College of General Dentistry Blog

A dental therapist’s unexpected journey

Poppy Dunton, the newly appointed Chair of the Board of the College’s Faculty of Dental Hygiene and Dental Therapy, reflects on her career in dentistry and how her mantra that “every day is a school day” has supported her development.

Never would I have expected to have the career that I have had out of dentistry. I was a disgruntled 15-year-old being told my graphic design two-week work placement had pulled out. With everyone else having picked their placements, I was left with the unexpected choice of a dental practice. “A dental practice! You’ve got to be joking?” I initially thought. Yet, as I made cups of tea and filed blue forms, the hustle and bustle of the place felt surprisingly comfortable. To say I enjoyed it was an understatement.

As the two-week period ended, the principal dentist offered me a part-time after-school job – making tea and cleaning the old impression trays (pre-single use era), and earning £3.15 per hour. I jumped at the chance, feeling like I was made of money. Every day after school, I would walk and do my 4pm–6.30pm shift. When a trial day at Northampton College for photography didn’t sit right with me, I informed the principal dentist that evening. My father was called in for a meeting, and that’s when the principal dentist said, “I’ll only give her a job here, Graham, if she makes something of her life.” That evening became the catalyst for my passion in dentistry.

The evolution of my career is intricately tied to a commitment to education. I embarked on an evening college course, alongside my apprenticeship, to train to become a dental nurse. Tuesday evenings in Milton Keynes led to passing the NEBDN Certificate in Dental Nursing. Once I had this, I spent the following months learning as much as possible – four-handed dentistry, impression taking, and implant nursing. The practice grew, and another was bought over the road, giving me the chance to set up an oral hygiene programme.

Following my return from Cardiff University, where I completed a Diploma in Dental Hygiene and Dental Therapy, I was privileged enough to be offered my job back in the practice where I had started. The first week was a week to remember; I ran an hour late, fell down the stairs, and stuck two teeth together. I had the most patient mentors, and working in an NHS practice was fantastic, allowing me to complete my full scope of practice, including paediatrics. Was it hard? Yes. Did it teach me speed and resilience? Absolutely.

After graduating in 2012, there were limited postgraduate options. Notable pursuits included constantly upskilling and working in a team supportive of therapists. Composite courses with GC in Belgium, a Level 6 qualification in employment law, and being promoted to operations manager of two NHS practices – eventually managing a team of 64 staff – led to me being offered a practice manager position four years into my career. This opened learning about people psychology, leadership and planning team meetings alongside my clinical career.

I was privileged enough to then open a squat practice alongside my principal, with a business plan for two surgeries over two years which resulted in 10 surgeries being opened over five years, including a vaccination clinic.  Three CQC inspections later, and the role of CQC manager was also added to my repertoire. The most rewarding part of project managing the development of this new practice was recruiting a group of individual dental professionals and watching them grow into a wonderful team.

Upon completing the Perio School Diploma in Periodontics for Hygienists and Therapists and the Smile Dental Academy Diploma in Restorative and Aesthetic Dentistry for Dental Therapists, I was introduced to the College of General Dentistry and was eager to explore the recognition I could gain as a dental therapist.

Unfortunately, the course credits were not enough per course to contribute towards Fellowship, so I joined the College’s Certified Membership Scheme (CMS) to gain guidance on how to continue advancing my career and choose the best postgraduate training to reflect my aspirations. As part of the scheme, I have regular contact with a facilitator who consistently ensures that my investment in courses leads me in the correct direction. Ongoing self-reflection allows me to constantly critique myself, and the leadership module fits well with my management of staff, completing practice meetings and public speaking. Being part of the CMS has supported me to complete a City & Guilds Diploma / ILM Level 5 Diploma in Leadership and Management by enabling me to choose an appropriate course and help develop leadership qualities.

The College’s Professional Framework, which underpins the CMS, maps 22 key capabilities, many of which have played a crucial role in my journey. Emphasising the value of postgraduate education, I would encourage new graduates to embrace opportunities for further learning and to constantly be self-critical of their work. Recording self-reflection, taking photographs, and analysing what went well in each case, shadowing peers, or approaching colleagues for their opinions are essential. Don’t fear failure; it’s what makes you better.

In my experience, this profession can be challenging and, at times, isolating. There are days when running late, neglecting notes, skipping meals and even necessities like restroom breaks become the norm. The toll on one’s body—back pain, eye strain, and hand fatigue—can be significant. Looking after your long-term career is vital. Record-keeping has been one of the largest changes I’ve seen, starting in my early career with very short notes. Now, ensuring my conversations with patients are highlights in notes, and my nurses help and scribe during appointments. This has proved invaluable when a complaint arises. Protecting yourself is vital.

The most unexpected rewards in my dental therapy role often come during these challenging moments. Patient gratitude and the joy of assisting anxious individuals through treatment illuminate the darker days.

This career has allowed me ongoing dedication to continuous learning, reflecting on my mentor’s ethos of “everyday is a school day”. My commitment to education and mentorship is rooted in a desire to guide new professionals in navigating complexities while maintaining their wellbeing. In 2023, I was privileged to join the Board of the Faculty of Dental Hygiene & Dental Therapy for the College, and I am even more privileged to have now been appointed Chair.

Recently I have relocated due to family illness, and this marks the end of a significant chapter in my career, prompting reflection on the unconventional path that led me to the field of dentistry, the intricacies of managing a bustling practice, combined with the personal growth and educational pursuits that defined my journey. Alongside all early career dental professionals, I continue to embrace new challenges and aspirations, remaining steadfast in my commitment to contributing positively to the ever-evolving world of dental therapy.

