DHS - 5th Anniversary

Dental Health Spa - 5th Anniversary

Half a decade may seem a relatively short time but in business it is a lifetime: especially if it is your business! Christina Chatfield has gone from  Dental Hygienist to innovative practice owner and become a mover and shaker along the way. The latter not planned but driven  by circumstances and the long awaited shift towards increasing access to dental services in the UK.

 

The celebration of this milestone was attended by the great and good that have shown support and faith in the belief that patients should have the right to access dental care at any point in the circle. The pyramid route via the dentist is clearly not working for huge swathes of rhe population and we are seeing that within dentistry, the practices that market to the custmers' needs are doing increasingly well. The Dental Health Spa is one such practice.

 

Designed with the patient experience as its focus, Christina and her team have created a unique and innovative patient centred home for dental care. Building a practice is a brave step for anyone, building a practice amidst  the shifting sands of legislation, opposition and suspicion is quite another.

 

As the sands shift into a more level playing field for those that deliver oral care, practices like the Dental Health Spa will serve to increase access to care and shift the focus from treatment to education and prevention, which is what oral health is about really.

 

 

 

Endorsement by Nigel Carter OBE

When Christina Chatfield first opened the doors of the Dental Health Spa in 2007 her vision was to create an innovative oral health care clinic right on the high-street. Since then, Christina’s pioneering hygiene-led approach to delivering oral health care, along with her consistent drive to provide care and treatment regardless of a patient’s medical history, has led to her gaining an outstanding reputation among many of the industry’s top peers. We are fortunate to have her knowledge and expertise in our community.

One particular area which has impressed me the most with Christina’s work over many years, has been her dedication to help those with dental phobias combat their fear and get them back in the dentist’s chair. One in ten people are now estimated to suffer from some form of dental anxiety, which is undoubtedly one of the major barriers in preventing people from visiting the dentist on a regular basis. Dental phobia can have tragic consequences for individuals, which is why Christina’s hard work, attention to detail and empathy in helping these groups of patients become more comfortable should not go unrewarded.

Christina has cultivated an effective new model of oral hygiene practice with her wide array of treatment plans, and in so opening dentistry up to a wider community. At the British Dental Health Foundation, we are dedicated to improving oral health for all…

Christina shares this vision, and what she has built at the Dental Health Spa strikes a proficient balance between delivering quality patient education with carrying out hugely successful treatments. It has culminated in Christina forging a business which puts people’s health first. Ensuring they not only leave with a clean bill of health but a smile on their face too – for this, I wish her every luck!

Dr Nigel Carter, OBE
Chief Executive of the British Dental Health Foundation

Chrissie's Angels - DHS Award Winning Marketing Campaign

 

  Click on image to see photo shoot video



What were you doing on the day the 2012 Olympics launched?

To inspire a generation, was our Olympic slogan and we at Dental Health Spa had our own unique take on this. Our goal is to inspire everyone to recognise the importance of the Dental Hygienist.

On the day the London Olympics began and just ahead of Dental Health Spa's 5th anniversary, a new marketing campaign was launched with a photo shoot..... Click here to view video

Introducing "Chrissie's Angels"  

In a world where people are more frightened of dentists than they are of snakes or spiders (according to the British Dental Health Foundation), we want to make Dental Hygienists the stars of the future.
 

By raising the profile and the benefits of seeing a dental hygienist, the health and social benefits of having a cleaner and fresher mouth will be more readily understood. Providing this education and hopefully with greater accessibility via the Direct Access initiative will not only improve peoples dental and general health but also make them...100% Kissable.

Campaign - "Hygiene is not just for Girls"-- coming soon ........

Thanks to:

Photographer: Helen Tinner
Hair dressers: Willie Hendry - great wigs!, Johan Van de Merwe - Hair and makeup & Scott McCall - Stylist
Model: Nathan Attwell
Nurses: Mike MacGregor, Hayley Walker

Hygienists: Emma Smith, Madalyne Tucker and myself Christina Chatfield

 

Dental Hygiene & Therapy: Direct Access Article - June2012

Chief dental officer Barry Cockcroft shares his thinking on the possible changes in practice following the Office of Fair Trading’s report regarding Direct Access.

