes to walk around the shopping area. However the 360 degree mountainous views more than make up for that!

After a couple if initial welcome and product update talks we were split into our 2 groups, those learning about Tetric EvoCeram Bulk Fill direct composite and those in the CADCAM group. I was in the Bulk Fill group, which is a material I use everyday and lecture on it quite regularly.

I heard from the CADCAM guys of some pretty exciting new Emax developments, wish I could have been in both groups really. Problem is, they aren't launched yet so we can't really discuss them, but exciting times ahead.

Our composite group went off to the Research and Development department to receive some high quality scientific knowledge about this exciting product.

We heard excellent lectures from extremely well respected industry leaders and product development team members. Many agreed that this material, placing 4mm layers at a time, sometimes whole restorations in one increment, was a great paradigm shift in the way we were taught. However, I believed as many do that this material is an enhanced version of an already well established product and the longevity data is there already. Combined with this materials three main facets, longer working time, 4mm (and more) depth of cure without needing to be translucent, and the prepolymer fillers that reduce the shrinkage pressure, many of us felt satisfied that this material is excellent, safe to use, looks great, shines well and is very strong. The thicker increments mean we can place composite restorations more efficiently, with fewer layers, still maintaining excellent aesthetics, low post op sensitivity, great marginal integrity and patient satisfaction.

After an excellent q&a time, we caught the bus to the Kunstmuseum Leichenstein for a slightly bizarre museum tour and an extremely tasty dinner.

All in an excellent and memorable day, got to meet some excellent colleagues, all dental heroes of mine.

Relative Analgesia in my General Practice Part Four

Dental treatment for those who don't feel they require being "knocked out"


This is something I come across a lot. A patient who is obviously nervous, really isn't looking forward to a procedure but has decided to go through it anyway. Maybe the patient feels that they "should" be brave, it's what's expected of them as a patient.

Dare I say, I've been in a position myself when I've been in hospital, about to have an unpleasant procedure and feeling guilty asking for anaesthesia. I've had dental treatment before where I've asked for sedation and I've been told "ahh, you don't need that".

I am a great believer in healthcare guilt and have written about it many times before. Patients often feel guilty that they have let their oral health slide. They feel guilty asking for help, asking for pain relief. They feel like they are going to get a bollocking from their dentist or hygienist. (By the way, if you think that your team doesn't think like that, how many times have you heard a team member say "how could Mrs X let her teeth get that bad! It happens in my practice sometimes)

If the culture in the practice changes, great things can be acheived for patient comfort. For example, rather than offering sedation as an option for implants, simply saying "we tend to use sedation for this procedure" makes the patient feel like their comfort is very much caterered for and not something that they have to opt in to.

RA is great for this. For the patient who is to undergo an extraction for example, saying "we often give happy air for extractions as it makes it much comfortable" rather than the standard line "we offer sedation for nervous people"

Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com

Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.

Relative Analgesia in my General Practice Part Three

Treating Children without setting up a damaging future phobia.


Young people who need dental treatment present a difficult challenge. There are so many adults out there who have neglected their oral health because of the memory of atrocious dental treatment when they were younger. Patients we come across everyday in practice.

It makes me feel much more responsible that not only are we trying to sort out any dental issues right now but what we do may set a tone for compliance in the future. I don't want to be the one that gets blamed for putting someone off great dentistry in the future.

This is where RA fits in beautifully. Treating children becomes a lot easier when there anxiousness levels are reduced and their analgesic levels are increased. Giving a local becomes almost in-perceivable to the patient and the RA helps a better depth of general analgesia, making for a more comfortable experience.



Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com

Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.

Relative Analgesia in my General Practice Part Two

Patients losing a day

With IV sedation there's no way a patient is trying to make it home on their own afterwards. I did have a case once of a late teenage boy who brought his mum with him, they had both signed the appropriate consent forms, including the escort instructions, I took a tooth out under sedation and unbeknownst to us, she had changed her mind and left. The young lad waited in the waiting room, phoned her and then discharged himself, tried to walk home and ended up asleep on a bank round the corner from the practice!