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This article has been updated from a previous version published on 24 January 2024

College of General Dentistry Blog

Exploring occlusion: insights from the first symposium

Dr Nathaniel-Edouard Davidson, Associate Member of the College and winner of the inaugural CGDent-GC Award, reflects on what he learnt at the first Introduction to Occlusion Symposium and why you should go to the next one.

When I first saw the announcement for the Introduction to Occlusion Symposium, I was not sure if it was for me. Occlusion felt like one of those important, yet complex (and slightly intimidating) areas of dentistry where it’s difficult to apply the extensive teachings in day-to-day practice. However, after dealing with a rising number of fractured restorations, TMJ complaints, and patients reporting muscle soreness and headaches, I realised I needed to deepen my understanding.

From the moment the first lecture started, it was clear this was not just a day of theory. The symposium tackled real-world challenges that many of us face every day in practice. The sessions covered everything from the history and implications of occlusal disease to practical techniques for restoring worn dentitions; always maintaining a strong focus on understanding the “why” behind the “what.”

The first Introduction to Occlusion Symposium in London, 5 April 2025

What stood out most

One of the key points from the day was to focus on the high prevalence of occlusal disease, which is even more common than caries or periodontal disease. There are many signs that indicate the presence of occlusal disease, such as fractured cusps, worn-down restorations, mobility, gingival recession, abfraction lesions, TMJ pain, headaches. These issues often seem unrelated, however, the symposium effectively demonstrated how these issues are in fact interconnected.

“A single night of bruxism can cause as much damage as a lifetime of chewing”. This significant insight was discussed, along with how the loss of proprioception during sleep can result in forces generated by nocturnal clenching increasing tenfold. This may explain the rise in failed restorations and unexplained wear.

Practical knowledge I’m already applying

One of the best aspects of the symposium was the clear, actionable treatment planning advice. We discussed the importance of the “Five Laws” for an ideal occlusion and successful occlusal appliance:

  • Mutually protected occlusion
  • RCP = ICP around the retruded axis position
  • Anterior guidance
  • No non-working side interferences
  • Posterior stability

Frameworks like these make managing occlusion more straightforward.

We also explored how to manage occlusal wear with restorative approaches. One fascinating technique that stood out was the use of additive composite canine risers. We can maintain the intercuspal position, but through the use of composite additions to the canines we can reintroduce anterior guidance – this alone can disclude posterior teeth and prevent further wear. It’s simple, it’s effective, and it’s something I can do in day-to-day practice.

The Introduction to Occlusion Symposium speakers (l-r): Dr Tif Qureshi FCGDent, Dr Shiraz Khan, Professor Paul Tipton FCGDent, Dr Tom Bereznicki FCGDent, Dr Ken Harris FCGDent and Dr Koray Feran FCGDent

A shift in perspective

The symposium clarified occlusion terminology, particularly centric relation (RCP) versus intercuspal position (ICP). I now understand that while ICP is used for day-to-day dentistry, centric relation is stable and reproducible for complex treatments. Knowing when to use each position and whether to conform or reorganise has improved my approach.

The rule of thumb we learnt

Reorganise: when there is heavy wear, multiple restorations, TMJ symptoms, or a need to increase vertical dimension.

Conform: when the five laws of ideal occlusion (as mentioned above) are met, when there are fewer restorations to carry out, or when there are potential financial constraints.

What I’ll do differently now

Since attending the symposium, I have already started using articulating paper markings in both RCP and ICP and taking intraoral photos and scans to help with diagnosing current or  potential future occlusal problems. I am more able to practically ‘see’ a reduced envelope of function. Patients who used to report “chipping front teeth” now make me think of reduced overbite and a collapsed envelope of function, rather than just failing restorations and parafunctional habits.

In addition, I am now more proactive about spotting early signs of parafunction, reducing interferences and offering occlusal splints. Perhaps most importantly, I now understand that restoring anterior guidance early might actually save the need for more invasive posterior restorations later. The symposium has motivated me to pursue further learning and has provided clear direction on where to focus my efforts.

Why should you attend the Occlusion Symposium?

This symposium did more than just teach occlusion – it sparked a genuine interest in the subject and gave me practical tools I can use right away. It is easy to overlook occlusion in favour of more popular topics in dentistry, but this symposium reinforces that getting the fundamentals right is what leads to predictable and long-lasting results.

If you are on the fence about attending a future occlusion symposium, I would say this: do it. Whether you are early in your career or years into practice, the insights you will gain are invaluable. If you are a Principal of a practice, why not encourage your Associates to attend? It is not just about protecting teeth, it is about treating the whole system, understanding function, and elevating the quality of care you can provide.

The next Introduction to Occlusion Symposium will take place in Edinburgh on Saturday 1 November 2025. Open to all dental professionals and with six hours’ CPD, tickets are just £90 for those who qualified between 2020 and 2025, and £110 for all other attendees. For further information, and to book your place, visit our event page

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College of General Dentistry Blog

The art and science of oral medicine

Professor Igor Blum, Editor of the Primary Dental Journal (PDJ), introduces the latest issue, which provides an overview and update on oral medicine for the general dental team

The art and science of oral medicine begins with the pioneering work of Sir Jonathan Hutchinson (1828–1900), a surgeon at the London Hospital, who is also regarded in the UK as the Father of Oral Medicine.1 He reported on the dental manifestations of congenital syphilis, intraoral pigmentation and perioral pigmentation associated with intestinal polyposis, later described by Peutz in 1921.2 Subsequently, ten further cases were described by Jeghers, McKusick, and Katz who also reviewed the literature on this topic in 1949.3 Individuals with Peutz-Jeghers syndrome commonly present with an association of gastrointestinal polyps, mucocutaneous pigmentation, a familial incidence, and are at an increased risk of various cancers.