 

Time is a figure eight; at its centre is the city of Deja Vu. 

Robert Brault.

It has now been nearly a decade since the Consumers Association(WHICH) initiated the biggest ever super compliant against the business of dentistry.. Now following on from a 2nd report published by the OFT in May 2012 they urge GDC without delay to revisit and remove the current restrictions preventing patients from being able to see a dental hygienist without the need for seeing a dentist first.

Is direct access to patients about to become the jewel in the crown for DH&Ts
Julie Bissett Managing Editor for DH&T caught up with Chief Dental Officer for the Department of Health Barry Cockcroft where he shares his thinking on the possible changes in practice following the Office of Fair Trading’s report.

Last month, the Office of Fair Trading published its report following an extensive look at how dentistry is working for patients in the UK. A key and relevant part of this was its urging of the General Dental Council to remove restrictions preventing patients from making appointments to see dental hygienists, dental therapists and clinical dental technicians directly, as soon as possible, and without the current referral to a dentist. DH&T caught up with CDO Barry Cockcroft to learn what this may mean for you.

Change of mind?
So, will this recommendation by the OFT see an immediate change in the GDC’s views on direct access? CDO Barry Cockcroft explains: ‘The GDC is currently consulting and will take note of the views expressed by all stakeholders’.

As many of you may know, the GDC is already considering whether to remove this requirement and to allow ‘direct access’ for all patients which would mean that patients could see other members of the dental team without seeing a dentist first, for example a dental hygienist or therapist. A task and finish group has met for the first time and will ensure that any decision made is based on robust evidence. The group still wants to hear from as many stakeholders as possible and a short ‘call for ideas’ questionnaire has been published on the GDC’s website www.gdc-uk.org The results from this call for ideas will be analysed and considered by the Direct Access Task and Finish Group at its meeting on 2 July 2012. The Group has spoken with a number of key stakeholders and has also commissioned a literature review covering the available evidence.
 

Business model
But if direct access does go ahead, will more hygienists be establishing their own cosmetic clinics on the high street?

There are already a few hygienists scattered throughout the UK who run their own dental practices, either relying on local dentist referrals or employing dentists within the practice.  The Section 60 changes to the Dentists Act opened the door for all registered DCPs to own and run a practice. However, the stumbling block to new business opening by DH&Ts has proved to be this reliance on a written treatment plan by a registered dentist. The CDO was realistic in his views on future businesses opening up. He explains: ‘It is not for me to dictate business models that people may wish to develop but I see the expanded role of DH&Ts as being within a team environment. There would be significant financial pressures involved with a hygienist-only service, including the cost of CQC registration and compliance with HTM 01-05 and just the basic capital investment required when the range of services provided can potentially be quite restricted by competencies.’

New horizons
But Barry Cockcroft does expect to see an increased use of DCPs in the coming years. He says: ‘We do see an increased role for DH&Ts in the provision of NHS dental services. Medical Education England produced a report on skill mix in January saying just that. We have to be mindful, however, that people always work within their skill and competency. This means if roles have to be expanded, the provision of education will also need to be expanded and how this goes forward will clearly be dependent on the view the GDC takes following its Scope of Practice consultation.’

 

Patients matter
The OFT also called for patients to have clearer information about what they are entitled to from an NHS system. Did the CDO agree with this? ‘Absolutely,’ he says. ‘It is already a contract requirement for dentists with an NHS contract to display details of charges and treatment entitlements. My own view is that it is only a matter of time before private dental practices have to display specimen charges, too.’

 

Dental Hygiene & Therapy: Direct Access Article - March 2012

The fight for direct access. Here, we look ahead to what it means and look back on the path it has taken.

I hope that when people read this article they have a clear understanding of what Direct Access would mean for our profession, for our patients, the role we play within the team and our own self fulfilment in our working lives.  When I refer to Direct Access in this editorial I am referring solely to access to hygiene services without the need for a referral from a dentist.
 

In 1986 the Dental Auxiliaries Regulations1986, which came into effect in 1991 and still continues to change and enhance our skill set. I found it very surprising when I set the business up nearly five years ago that some still believed that a dentist had to be on the premises for dental hygienists and therapists to be able to treat patients!