Even with verbal and signed written consent in advance to bring an escort, patients can arrive for an appointment and say "I'll just order a taxi". Of course we then refuse to treat them.

With "Happy Air" nitrous oxide, it's quite different. The patient is still fully consented but they don't need to being someone with them. They can even drive to their appointment and return to work afterwards.

This means that life starts to get simpler for all of us! We can consent and treat at the same visit which means we can use it opportunistically.

I love the effect nitrous oxide has on the gag reflex. I have treated the most crazy of gag reflexes using RA. I love the fact that for a while after the RA the gag reflex is still reduced.

Two patients we saw last week.
Patient A was a chap who needs a bridge but we need to plan it first using a wax up. He's got a pretty bad gag reflex so impression taking was going to be interesting.
After 5 minutes of RA at 40% NO2, I took a lower alginate. nothing! We took the mask off so I could get better access anteriorly. Upper alginate - nothing!

The patient reported that he thought he could feel a gag reflex trying to start but it wouldn't properly appear. There wasn't any nausea at all.
He's now asked to have Happy Air for everything! No problem!

The second chap has the most incredible sounding gag reflex. You know how some people just make slight retching sounds? This guy is can be heard outside the building, even when a mirror touches the side of his tongue.

Everyone in the practice knows about this chap, but in a nice way. He's a great guy (beats me at table football though) and is really easy to get on with. I think though that over the years, previous dentists have been dreading the thought of ever doing posterior restorations on him.

He comes in one day with a lingual cusp fracture on a lower right posterior amalgam filled tooth. Colleagues said "good luck trying to sort this tooth out!"

I did an opportunistic 10min Happy Air trial session with him, 5 minutes at again 40%NO2 and the gag went completely.

We then saw him a few days later, uses the same dose, put in an ID block, he was able to communicate how numb it was and how comfy he was. Good skin peripheral analgesia, it's a very nice sensation.

We did the composite restoration for him totally without event. Afterwards he said "would have loved to have seen you try that without Nitrous!"

He drank coffee in the waiting room for about half and hour and then drive back to work.

I'd had my RA machine for years but had got so tied up in IV, I had neglected to realise the potential. So i got to spend some time with Richard Charon in Newbury.

Richard is a great proponent of RA and lectures all over the world. He trains many dentists hygienists and therapists every year to practically allow them the next day to introduce RA to their practices, to start making a huge difference to their patients.

Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com

Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.

Relative Analgesia in my General Practice Part One

My Relative Analgesia "Happy Air" experience in General Practice

I am delighted to help host the Richard Charon Inhalation Sedation training event on Saturday 27th March 2013 in our modern training facility in Stratford upon Avon. I can highly recommend Richards approach to handling nervous patients and its great to do a day like this and go away fully prepared to start using these techniques.

I have been involved in IV sedation for quite a few years, carrying out over 1000 sedation dental procedures. I am used to it, I like the technique, I like how it makes people feel and I know that even the most phobic patients, those who haven't been for 20 years, can be treated with the minimum of fuss, pain free and anxiety free.

However, there are quite a few problems and barriers I have come across on my Dental Sedation Journey. I'll run through them over the coming articles and then explain how Relative Analgesia with Nitrous Oxide has helped me and my patients overcome them. Hopefully you'll get to see how much more it is possible to become a "Hero" to our patients!

Richard has helped me to understand that IV is not the "be all and end all" and having an "armamentarium" of sedation techniques means we can help the most people with the widest range of comfort levels and dental needs.

The topics I am going to cover are:

Easing Patients expense, making sedation more affordable

Patient having to lose a whole day

Treating Children more easily, so helping to prevent future phobias

Those who don't feel that things are bad enough to require "knocking out"

Hygienists and therapists making patients lives easier on a day to day basis.


Lets talk about Patient Expense.

In my private practice, I allow generally an hour for an IV sedation session. Once I have consented the patient again, confirm the treatment plan and gone through aftercare, cannulated, induced, reached end point, I am ready to start dentistry. This may be 15-20minutes into the session already.