Much of the early description of oral mucosal diseases was found in dermatology textbooks, as documented in the works of the English surgeon and dermatologist Sir William James Erasmus Wilson (1809–1884).4,5 Sir William Osler (1849–1919), a Canadian physician and co-founder of the Medical Library Association of Great Britain and Ireland, recognised the importance of the oral cavity and believed that the tongue and oral mucosa reflect a patient’s overall health.6 This idea, held in various medical and traditional practices, suggests that changes in the appearance or condition of the mouth, including the tongue and soft tissues, can indicate underlying systemic health issues.

In a thoroughly researched and well written article by Professor Crispian Scully in 2016, he described the immense contributions of various stalwarts who were instrumental in the initiation and popularisation of the discipline of oral medicine over a 50-year period, between 1920 and 1970.7 In the UK, the evolution of oral medicine has its origin in oral pathology and resulted in its recognition as a dental specialty by the General Dental Council in 1998, with tribute paid to the founders of the British Society for Oral Medicine (BSOM) – the predecessor organisation of The British & Irish Society for Oral Medicine (BISOM) which was established in 1981.

Although not a substitute by any means for an extensive quality textbook on oral medicine, the editorial team felt it was timely to produce an issue of the Primary Dental Journal devoted to the common and important oral medicine conditions encountered in general dental practice. This themed issue on oral medicine is geared to primary care dental practitioners and dental care professionals as a refresher and an update on oral medicine-related diseases. The articles in this issue provide an overview of current thinking in the more relevant areas of oral medicine. The clinical aspects of the relevant disorders are discussed, including a brief overview of the aetiology, detail on the clinical features, and how the diagnosis is made. Guidance on management and when to refer is also provided, along with relevant websites which offer further detail.

A major challenge in the diagnosis of oral disease is the need for memorising long lists of oral lesions from oral medicine/oral pathology literature. This is made more difficult because many of these lesions are not frequently encountered by the primary care dental team. This new issue of the journal highlights common oral conditions that may be encountered in the dental practice. Pulpal, periapical, and periodontal diseases are intentionally not discussed in this issue since primary care dental clinicians are experienced in diagnosing and managing those conditions.

I trust that the oral medicine-themed issue of the PDJ will serve as a tabletop reference in General Dental Practice. The discussion of the entire spectrum of oral diseases is beyond the scope of this single issue; instead, we have selected what we believe to be important oral medicine conditions. The introductory article addresses an approach in formulating clinical diagnosis and management of the various types of oral candidosis. This is followed by articles on oral lichen planus and lichenoid lesions, managing a dry mouth in primary care, a review of common oral medicine conditions in children, oral facial pain, burning mouth syndrome, and chronic graft versus host disease (cGvHD). Although the latter is less common, it can occur in the increasing numbers of patients receiving hematopoietic stem cell transplants.8

The information presented is primarily aimed to cover the diagnostic aspects and an overview of patient management, including patient referral. The main objective is to provide readers with a cutting-edge update on the above topics, including raising awareness of the need to diagnose and manage patients with oral medicine conditions in primary care, and when to make a referral to an oral medicine service if available. Alternatively, a referral to a specialist in oral and maxillofacial surgery can be made when appropriate.

It is hoped that this themed issue will help the primary care dental team to integrate the principles of oral medicine and oral pathology into clinically applicable concepts that will enable the practitioner to develop clinical differential diagnoses and participate in definitive diagnosis through a multidisciplinary approach with dental specialty teams. It is my further hope that the reader will not only be provided with updated information as to the multiple facets of oral medicine conditions but will also find new information to further aid them in the diagnosis and management of these occasionally enigmatic disorders.

No issue of the Primary Dental Journal could come to successful fruition without the contributions of well-qualified authors. I am extremely thankful to the guest editor, Dr Emma Hayes, consultant in oral medicine, and to all contributing authors for their invaluable input to this issue. I believe that this edition of the Primary Dental Journal will be an asset and resource to the general dental practice team.

FIND OUT MORE ABOUT THE ORAL MEDICINE ISSUE

The Primary Dental Journal is the College’s quarterly peer-reviewed journal dedicated to general dental practice. The titles and abstracts of PDJ papers are available to all dental professionals via the searchable PDJ homepage, with full paper access available to College members through the PDJ Library.

Printed copies of the Summer 2025 issue on oral medicine should arrive with College members in the second half of September.

References

1 Spielman AI. History of Oral Diagnosis, Medicine, Pathology and Radiology. In: Illustrated Encyclopedia of the History of Dentistry. [Internet]. New York: History of Dentistry and Medicine; 2023. Available at historyofdentistryandmedicine.com [Accessed Jun 2025]

2Peutz JLA. Over een zeer merkwaardige, gecombineerde familiaire pollyposis van de sligmliezen van den tractus intestinalis met die van de neuskeelholte en gepaard met eigenaardige pigmentaties van huid-en slijmvliezen (Very remarkable case of familial polyposis of the mucous membrane of the intestinal tract and nasopharynx accompanied by peculiar pigmentations of skin and mucous membrane). Nederl Maandschr v Geneesk. 1921;10:134-146. Dutch.

3Jeghers H, McKusick VA, Katz KH. Generalized Intestinal Polyposis and Melanin Spots of the Oral Mucosa, Lips and Digits — A Syndrome of Diagnostic Significance. N Engl J Med. 1949;241(26):1031-1036.