Being able to take radiographs, give local anaesthesia and inferior dental nerve (ID) blocks all show faith and belief in our training and our profession. When our competency is constantly questioned, it should be noted that as our scope of practice has changed over the years, so has the robust core training programme that underpins our profession.

We understand that BDS undergraduates complete a longer training programme but they have many disciplines to cover. We focus solely on prevention of oral diseases and managing of periodontal diseases in our training and in our every day working life.
In terms of diagnosis and treatment planning of periodontal disease, we have BPE code that give us our treatment needs allowing us to tell if it is a case of gingivitis, mild periodontitis, mod/advanced periodontitis or advanced periodontitis according to the British Society of Periodontology guidelines. In terms of a clear diagnosis, other than a dentist saying the patient has gum disease – how many times are you advised whether it is chronic or aggressive?. Exactly- you are left up to decide this for yourselves. Disease classification has evolved over the years as research and understanding changes.

Incedulous

It would seem we never stopped learning. It does seem to me that there are many who do not know how to use something as simple as BPE which incidentally has been taught as part of undergraduate training since 1988. It seems incredulous that we are anecdotally informed of referrals to Periodontists, teaching schools and hygienists that still quote scores of 6, 7,etc.

In 2006 Independent Practice was borne, as a result of an Amendment to the Business of Dentistry Act, that allowed a dental hygienist or any other registered Dental Care Professional with the General Dental Council (GDC), to set up and manage a dental business.

This change of law came about because in 2003 the Consumers Association (WHICH) instigated the biggest ever super complaint against private dentistry. As a result of that complaint, The Office of Fair Trading investigated claims made by the Consumers Association and the results of those investigations and their recommendations were made public.

Monopoly

They asked for transparency of pricing, choice and removed the monopoly of dentists being the only ones to manage the business of dentistry to allow a more competitive market. A statement made by The Office of Fair Trading also said that the GDC should review the 'under a prescription rule' and consider whether dentists should be obliged to inform consumers of their choice.

Unfortunately that 'under prescription rule' still stands - which means you cannot see a dental hygienist or therapist to have your mouth cleaned, for want of a better description, without a dentist’s permission. But you can take a copy of your treatment plan to any clinician of your choice. How many patients are given an in depth treatment plan along with a BPE ? it makes a mockery of their right to chose.

Fast Forward

Fast forward to 2012, nearly a decade on from the first investigation; the OFT are once again involved in compiling a new report and revisiting the Direct Access issue.
So I believe we have the skills, do you?  Direct Access is not Independent Practice- believe me that is a hard road and we have been able to do that since 2006.

Direct Access is allowing the patient or consumer to access the “Circle of Care” through another entry point. A huge proportion of the population does not go to the dentist at all or on a regular basis, whether that is through fear, cost or accessibility. This also means that with Oral Cancer on the increase, regular screening and smoking cessation advice for this core group is also being missed. The last Adult Dental Health survey (2009) highlighted that 12% of the population studied do not access dental services because of dental anxiety. A survey published by the British Dental Health Foundation in 2011 said that people were more frightened of dentists than they were of snakes and spiders!

Regulation is good. It protects the public and ensures that people are professionally trained and competent to treat, as well as being kept up to date with continuing professional development. It never ceases to amaze me the treatments that the public can have from unregulated professionals.

So, with levels of gum disease high and consumer awareness growing- access to hygiene services is very much in demand, Dental Health Spa is a testament to that with over 4800 patients walking through my door in over 4 and a half years

As a profession we need to stand united to provide evidence of the status of the existing referral, and we need your help.

Please take a few minutes to fill out the brief survey – using the simple survey monkey. Go to: www.surveymonkey.com/s/HK8C56P

We need the evidence on behalf of the profession to influence change

Thank you, Christina
On behalf of The Direct Action Group

 

 

 

 

 

Mouth Cancer Action Month launch - October 2011

On Tuesday 25th October, Mouth Cancer Action Month was officially launched at the Houses of Parliament in London. This year’s campaign urges people, ‘if in doubt, get checked out'.

Christina attended alongside other colleagues from the dental profession to the Houses of Parliament, which was hosted by British Dental Health Foundation (BDHF).