I can then do about 30 minutes dentistry, take out a few teeth, do lots of root surface debridement or maybe a few fillings.

Then the patient recovers and is ready to go 50 or so minutes after they came in.

This is fine, I enjoy working like that but it does mean that what could be a simple extraction ends up being unaffordable for a lot of people.

I could finish the procedure, get the patient out of the chair, into a wheelchair and out into a recovery facility with a recovery nurse but I always feel I've got part of my brain in with them. I'm also conscious that as its just me doing IV, if the sedation was complex or difficult and my attention is required, I have to leave another potentially sedated patient. One thing at a time for me.....

Since my coaching with Richard, I have been able to do more RA procedures in half the time with patients feeling very relaxed and with really great analgesia from the nitrous. They recover in the chair in two minutes and are on their way home in 15 or so. This makes safety even better and allows me better control over my working situation.

So the patients who want "oblivion" get the IV, those who want to make it pleasant and really comfortable, I can use RA. It actually opens up my market of patients to those who are on more of a budget whilst still providing a chargeable service to my patients.

The next thing I will talk about is patients having to lose a whole day because if dentistry. Thanks for reading!


Dr Rob Endicott is a General Dentist and Sedationist based in Stratford upon Avon, carrying out dentistry for patients under sedation almost every day.
Http://Www.phobiadentist.com

Saturday March 23rd sees the training centre at Stratford Dental (www.stratforddental.co.uk) hosting an RA training day with Dr Richard Charon, the RA Coach (www.the-RA-coach.co.uk) for the whole dental team.

Leichtenstein blog day one

Thursday 14th February.

Still reeling from the flu, I am on board the flight to Zurich hoping that the taxi at the airport will have some sort of sign so I know who they are!



I've been invited by dental materials manufacturer Ivoclar Vivadent for the second year in a row to attend their "train the trainer" event at their headquarters in Leichtenstein. I occasionally carry out paid lectures for Ivoclar on Composites, adhesives and ceramics but I am not on their payroll. I am also privileged to be a Uk product tester and evaluator so I get to see the cutting edge stuff just before its released.

It is truly is a beautiful place to have a manufacturing facility, nestled amongst the snow capped mountains next to the Rhine river. The view from every window deserves a photograph taken of it and I will endeavour to upload a few panorama pics onto the blog.

Ivoclar is a very famous business in Leichtenstein. It used to be known as the "False teeth factory", being historically the largest producer of denture teeth in the world. I was told by workers there that in the past, if you had been a naughty child in leichtenstein, you would be sent to work in the false teeth factory!

I am pleased to report that's it not thought of like that anymore. When you walk around, you notice how utterly state of the art this place is, really at the forefront of dental materials research and development.
There is still an enormous room full of false teeth which is a sight to behold but there is an atmosphere of immense pride amongst the staff here in what they do, from the guys on the shop floor or distribution centre to the chemists knew deep in resins and catalysts, nobody has to try very hard to give an impression of professionalism and contentment in their work.

Some factory highlights from last year:
The false teeth room
The mighty tumblers that mix up the various parts of composite filling materials
The huge vats of ceramic powders
Meeting the chemists who spend all day experimenting with different materials components to produce the next generation of materials
The cafeteria in the ICDE training facility that serves amazing lattes that you enjoy whilst looking out towards the mountains and talking to enthusiastic colleagues and dental industry partners.

We are looking forward to 2 days of lectures, product updates, factory tours and the chance to ask lots of questions. I love dental materials and have always been fascinated by how much time, thought and energy goes into things that we take for granted in our profession. I have always been a believer in knowing more than I need to about the individual facets in my job, it makes decision making about things like materials purchasing so much easier when I know what the differences are and what I want.

Just a quick footnote, it's Valentines Day today, I left my wife in bed at 6.30 this morning and I am grateful that she loves me so much that she she doesn't make me feel guilty about going away for a few days to indulge a passion (a passion that does not rival the one I have for her!)

Happy Valentines Day Lulu!