4Wilson E. On The Management of the Skin as a Means of Promoting and Preserving Health (3rd ed.). London: John Churchill; 1849. Retrieved 15 June 2025. Full text at Internet Archive (archive.org)

5Wilson E. On Diseases of the Skin (4th American, from the 4th & enlarged London ed.). Philadelphia: Blanchard & Lea; 1857. Retrieved 15 June 2025. Full text at Internet Archive (archive.org)

6Stone MJ. The wisdom of Sir William Osler. Am J Cardiol. 1995;75(4):269-276.

7Scully C. Oral medicine in academia. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(1):111.

8Passweg JR, Baldomero H, Chabannon C, et al. Hematopoietic cell transplantation and cellular therapy survey of the EBMT: monitoring of activities and trends over 30 years. 2021;56(7):1651-1664.

College of General Dentistry Blog

Standards in Dentistry, 3rd edition: what’s changed?

As members of the editorial team responsible for the recent revision of Standards in Dentistry, Professor Christopher Tredwin FCGDent, Dean of Queen Mary University of London Institute of Dentistry and Lorna Burns, Lecturer in evidence-based healthcare at the University of Plymouth, introduce the updated guidance.

Professor Christopher Tredwin
Lorna Burns

The third edition of Standards in Dentistry has been published and is now available to view online. Members of the College can also download and save it to their desktop or other devices.

The editorial team tasked with updating the guidance was led by Ewen McColl FCGDent, Professor of Clinical Dentistry and Head of Peninsula Dental School at the University of Plymouth, and included Chris Tredwin FCGDent, Professor of Restorative Dentistry, Dean and Director of Queen Mary University of London Institute of Dentistry; Robert Witton FCGDent, Professor of Community Dentistry at Peninsula Dental School and Chief Executive of Peninsula Dental Social Enterprise CIC; Lorna Burns, Information Specialist at Peninsula Dental School and lecturer in evidence-based healthcare at the University of Plymouth; and general dental practitioners Nicola Gore FCGDent and Susan Nelson MCGDent. The team also worked closely with Abhi Pal FCGDent, then President, now Immediate Past President of the College.

The fully revised edition incorporates new and updated guidelines and standards which are appropriate for the whole primary care dental team. It follows the structure of the previous two editions, and contains two main sections: summary tables of clinical standards, and lists of guidelines, arranged topically by area of care. The publication does not intend to imply that patients should receive identical care.

Guidelines provide recommendations for effective practice in the management of clinical conditions where variations in practice occur and where effective care may not be delivered uniformly. 

Clinical standards are used to describe the specific elements of care that need to be correct in order to optimise the outcomes for patients. Standards must be unambiguous and measurable.

The clinical standards tables are presented as A: Aspirational, B: Basic and C: Conditional. The A,B,C clinical standards are process measures, not outcomes. 

  • Aspirational – gold-level standards which are not essential
  • Basic – minimum standard necessary to ensure patient safety
  • Conditional – these recommendations only apply in particular situations

Clinicians can use the aspirational standards to improve their practice whilst ensuring that basic standards are met. However, clinicians must assess each clinical situation, the circumstances and the evidence available to them, and use their clinical judgement to settle on the course of action which is in the patient’s best interests. It is recommended that clinicians explain the choices to the patient, the reasons for recommending the chosen course of action and then seek the patient’s consent before clearly justifying the reasoning and recording the consent in the patient’s records. 

The editorial team drew the summaries of clinical standards from multiple, authoritative sources of guidance for primary care dentistry. All of the summary tables have been reviewed and updated for this edition, and revisions were peer-reviewed in consultation with representatives from across the UK dental sector. 

There are new summary tables for Digital Dentistry and Aesthetic Dentistry, reflecting changes in dental care. The newly incorporated standards for Digital Dentistry recognise that dental practices are at different stages of implementing full digital workflows. Therefore, the basic standards in this table refer to the legal necessities such as meeting GDPR requirements and maintaining secure electronic systems. However, in recognition that practices will be working towards the aspirational goal of full clinical digital workflow, there is also a basic standard for members of the dental team to develop the skills and knowledge to enable the transition. 

The new standards for Aesthetic Dentistry are aligned with the legal position decided by the GDC in light of the High Court ruling in the case of GDC v Jamous. Tooth whitening treatment is the practice of dentistry and can only legally and safely be carried out by registered dental professionals. The basic standards for Aesthetic Dentistry highlight the importance of communications with patients, including discussion of risks and managing expectations. There is also clear emphasis on the responsibilities of the dental care professional to act within their scope of practice, competence and training.

The new 2025 edition of Standards in Dentistry is designed for the busy practitioner as a chairside guide which compiles guidelines from multiple bodies, covering all aspects of clinical care from diagnosis to treatment. 

In updating this publication, the editorial team reviewed and updated summaries of the guidelines of more than twenty, mostly UK guideline-producing bodies such as the College of General Dentistry, Scottish Dental Clinical Effectiveness Programme, British Endodontic Society, British Orthodontic Society, British Society of Paediatric Dentistry, British Society of Periodontology and Implant Dentistry, and Royal College of Surgeons Faculty of Dental Surgery. 

This comprehensive guidance for all members of the oral healthcare team, plays an essential role in maintaining standards of excellence within general dentistry, and supports practitioners to continue providing high standards of care to their patients.  

The third edition of the Standards in Dentistry is available to view online. To gain access you must be signed in as a College Member or as a free College Subscriber. Members of the College can also download it to their devices as a PDF for personal use, giving access to search, text-select and print functionality.

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College of General Dentistry Blog

Building the right bite: occlusion and the successful delivery of aligner therapy

Dr Andy Toy FCGDent, a general dental practitioner and educator with a special interest in occlusion, highlights the fundamental link between occlusion and the long-term stability of aligner therapy.