This year's guest speaker Sally Bragg, had herself suffered the devastation of mouth cancer. Sally told of her difficult journey from the moment she discovered the mouth ulcer, to saying goodbye to her son as she waited, terrified, to undergo a 10-hour operation. The operation involved having her lower back teeth removed, part of her jawbone sawed away, an artery from her arm implanted in her face, and skin from her stomach grafted on her arm as she had the whole tumour from her cheek removed.

The most shocking aspect of Sally’s story is that both her dentist and doctor failed to notice the most obvious of mouth cancer symptoms; it was only Sally’s persistence and gut feeling that something was wrong that eventually got her referred to a specialist.

In the UK, the numbers for late diagnosis are growing, and people are failing to seek medical advice if they have symptoms. But what has brought on a new rate of concern, is that trends are showing rising rates of mouth cancer in younger people. This is in relation to the the Human Papilloma Virus (HPV), which has been shown to be a risk factor in developing the disease. A study undertaken by the Health Protection Agency showed that last year alone, a total of 482,696 new STI cases were reported in the UK, and with HPV considered as the fastest growing cause of mouth cancer, the figures are a cause of great concern.

Mouth cancer is on the rise, with almost 5,000 people being diagnosed each year, and 1,700 dying each year from the disease. This is a 17% rise in the last five years, which means more people are dying from mouth cancer than testicular and cervical cancer combined.

Early diagnosis is key for for survival, but unfortunately awareness is low.

If you notice any of the following, then get checked out:

     - Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums, or other areas inside the mouth.

     - Velvety white, red, or speckled (white and red) patches in the mouth.

     - Ulcers that do not go way within 3 weeks.

To help spread awareness, we're tweeting and facebooking a fact daily, so follow us to see how much you really know. We're also offering free mouth cancer screening up until November 30th, 2011. So, if in doubt, get checked out.

www.twitter.com/dentalhealthspa

www.facebook.com/dentalhealthspa

Dental Health Spa: 4 years on - September 2011

With all of us at Dental Health Spa celebrating our 4th birthday, Christina talks a little about why she set up the business and how the hygiene referral has affected our progress so far.

"Dental Health Spa opened on to Brighton high street 4 years ago on September 17^th 2007, without a single patient on our books.

I wanted to take dental hygiene to the high street. Gum disease affects up to 50% of the population and is often undiagnosed because it's not painful and goes unnoticed by the patient. People loose teeth through gum disease, their breath smells and their confidence is affected - all things that can be prevented. As the science proves, there are more health benefits for the rest of your body if the bacterial load in your mouth is reduced, not to mention the fact that gum disease is linked to systemic diseases. As a population we are living and holding on to our teeth for longer, therefore prevention is better than cure as well as being more cost effective. With taking dental hygiene to the high street it seemed a logical step to do what I know and to do it well.

Yes we are 4 years old and its been tough. So why did we do it? What changed that allowed a dental hygienist or any other registered Dental Care Professional with the General Dental Council (GDC), to set up and manage a dental business?

In 2003 the Consumers Association instigated the biggest ever super complaint against private dentistry. As a result of that complaint, The Office of Fair Trading investigated claims made by the Consumers Association and the results of those investigations and their recommendations were made public. They asked for transparency of pricing, choice and removed the monopoly of dentists being the only ones to manage the business of dentistry to allow a more competitive market. A statement made by The Office of Fair Trading also said that the GDC should review the 'under a prescription rule' and consider whether dentists should be obliged to inform consumers of their choice. Unfortunately that 'under prescription rule' still stands - which means you cannot see a dental hygienist or therapist to have your mouth cleaned, for want of a better description, without a dentist telling you you can.

Don't get me wrong, regulation is good. It protects the public and ensures that people are professionally trained and competent to treat, as well as being kept up to date with continuing professional development. It never ceases to amaze me the treatments that the public can have from unregulated professionals.

But, and there is a big but - a huge proportion of the population do not go to the dentist at all or on a regular basis, whether that is through fear, cost or accessibility. This also means that with Oral Cancer on the increase, regular screening and smoking cessation advice for this core group is also being missed. The last Adult Dental Health survey (2009) highlighted that 12% of the population studied in this study do not go because of dental anxiety. A survey published by the British Dental Health Foundation in 2011 said that people were more frightened of dentists than they were of snakes and spiders.

