I am studying for my MJDF qualification and I have been lucky enough to attend this superb course organised by Dr Nick Cooper and Dr Anwara Chambers. They hold regular meetings and have created an excellent website which guides you through putting together the folder of evidence you need to demonstrate your knowledge of the core dental subjects.

Mersey MJDF Study Group & Core Skills On-line

The study group meetings

The core subjects are listed below:

1. Medical Emergencies in Practice
2. Infection Control
3. Radiation Protection
4. Record Keeping
5. Team Training
6. Health & Safety Legislation

Colleagues at all different stages of their careers, principals (old timers, there I said it), newly qualified dentists and hospital based folk all attend the meetings. I am very impressed with the calibre and dedication of the attendees, I personally have learnt a great deal out of every meeting.

Anwara and Nick run through the topics you need to study, they are knowledgeable tutors and teach using PowerPoints, discussions, handouts and practice questions.

Core skills on-line

Their website guides you through pulling together all the written work, photographic evidence, references, and helps you produce your case presentation and clinical audit. Here are some more website features:

1. There are suggested references with direct links straight to the online resource
2. You can upload photographs of the evidence you need to provide
3. There is a detailed chart of your progress through each core skill
4. You can email queries to your mentor or ask for their feedback on completed sections of your work
5. There is a feature to pick up right from they section you were last working on
6. The site puts together your cv, a cpd log, a personal development plan

Conclusion

This is first rate, contemporary postgraduate dentistry, I have learnt a vast amount in the 12 months I have been attending the meetings. I have just signed up for another year and plan to do the qualification in 2011. The website is a brilliant tool to guide you through the preparation of your portfolio, it fun, informative and great for busy dental surgeons aiming at striking that work/life balance. Whether you plan to do the exam or not it will bring you bang up-to-date with core dental skills that are an important part of everyday dentistry.

Core skills website http://www.coreskillsonline.com/index.php

Study group http://www.merseymjdfstudygroup.com/index.php

Dental Cosmos http://quod.lib.umich.edu/d/dencos/

Simplant http://www.ctscan.co.uk/products/softwares/simplant_about.html

Quintessence publishing http://www.quintpub.co.uk/index.php?modules=content&page=contact_us

Clinical Journal of Periodontology http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1600-051X

Thermafil instructions Densply https://cheshiresmile.co.uk/wp-content/uploads/2011/02/Brochure_Thermafil.en1_0.pdf

Keys to Clinical Success with Pulp Capping: A review of the literature by Hilton is an excellent review article on both direct and indirect pulp capping. Operative Dentistry, 2009; 34-5, 615-625

The author indicated several key points that must be considered when evaluating studies on pulp capping. First, clinical pulp capping studies rarely reflect clinical reality.  Many are carried out on healthy teeth that are planned for orthodontic extraction. Second, the histologic pulp status of a tooth cannot be determined by clinical signs and symptoms.  It is also noted that studies in animals are not necessarily predictive of human outcomes.

An electron micrograph of calcium hydroxide

The conclusions to the review were:

1. Avoid exposing the pulp. The chances for tooth survival are excellent if the tooth is asymptomatic and well sealed, even if residual caries remains.
2. Control haemorrhage with water, saline or sodium hypochlorite. Water and saline are the most benign to the pulp; sodium hypochlorite is best at controlling haemorrhage and disinfecting.
3. ZOE, GI/RMGI and adhesives are poor direct pulp-capping agents and should be avoided for this application.
4. MTA demonstrates comparable results to calcium hydroxide as a direct pulp cap agent in short-term data.
5. Calcium hydroxide remains the “gold standard” for direct pulp capping. It has the longest track record of clinical success, is the most cost-effective and is the likely effective component in MTA.
6. Provide a well-sealed restoration immediately after pulp capping. This will provide protection against ongoing leakage and bacterial contamination that can compromise the success of the pulp cap.

It is also worth pointing out that MTA is hideously expensive!

It is often best to remove large amalgam, composite and cast restorations from teeth that are planned for endodontics. Dentistry leaks and cement lutes fail. There is often hidden dental caries beneath repairs. It is necessary to visually assess the amount and quality of remaining tooth tissue in order to determine if teeth are beyond reasonable restoration before endodontics commences.

 Komet crown-cutter

Removing crowns

Use a round diamond to remove the porcelain veneer from PBC’s. Use a transmetal bur to brush cut through the metal casting, use the largest bur for maximum strength. They can fracture in use although this has only ever happened twice in 6 years. Make sure you, the patient, your assistant all wear safety glasses.

A WAMKey  or equivalent can be used to lift off crowns safely as illustrated below.

WAMKey

Removing restorations does place an additional burden on patients but very often teeth are borderline restorable and beyond and it is in the patients best interest to determine this before root canal commences.

Removing plastic and cast restorations frequently reveals dental caries, the dentist can assess for fractures and provide for an effective seal between visits when the root canals have been prepared and dressed with non-setting calcium hydroxide.

 The WAMKey is inserted and rotated, the oval profile is used to lift off the crown

 The crown is lifted away

 Evidence of leakage

 Extensive caries, the tooth is unfortunately beyond  reasonable restoration