Simply aligning a few anterior teeth can significantly alter a patient’s occlusion.  Whilst many patients seem to cope with their ‘new bite’, there are others who suffer from TMD, chronic pain or mobile teeth because of their aligner therapy.  There are also patients presenting with challenging occlusal problems that could be resolved with the right type of aligner orthodontics.  Every aligner case requires the dentist to understand how to diagnose, plan and finish their patients with a healthy functional occlusion.

I will be delivering a half-day lecture at the Perio-Occlusion Symposium on Saturday 20 September, to address issues like these. My presentation will provide a clear and simple approach to occlusion and clear aligner therapy based on over 40 years of learning and teaching. My aim is to help you:

  • Differentiate between easy and challenging aligner cases
  • Assess the patient’s TM Joint and occlusion and create a treatment plan to deliver a healthy, functional bite
  • Know how to finish and retain your aligner cases

Why is Cassie easier to treat than Jim?

Cassie
Jim

If Cassie and Jim walked into your practice, in my experience most novice orthodontists would steer clear of Cassie and see Jim as an easy win.  Jim has mild crowding with some wear that’s crying out for your best bonding technique.  What a great Align-Bleach-Bond case!  Ker-ching!!  Cassie has more crowding and, even worse, an anterior open bite?  What a nightmare!

In fact, once you do a thorough assessment of TMJ function and occlusion, combined with discovering the patient’s wishes, you would find that Cassie is much easier to treat than Jim. 

Why is this?  Jim has an edge-to-edge occlusion on a class III base – these cases are often much more difficult than they first appear.  The challenge is creating enough overjet to give you space for your bonding and create a healthy envelope of function.  You will need to: a) create lots of space in the lower arch with inter-proximal reduction; and b) control the anchorage to maximise the lower anterior retraction. 

Case photos: Jim

Cassie simply wants to align her teeth and isn’t bothered by her anterior open bite.  Comprehensive assessment of her TMJ and functional occlusion indicates that her bite is healthy.  She just needs some levelling and aligning.  Simple!

Case photos: Cassie

Correct biomechanics ensures successful aligner therapy  

Jeff is another class III case.  I used Invisalign Go™ (that is moving 5-5 only and up to 25 aligners) combined with class III elastics to support anchorage and we finished with a great looking result and healthy occlusion.  In fact, Jeff is easier to treat than Jim.  Can you see why?  It’s all down to how you assess a cross-bite.   Once you know how, it’s much easier to choose your winners and avoid creating an occlusal cripple.

Case photos: Jeff

Aligner therapy can eliminate occlusal dysfunction

Brenda is not too concerned about her appearance, but she is very worried about the pain she is experiencing and the possibility of losing her teeth.  She’s also in her 70s and not overly keen on dental treatment.

Brenda has multiple crossbites, tilted teeth and missing molars.  Where do you start?  My approach is: thorough assessment and diagnosis of her TMJ function and dynamic occlusion; careful planning of her Invisalign Comprehensive™ treatment; and a patient-centred consent process.  That way Brenda knows what the problem is, how we may treat it and what benefits and risks she may encounter as a result.  This gives Brenda the confidence to go ahead with the plan and enjoy a healthy, comfortable bite for the rest of her life.  Come along to the Symposium and I’ll show you how I used aligner biomechanics on Brenda’s case so that you can apply them on your own patients.

Case photos: Brenda

If you are able to attend the symposium, you’ll be better placed to avoid cases that are beyond your experience level; feel confident that the cases you do treat will have a healthy, functional bite; and sleep better at night. You can find out more and book your place here.

The Perio-Occlusion Symposium takes place on Saturday 20 September in London.

Click here for further details and to secure your place

Read our blog on Pink Aesthetics to find out more about the topics included in the morning lecture, delivered by Dr Reena Wadia.

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College of General Dentistry Blog

Why should early career dental professionals learn about gum aesthetics?

Dr Tom Bereznicki FCGDent, founder of the Tom Bereznicki Dental Educational Foundation, considers the vital role of gum aesthetics in digital smile design, an area of dentistry which early career practitioners are increasingly becoming involved in.

It is increasingly important to consider the appearance of the gum when treating aesthetic cases, particularly in digital smile design. But despite the crucial role of ‘pink aesthetics’ in aesthetic dental practice, it is a topic that is often not so well understood by early career dental professionals, mainly due to a lack of education in this area.

In many cases, paying attention to a patient’s pink gum can be as vital as treating the shape, position and colour of their dentition. Cultivating the right balance between the tooth and periodontal tissue may be key to achieving the ‘ideal smile’ and improving your patient’s confidence.

In days gone by, patients were happy with their appearance if they avoided dentures. These days, patients are much more discerning and restorations like the cases shown below from my archives, would now be regarded as aesthetically unacceptable.

If a patient has a low lip line, the position of the gum, in theory, is not an issue. However, many patients these days often judge outcomes by aesthetics when they lift their lips out of the way.

If a lot of gum is visible when the patient smiles, the appearance and position of the gingival tissue, as well as the teeth, will certainly need to be carefully planned – in particular matching zenith points and ideally showing no ‘black’ triangles.

Correct diagnosis is essential. In the two cases below, both patients attended asking to have their teeth veneered as they hated their smiles because they thought their teeth looked too short. However, neither case required procedures to lengthen their teeth, they merely had too much gum showing and required crown lengthening.

Correct treatment planning is also crucial to greatly improve the final aesthetics of treatment. In this case, crown lengthening around the lateral incisors prior to the provision of two veneers delivered the best result for the patient.

Improving a patient’s smile by treating the appearance of the gum does not have to be complex. Even the smallest minimal surgical procedure can have a dramatic effect on aesthetics and patient confidence. 