So, with levels of gum disease high, consumer awareness growing, access to hygiene services limited – Dental Health Spa opened on Brighton high street (there were already 60- 70 dental practices in Brighton and Hove and the surrounding areas). With all that in mind, and still working with the 'under prescription rule', how has Dental Health Spa faired in the last 4 years?

4 years on we have clearly demonstrated that with 4,258 patients now in our books, and with a 30% increase in our hygiene only numbers since last year, we cannot be wrong. The Office of Fair Trading's most recent announcement last week re-looks at dentistry again and hopefully this time the 'under prescription rule' will go, allowing people more choice where they can go and who they can see. Certainly a proposal has been put to the GDC by both the British Society of Dental Hygiene and Therapy and the British Association of Dental Therapists asking them to look again at the position of access to hygiene services, backed by a robust undergraduate programme that show our training is almost the same except in areas outside our competencies.

To start the year off and to help really push things forward, we are now collating information from patients to provide some validated data to support the consumer wants for access to hygiene services. When we, the Direct Action Group, put our case forward to the GDC in March 2012, they need to be aware that it is a consumer want. But we also want our consumers to be aware that it could change, and their views really do matter."

Chris

Agreement on future regulation of tooth whitening products - September 2011

We're very pleased to hear that there has finally been an agreement in regards to tooth whitening regulations. This agreement means that they're finally going to start clamping down on illegal, non-dental tooth whitening in places like salons, hair dressers, gyms etc. Tooth whitening is the business of dentistry and as such, all dental professionals performing tooth whitening are regulated by the General Dental Council and the Care Quality Commission, insuring the patients safety is paramount.


You can read the story from The British Dental Association here.

Direct access to hygiene services: Christina writes to Brighton MP Caroline Lucas - March 2011

Due to the recent involvement of The Office of Fair Trading, who are now looking at direct access to hygiene services, we thought it'd be relevant to put up Christina's letter from March to Brighton MP Caroline Lucas, requesting her support in campaigning to get the referral lifted. Caroline responded saying she was interested to read the issues faced surrounding dental hygiene, especially those regarding equality of access and the current referral. Caroline then wrote to The Department of Health, and we've since received a response from Earl Howe, Parliamentary Under Secretary of State (Lords).

21st March 2011

Dear Caroline,

I would like to bring an issue to your attention that affects the access and provision of dental services to our communities. I am a Registered Dental Hygienist with over 25 years experience in clinical dental practice. In 2006 there was an amendment to the Business Of Dentistry Act that allowed other registered Dental Professionals other than dentists manage the business of dentistry. There was a review at that time of the Scope of Practice of a dental hygienist and dental therapist. Unfortunately it did not remove the prescription from a dentist for a patient to access the services of a hygienist. It does however allow for patients to take a copy of their prescription to any clinician of their choice. We currently have a system in which access to dental hygiene services and oral health promotion can only be achieved by paying for a dental inspection and then being referred on for hygiene care. This 'treatment' is currently undertaken only under prescription from a dentist.

The latest Adult Dental Health survey clearly showed that the UK continues to have high numbers of anxious patients that for many reasons choose not to attend for routine dental treatment and more importantly routine preventive advice and essential oral screening. The incidence of mouth cancer has risen by 43% in the UK over the past 10 years. Regular oral screening can detect the cancer at an early and therefore treatable stage. The 3000+ deaths a year from oral cancer are largely attributable to late detection.

The provision of dental care is clearly outlined in The General Dental Councils' Scope of Practice Document which is currently under review. Members of my profession are working to remove the requirement for the need to see a dentist before accessing dental hygiene and possibly therapy services. This would allow for greater access to dental services because more patients would electively access what they percieve as a less threatening option. Patients entering the circle of care by this route would still have thier mouths assessed and duly referred to the dentist if this was deemed appropriate.

