Practice News

our service

March 2020

I am delighted to announce that our extended contact activity has just been confirmed. Should you wish to make an appointment for yourself or someone else, kindly get in touch with us at your convenience. -Conrad Costa

 

GDPR

May 2018

We have updated our privacy policy in accordance with GDPR legislation. Our website does not track you, nor do we collect any information about you whilst you browse our website. We do not covertly make you mine Bitcoin on our behalf nor do we drop any cookies or sell you adverts. We value our own privacy very much and therefore have a lot of respect for your online privacy.

Patient satisfaction Survey

August 2016

Our patient satisfaction survey, which had been ongoing since April, is now closed. We would like to thank all those who participated. We would nonetheless welcome your feedback (whether written, verbal or by email) at any time. Our Friends and Family Test remains ongoing.

New Practice manager

January 2016

We would like to extend a warm welcome to Ms Angelique van Woerkom, who joins us at Castle and Costa as our new Practice Manager. Angelique has many years of experience as a Dental Care Professional and had worked for us frequently as a locum. She is familiar with our working system and is very eager to learn and help us improve our service.

New Associate Dental Surgeon

August 2015

We are pleased to welcome Dr Gavin Gill to our practice as our new associate dental surgeon, following the retirement of Dr Gillian Fellows. Dr Gill has many years of experience in general practice and in teaching hopsitals and will prove to be an asset to our team.

CQC inspection and report

June 2015

We are delighted to announce that Castle and Costa Dental Surgeons have passed their CQC inspection. Following a visit by two inspectors, we were given a clean bill of health - as well as a few suggestions - which we have taken on board. For more information, visit our Resources page.

Dementia Awareness training

November 2014

We extend our congratulations to our dental care professionals and dentists after they were awarded an NVQ level II in dementia awareness training. This will enable us to engage with our patient base better and to improve our understanding of their condition.

Conrad and audrey Costa

March 2013

We are pleased to announce that following the sad demise of Mr Castle, Conrad and Audrey Costa have recently taken over the running of the practice and will strive to maintain and improve the good standard of care that Castle and Costa have been delivering to the non-ambulatory for the past years.

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Oral Hygiene Advice

Poor oral hygiene can lead to decay and gum disease, and has also been linked to a poor state of general health. Your dentist will be able to give you appropriate oral hygiene advice tailored to your specific needs. It is important to note that regular oral hygiene is the patients' responsibility. In the case of patients who are unable to care for themselves, oral hygiene is a crucial part of the care they should receive on a regular basis.

 

Principles of toothbrushing

Regular and careful brushing of the teeth and gums is an important cornerstone of oral hygiene. Thorough brushing does not imply scrubbing the gums very hard, as that might damage them. Rather, it involves careful up-and-down brushing and gently "massaging" the gums when brushing. A manual toothbrush will do the job if used properly but for those amongst us who have a hard time cleaning the teeth or who lack manual dexterity, a recent Cochrane Review suggests that a rotating-oscillating rechargeable electric toothbrush (very important - not a 'sonic' brush and not battery-operated) may be of additional help. Read more about the review here.

Your typical rotating-oscillating rechargeable electric toothbrush. Note the small, round head design.

 

You will need to hold the brush head tightly against the teeth, pointing downwards onto the gums. Let the brush do its work for you and gradually move from the left hand side of the mouth to the right in a systematic fashion. Brushing the lower gums (inner and outer surfaces) should take around 30 seconds (with experience).

 

After brushing the gums, it will take another 30 seconds to brush the teeth thoroughly this time. You will need to find novel ways of holding the brush to reach areas that are hard to get to.

 

The same process is repeated for the top gums and teeth. The whole performance should take about 2 minutes.

 

Inter-dental cleaning

The spaces between the teeth (the inter-dental spaces) are not reached effectively by the bristles of a toothbrush and therefore require attending to separately. Generally speaking, aids such as floss, super-floss, spiral and interdental brushes are extremely useful in the maintenance of a satisfactory level of oral hygiene.

A spiral interdental brush of an appropriate size is a useful tool in cleaning between teeth with large interdental spaces.

 

Floss-picks are extremely useful gadgets that greatly facilitate flossing. Squeezing the limbs of the pick together to tighten the floss, thread it through between the teeth togently slide into the interdental space, then push the floss to the side of one tooth and move down onto the gum as far as you can. Do the same for the interdental surface of the other tooth in the same space.

 

Superfloss helps in keeping the areas underneath bridges clean. It is also useful when crowns have rough margins or where ledges exist under old fillings. First, thread the tough end of the superfloss between the teeth...

 

...then pull the spongy bit through and use it to clean the interdental space.

 

Physical Disabilities

Patients with physical disabilities who are still able to maintain a fairly independent lifestyle may find it easier to use an electric toothbrush than an ordinary one; the fairly large handle and the rotating action of the brush head will help achieve a consistent level of oral hygiene. In certain instances, modification of standard brush handles by the application of insulating foam, rubber bands etc may be sufficient to enable the patient to maintain their own oral hygiene. In other cases, patients may depend on their carers to carry out their oral hygiene routine in its entirety or to 'top-up' the patients' own previous efforts. Carers should be aware of the difficulties patients may face and offer to help out with personal care.

 

Mental Disabilities

Patients with mental disabilities may be entirely dependent on their carers to maintain a decent level of oral hygiene and thus prevent the onset of dental decay and gum disease. In cases where patients are unable to consent to the carrying out of their personal care, carers should treat patients in their best interests. Failure to do so may result in wilful neglect of the patients under their care.

 

Oral Neglect - Note the thick white deposits of plaque round the teeth, broken teeth and sore, bleeding gums

 

Patients who are unable to care for themselves often find their oral hygiene neglected. This can happen for a variety of reasons, including embarassment and lack of awareness on oral health issues. Carers should be alert to signs of potential problems and contact the dental team for an assessment if in any doubt.

 

Oral Neglect - Note the gross deposits of calculus (scale) on the teeth and swollen, inflamed gums

 

Oral Neglect - Note the broken, decayed teeth and the droplet of pus on the gum, indicating a possible dental infection

 

When helping patients under your care with their oral hygiene, it is important to involve them as much as you can in the process.

1. Find a time that is mutually convenient, when your patient is comfortable and at ease and is more likely to comply,

2. Wearing suitable personal protective equipment (gloves, face shield if necessary etc) get the patient's brush and clean it gently under running hot water to soften the bristles. Apply a smear of toothpaste to the brush. Excess toothpaste is not beneficial, and the excessive foam may make some patients gag,

3. Inform the patient of each step in the hygiene process as you go along. Some patients find it easier to comply if they can monitor the process in a face mirror while you approach their mouth from behind.

4. If the process is too tiring or the patient gets agitated, you may be better off leaving the rest of the hygiene process for a later opportunity. Record your progress for the session and hand it over to the next shift of carers if appropriate, so as to ensure that the full oral hygiene process is completed thoroughy at least once every 24-48 hours.