Whereas carrying out crown lengthening procedures exposes more of the patient’s tooth to achieve a harmonious balance between the gum and the tooth, gingival recession can also be treated through minor surgical procedures. In the cases shown below, a laterally repositioned flap provided a successful, long-term solution. 

30-year follow-up

The upcoming Perio-Occlusion Symposium on 20 September addresses gum surgery cases similar to the cases covered in this blog. My introduction to the topic will be followed by a half-day lecture delivered by Dr Reena Wadia MCGDent, a well-known specialist periodontist. Reena will examine the indications and steps of crown lengthening surgery and the optimal aesthetics we aim for. In addition, she will discuss the indications of gum recession surgery and the various procedures available. The afternoon session will be delivered by Dr Andy Toy FCGDent on how occlusion can affect the long-term stability of treatment using aligner therapy.

For those who wish to extend their knowledge further, information will also be available on postgraduate courses which cover these topics in greater depth.

The Perio-Occlusion Symposium takes place on Saturday 20 September in London.

Click here for more information and to book your place

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College of General Dentistry Blog

Our Coat of Arms: an encapsulation of the College’s ethos and aspirations

Sir Nairn Wilson CBE FCGDent, President Emeritus of the College, describes the symbolism and meaning behind each of the heraldic elements in the College’s newly-granted Coat of Arms.

Sir Nairn with the Grant of Arms presented to the College on 19 May 2025

A Grant of Arms is a formal recognition bestowed by the official heraldic authority, the College of Arms, and symbolises legitimacy and identity. Dating back centuries, grants of arms are typically conferred upon those organisations and individuals which meet established criteria of permanence, achievement, and contribution in their respective fields, and the College (intended Royal College) of General Dentistry has recently been so honoured.

The process leading up to the Grant of Arms involved the design of an ‘Armorial Achievement’ – colloquially known as a Coat of Arms – which includes various heraldic elements such as a shield, crest and motto, each imbued with symbolic meaning. These elements collectively encapsulate the ethos and aspirations of the organisation.

The Armorial Achievement (Coat of Arms) of the College of General Dentistry

The shield – the centrepiece of the heraldic achievement – has a blue background (field). The central feature of the shield is a golden pelican ‘in her piety’ – feeding a brood of three chicks in a nest, with the chicks pecking and wounding their mother’s breast, anxious to be fed. The principal meaning evoked by the pelican is caring: first and foremost for patients, secondly for early career oral healthcare professionals and students, and thirdly for the moral compass of the profession – hence the three chicks.

The pelican is surmounted by a golden band (‘chief’) displaying three snakes, each knotted (‘nowy’). The knotted snakes symbolise unity within the profession, unity with other health professions and unity of purpose in healthcare, emphasising the importance of oral health to general health and wellbeing. Together the pelican and snakes symbolise trust and reliance.

The crest on top of the helm features the upper half of an ‘opinicus’, resting its right (‘dexter’) foreleg on a giant pearl. The traditional opinicus, derived from the crest of the Company of Barber Surgeons, which was incorporated in 1462, is a symbol of influence, and of strength in diversity and inclusivity within the College. The pearl signifies wisdom in the art and science of dentistry. The opinicus, rarely included in heraldic achievements, resembles a dragon in the forepart and in the wings, with a beaked head and ears similar to those of a griffin. The hind part and the legs resemble those of a lion. The tail is similar to that of a bear.

The mantling around the shield and helm displays the livery colours of the College – azure blue and gold.

Below the shield sits the College motto: Sanitate oris venit fortitudo – Strength through oral health – strength for patients and strength for the profession.

The College of General Dentistry badge

The badge of the College is a proud and bold opinicus in College blue and rampant posture (standing on one hind foot in profile, with raised wings and tail), holding the giant pearl of wisdom, as featured in the crest of the Arms, between its clawed forepaws.

The Grant of Arms adds to the legitimacy of the College, which is now firmly part of the healthcare establishment, and is considered to be an important step towards eligibility for the granting of a Royal Charter – a priority for the College in its further growth and development. The College is only the ninth dental organisation in the UK, Australia or New Zealand to have receive a Grant of Arms, and will now start making use of its Arms and badge in, for example, a re-design of diploma certificates and the introduction of College regalia.

The full text of the Grant of Arms can be read here.

This abridged article is presented with the kind permission of the Dental Historian, the journal of the Lindsay Society, a membership organisation which promotes interest, study and research into the history of dentistry and brings together people who share these interests.

The version of record (‘Making history: The grant of arms to the College of General Dentistry’) is available in the Dental Historian, volume 70 (2025), issue 2.

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College of General Dentistry Blog

Marking another milestone

Igor Blum FCGDent, Clinical Professor of Primary Care Dentistry and Advanced General Dental Practice at King’s College London and Editor of the Primary Dental Journal, and Sir Nairn Wilson CBE FCGDent, President Emeritus of the College and the journal’s first Editor, celebrate the publication of its fiftieth issue

Prof Igor Blum FCGDent (left) and Sir Nairn Wilson CBE FCGDent (right)

The latest issue of the Primary Dental Journal (PDJ) – the 50th to date – is a truly special ‘general dentistry’ edition marking this significant milestone.

Not only does the PDJ have a rich history of serving general dental practice, but it is also one of the premier journals for intellectual discourse on all aspects of primary dental care pertinent to members of the whole dental team.

First published in 2012, shepherded under the tenure as Editor-in-Chief of the then Professor (now Sir) Nairn Wilson, it brought together three publications of the former Faculty of General Dental Practice (FGDP[UK]): Primary Dental Care (a research journal for dentists), Team in Practice (a journal for Dental Care Professionals) and the newsletter First Hand.