I set up Dental Health Spa in September 2007 after the last change in the Business of Dentistry Act and review of Scope of Practice. Brighton has 60-70 dental practices; some with hygienists some without, so the business plan was to have local dentists refer treatment. This was to increase availability, accessibility and patient choice, addressing a fundamental gap in the care pathway for these patients. The business model validity was based on statistics from the 1998 Adult Dental Health Survey (ADHS) on levels of periodontal disease which can be diagnosed/recognised and treatment planned from BPE something which all clinician’s (dentist, hygienist and therapists) are skilled and competent to use. According to the 1998 ADHS 40-50% of the adult population have mild to moderate periodontal disease with 10% falling in to the severe category requiring the services of periodontists; the majority of this cohort would benefit from the additional clinical support of a dental hygienist.

The reality for me nearly 4 years later is that despite the need for services and continued high levels of disease the referral rates from local dentists are low. To date 3856 patients/consumers have walked through the door of Dental Health Spa looking for treatment; less than 2% has come from dental referral. Many had dentists of their own and either their dentist did not have a hygienist, or had part-time hygienists with long waiting lists making access at best inconvenient. A significant percentage of the 98% have their own dentist/hygienist and choose to come to my practice. Unfortunately for some of them their dentists would not refer or give them a copy of their treatment plan, so despite having paid for an dental examination they currently now have to pay one of my dentists who I employ to write a written prescription or referral. This is not only unfair but also provides barrier choice.

My primary concern is for the percentage of the population that do not go to a dentists through fear/anxiety. The most recent ADHS reports that 12% of the population examined report this is the reason for non attendance or irregular attendance - that is 779 individuals in this one survey who do not access our services fully. My practice, which led by myself, as a Dental Care Professional, appears to reduce the fear that these patients have towards dentists, and I have certainly seen a high proportion of nervous patients; over 50% of patients that come here report of some anxiety. 30% of my patient base are not regular attenders, some have not been for years/decades! Some have gone on to have further dental treatment either here or elsewhere. For some that has taken over 2 years to build that level of trust and for others that trust is still being developed. People access dental services for different reasons; some through pain, some knowledge that regular attendance reduces dental need and some because they want whiter teeth, fresh breath and ultimately a healthy mouth.

Surely a route through hygiene services might increase the numbers accessing care allowing early detection of pathology, smoking cessation advice, oral health advice and help to develop self empowerment. Our current training curriculum fully meets the guidelines for clinical competency in oral assessment. I trained in 1981 and was taught to recognise abnormalities in the mouth and refer back as necessary, and to use radiographs for evidence of change. Patient safety should be the central pin of this move and I support fully any additions to our core subjects for CPD to ensure that this is maintained.

Patient safety and choice are central to this stance and we would welcome your support to have this restriction lifted from the dental patient care pathway.

I would be very happy to provide a more detailed brief on this subject area if you are able to assist us.

Yours sincerely,

Christina

www.carolinelucas.com

The Office of Fair Trading look at direct access: September 2011

It's about time The Office of Fair Trading looked at direct access to hygiene services. Christina has been at the forefront of the campaign, trying to push for the hygiene referral to be lifted, once and for all. It should be about the patient, the consumer, and their wants and needs. Easy access to information and services is the first step to healthy teeth and gums!


Check out the article on dentistry.co.uk

Latest 7 Magazine: Brush Up - August 2011

Our Bug Busters on the front cover of Latest 7 

Children will be all smiles with help from Dental Health Spa in Brighton

Kids, it's time to brush up on dental hygiene. The new school year may be a few weeks away but it's time to start swotting on a different subject: healthy teeth. Parents, pay attention, as there may be something you've let slip past the wayside, too. A shocking statistic shows the main reason for a child under the age of five having general anesthetic in the UK is for dental work following tooth decay.

So, how long should you brush your teeth for? How many times a day? How do you prevent cavities? And how often should we really be paying a visit to the dentist? Latest 7 answers all those questions and more with Christina Chatfield, director of Spa Kids, part of Dental Health Spa in Brighton.

Milk teeth

Our baby (milk) teeth begin to develop before birth, but they start to push through the gums at six months old. Generally, children have 20 baby teeth, which are usually in place by the age of two or three. Parents should introduce a toothbrush when their baby is a few months old, as the baby may have started to teethe already. Christina Chatfield identifies the reason as getting the baby used to the taste of toothpaste and having the brush in their mouth. At this young age, it's not about cleaning the teeth, and all the baby may want to do is chew on the brush, but proper brushing starts from a young age, which leads us on to the toddler years...

Brush up

Article featuring real life Bug Busters Max & Mia!

How long do you spend brushing your teeth? You may think it's for a good minute or two but in fact many of us only brush our teeth for around 30 seconds. To nail down the correct brushing time, Dental Health Spa offers talking toothbrushes for children - an ingenious idea. As soon as it's turned on, children brush their bottom teeth for one minute, before switching to the top teeth and brush for another minute. Christina will soon be offering a newer toothbrush from America that not only tells children to brush their top and bottom teeth, but also the inside and outside of the teeth too. "It is extremely common for children to brush the outside of their teeth but not the inside," says Christina. "It is the inside of the teeth and biting surfaces that are at high risk of tooth decay."

The question is, when do you brush? The answer for many may be after breakfast. It seems to make sense; why brush and then eat? But have you ever thought what the bacteria in your mouth are up to while you are sleeping? "They have been multiplying," Christina explains. "And, just like we are, but the time we wake up they are pretty hungry. The bacteria in our mouths feed on the sugars in the foods we eat and turns in into acids which cause decay. Unless you brush some of the bacteria away first, there will be thousands of them waiting to tuck into your breakfast with you!" So, before and after then? Leave it for quite a while after eating if you can. "The acid produced by the bacteria while you are eating softens the enamel on your teeth and the mechanical action of brushing can cause it to wear down," says Christina.

So, with many of us not brushing for the right length of time, the next step for improvement is brushing the teeth correctly. It's something that seems so obvious, but until we consciously think about it, we realise there is always room for improvement, what with being on auto pilot in the mornings and too tired at night. But brushing our teeth correctly is essential in maintaining healthy teeth and gums. But how do we know we're getting it right? To help children, Christina has developed Spa Kids at her Brighton spa. In a fun and interactive lesson, Spa Kids uses an Oral Insights Interactive System to look at children's brushing technique, which is great for kids aged 8 upwards. They wear a headset connected to a computer screen, which brings up a virtual model of their teeth. They then brush their teeth as they normally would. The difference to being at home is the computer highlights the time spent on each tooth and areas missed out altogether. Children get a score out of ten and are shown how to improve their brushing technique. Sounds like it's time to strive for a perfect ten.

The new disclosing solution at Spa Kids lets children see how bacteria manifests. The solution dyes the bacteria on the teeth, showing up a faint pink for traces of bacteria deepening to a dark purple for bacteria that has been there for days. "This can be a real eye opener to children - and adults too! You would expect to see traces of prink on some teeth, but to find whole teeth a deep purple highlights the areas missed by brushing," says Christina.

Keep teeth healthy

By only brushing our teeth we miss a large proportion of the teeth's surface. A gentle, non or low alcohol mouthwash will help keep the teeth and gums free from bad bacteria. Next, grasp the knack of flossing, as it helps reach around 35 per cent of the tooth brushing doesn't!

As already mentioned, our mouths are a busy destination for bacteria - there's the good bacteria and the bad. Some of the bacteria can be harmful, most are not and some are even helpful. However, some of the bacteria can attach to the tooth's enamel. If they're not removed, they multiply. Proteins in your saliva can also mix in, forming a white film on the tooth. This is plaque, which is what causes cavities.

To prevent tooth decay and cavities, limit sugary foods and drinks. Fizzy drinks may appear to be the worst offender, but fresh fruit juices can contain high sugar and are very acidic, which can damage the tooth's enamel.

Eat a healthy, balanced diet including all the food groups. Not only is it beneficial to your overall health, but for your teeth and mouth too.

By looking after our teeth through childhood means our teeth and gums are likely to stay strong and healthy through our adult life. Choose a toothbrush to suit you - ask your dental hygienist for advice in finding the perfect brush. Some prefer electric toothbrushes; others need a soft or medium brush, where the bristles can either be flat or shaped. Here's the question: when did you last change your toothbrush? If you can't remember then it was too long ago! As well as harbouring bacteria, a worn out toothbrush cannot clean your teeth properly and may damage your gums. Change toothbrush every two to three months, or when the bristles become splayed. Combine thorough cleaning with regular check-ups and you will keep smiling all year round.. Don't wait for a tooth-related problem to arise. Prevention and maintenance is key.

www.thelatest.co.uk/7