The fourth volume of the journal, published in 2015, was produced with the assistance of a new Clinical Editor – Dr (now Professor) Igor Blum. In addition to themed issues on Consent (curated by Guest Editor, Andy Toy), Special Care Dentistry (Guest Editors, Debbie Chandler and Richard Valle-Jones) and Paediatric Dentistry (Guest Editor, Richard Welbury), the volume included the journal’s first ‘general issue’ with papers on a range of topics, including temporomandibular dysfunction, contemporary laboratory work, tooth surface loss, the effects of bisphosphonates in implant dentistry, reducing harm (iatrogenic damage) in the provision of care, risk assessment and the prevention and management of dry sockets.

Volume 6, issue 1 was a special, one-off, commemorative issue of PDJ to help mark and celebrate the twenty-fifth anniversary of the formation of the FGDP(UK). In addition to a ‘conversation’ between Professor Nairn Wilson and the then Dean of the Faculty, Mick Horton, and a photo montage of the history of the faculty, the issue included commissioned papers by leading dental experts in the UK. This commemorative issue and the subsequent two themed issues – Dental Emergencies (Guest Editor, Russ Ladwa) and Extended Integrated Care (Guest Editor, Kathy Fan) were Professor Wilson’s last contributions to PDJ before passing on the baton to Dr Blum in 2017.

Professor Blum’s first issue as Editor-in-Chief was the December 2017 (Volume 6, issue 4) themed issue on Removable Prosthodontics (Guest Editor, Graham Stokes). Professor Blum’s vision for the journal was to evolve, grow and, in the process, continue to go from strength to strength. A further vision was to make the journal accessible on an international level, rather than limiting it to the readership in the UK, for the benefit of primary dental care teams and their patients around the world.

Within each annual volume, two or three issues are themed on specific and relevant fields of interest, and one or two ‘general dentistry’ issues cover a wide range of topics. Each issue offers a combination of research, clinical best practice papers and scenario articles which allow the whole dental team to work together to improve standards of patient care. In Spring 2021 the PDJ published its 10th Volume Anniversary special issue celebrating this remarkable milestone.

After nine years’ publication by the FGDP(UK), the College took over in 2021, and this 2025 Spring issue marks fifty issues of the journal as a source for dissemination of contemporary research, clinical and non-clinical articles relevant to general dental practice.

Since its inception, the PDJ has evolved substantially and earned an established place as an authoritative source in today’s dental literature. As such, it provides CGDent with one of its most valued membership benefits. While its purpose has been constant – to be a professional development journal for the whole dental team, and a record and source of news about the College – its editorial and production processes and standards have evolved over the years.

Most significantly, in 2019 the FGDP entered into a contract with Sage Publishing and the PDJ has progressed from an in-house ‘cottage industry’ publication to an internationally accessible publication with an electronic editorial management platform, ScholarOne. As such the journal benefits from the resources available through our publisher, which has facilitated its continued growth.

Over the years, we have watched with great pleasure how the PDJ has grown and gained ever-increasing standing and status in becoming an internationally recognised and esteemed journal, aimed at the whole primary care team. The journal is now indexed in PubMed/MEDLINE and Scopus, and 1,500 papers – past and present – are available online to CGDent members through the PDJ Library and in over 10,000 academic institutions worldwide.

With the current international exposure of articles published in the PDJ, there have been many thousands of downloads and citations of articles. This confirms that the PDJ has an international reach and impact on the dental team and clinical practice, both nationally and internationally, improving standards of patient care.

As a result, the PDJ has started to attract international dental experts as guest editors. In the context of a new membership organisation borne out of a more established one, the journal has also played a central role in providing reassurance and continuity of service to members over the last four years and has developed an important role in supporting the College’s membership retention and growth.

Looking back, we would like to express our sincere gratitude to the very many authors, guest editors, peer reviewers, staff and others who have contributed to each of the 50 issues to date and enabled us to reach this important milestone.

Special thanks must be extended to the former and current managing editors of the journal – Amy Brewerton, Hillevi Sellén, and Lily Atkins; to a member of the founding Editorial Board, Ario Santini FCGDent, who continues to provide highly rated abstracts of relevance to the contents of each issue of the journal; and to Darren Westlake, who has designed the covers and laid out the figures in each and every issue.

We are confident that we have created an attractive, distinctive, reader-friendly journal and it is our hope that you will enjoy the 50th issue and join the previous and current editorial team in celebrating all it stands for.

FIND OUT MORE ABOUT THE 50TH ISSUE

A list of the themed editions within the first 50 issues of the PDJ is available here

The titles and abstracts of PDJ papers are available to all dental professionals via the searchable PDJ homepage, with full paper access available to College members through the PDJ Library

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College of General Dentistry Blog, Uncategorized

The year in review 2024-25

Dr Mick Horton FCGDent, Chair of Trustees and co-host of the recent Annual Members’ Meeting, reviews the College’s achievements over the past twelve months.

I am delighted to open this report with the confidence that steady growth in membership supplies, strengthening our youthful organisation at a time when wider trends are not so positive amongst professional bodies. Fellowship in particular is proving an attractive goal for many senior practitioners, who have lacked the opportunity of such recognition in a healthcare system which provides too few opportunities to celebrate excellence in general practice. Growing strength in membership enables greater ambition in our service to the public through our professional community.

In the short existence of the College, more than 20,000 dental professionals and others have set up online CGDent accounts to make use of the key services we provide – and most significantly, our authoritative Standards and Guidance publications. In December, we launched our College Subscriber offer, as a means to serve this rapidly-expanding community more effectively – and to give us a much richer picture of who is using our guidance, and how.

This January, we published a vital statement of the mission of the College and Council’s Vision for Dentistry, shaping our thinking and planning for the future. This defining document sets out very clearly, how and why the College should be at the heart of thinking on the future for oral health in the UK and beyond.

Training and development is an increasingly confusing arena for all members of the dental team, and the College has been giving very careful thought to the most effective role that we can play to improve matters. We have a reputation built on the hugely respected qualifications delivered by the former FGDP over decades, but in today’s thriving postgraduate dental education market there is little room for the College to add value in quite the way that our predecessor organisation did. In 2024, we embarked on the development of a new ‘credentialing’ role, which will result in the launch of new forms of recognition for higher skills, in the first half of 2025. We have been delighted with the support and cooperation from so many organisations and agencies, enabling us to bring forward credentialing systems that will carry real weight and credibility.

Early careers are equally a focus for the College. The first Tom Bereznicki Charitable Educational Foundation awards were made in the summer, and we are delighted to be working hand in hand with the Foundation on Tom’s greater aspirations to develop the skills of early career practitioners. The first cohort of successful candidates, gaining remarkable training opportunities in Europe, were celebrated at our Fellows’ Summer Reception.

We reported last year on our partnership with Haleon, for which the College engaged a range of dental practices around the UK in an analysis of the opportunities for them to promote preventative care. We published our joint report in the autumn of 2024, and followed it up with a parliamentary meeting attended by MPs and officials.

Implant Dentistry has been a focus of activity for the College in the past year, with a pair of themed issues of the Primary Dental Journal and the launch of the College’s authoritative Register of Implant Mentors in partnership with the ADI and the ITI. This is just the first of a number of Registers of Expertise that have been mooted to raise standards in key areas of practice.

We celebrated the 50th issue of the Journal at Cutlers Hall, London, before the Fellows’ Winter Reception in January. Under the inspired Editorship of Prof Igor Blum, the journal now reaches worldwide audiences, gaining substantially in authority and credibility, and many of our themed issues have been commended as key points of reference for every practitioner – take, for one example amongst many, the recent issue on Dental Trauma.

The Fellows’ Receptions themselves have proven perennially popular for our senior membership community, and we plan to build on this in 2025 by linking the Reception to our first College Lecture. The College Lecture cements our role in thought leadership and our academic standing.

Fresh ideas and energy have been brought to Council with the election of a significant number of new representatives, and the appointment of our new President, Roshni Karia, following the completion of Abhi Pal’s three-year term of office. Abhi served as the College’s first President, and has done so much to establish the credentials of a new organisation, with boundless energy and ideas that have shaped our direction.

Thank you for your continued support.

The next Annual Members’ Meeting will take place on Tuesday 3 March 2026, 7pm-8pm, online.

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College of General Dentistry Blog

Why learning about occlusion is vital for early career dentists

Dr Tom Bereznicki FCGDent, founder of the Tom Bereznicki Dental Educational Foundation, explains the importance of occlusion and why he is committed to educating younger colleagues on the topic.

The modern undergraduate curriculum allows very little time for occlusion to be covered as a topic. Through my experience of teaching younger dentists, I have noticed in recent years that when I ask what the clinical occlusal examination findings are, the reply often comes back with an orthodontic classification. Few early career dentists are aware of the importance of studying not just the static occlusion, but the dynamic one too.

In over 40 years of practice, I have seen many cases of occlusally-related failure, highlighting the vital importance of paying due consideration to the occlusal scheme in treatment planning. I am passionate about educating early career dentists and through my charitable foundation, I have organised a symposium on the topic of occlusion, in collaboration with the College, which aims to enhance delegates’ knowledge of the basic principles of occlusion and how they can support the success and longevity of restorative treatment.

With the odd exceptions such as anterior open bites and skeletal Class 3’s, patients’ occlusal schemes should adhere to the basic principles of occlusion, not just when providing complex multiple indirect restorations and treatment of wear cases, but also simpler single indirect restorations, and most importantly, the long-term maintenance of intact healthy dentitions.

The cases illustrated below draw attention to some common examples of occlusally-related failure.

To avoid occlusal derangement, the extracted tooth should have been replaced as soon after extraction as possible

Failure to investigate the crack when it first appeared – now the tooth needs to be extracted

Correct dynamic mandibular excursions when fitting fixed restorations to help prevent failure especially with cantilever designs

Missing the tell-tale signs of unwanted wear, seen here as wear facets, can lead to root fracture

Spotting early signs of unwanted occlusal wear helps prevent extensive treatment at a later date

Failure to check excursive mandibular excursions, especially when fitting restorations, can result in loss of canine guidance and restorative failure

In bruxers, veneer failure can also frequently be seen as fracture of the porcelain in the gingival third of the restoration

Over instrumentation during root canal therapy weakens the root making it susceptible to fracture particularly when acting as a cantilever abutment

Although titanium is extremely hard, it is not unbreakable. If occlusal forces are not refined, fracture or associated non-perimplantitis bone loss can lead to failure

I will be addressing occlusally-related failure cases like these in the opening session at the Introduction to Occlusion Symposium. I will be joined by a fantastic line-up of experts: Professor Paul Tipton, Dr Ken Harris, Dr Tif Qureshi, Dr Shiraz Khan and Dr Koray Feran. Through a series of lectures, they will examine the five basic principles of occlusion in detail and how they can support the placement of successful, long-term restorations.

Information will also be available on a range of postgraduate courses which cover aspects of occlusion in greater depth, for those who wish to extend their knowledge further.

The Introduction to Occlusion Symposium, takes place on Saturday 5 April 2025 in London.

Click for further information and to book your place

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