Adult Orthodontics – Upper and Lower Crowding. By Andrew Farr

Mrs K. presented complaining of upper and lower arch crowding. She had orthodontics completed in her adolescents and this has now relapsed due to a lack of retention following treatment.

Mrs K. had 4mm crowding in the upper arch with the Maxillary right first molar buccally placed. The lower arch had mild crowding of around 3mm as shown above. Treatment options were discussed and it was decided that fixed upper and lower arch short term orthodontics followed by fixed retention in the form of a bonded retainer would provide an acceptable outcome.

The treatment was provided at Broad Street Dental Surgery using the QST (Quick Straight Teeth) system and took approximately 6 months to complete. Excellent result were achieved and the patient was provided with fixed upper and lower retainers along with Essix retainers to wear at night.

If you are interested or know of anyone interested in short term orthodontics then please visit Broad Street Dental Surgery in Hereford.

Dr Andrew Farr (Dentist) BDS(Hons), MJDF




Dental Tips to Start the School Year with a Smile

With the new school year fast approaching the following back-to-school dental tips for parents are sure to help your child start the school year with a healthy smile, and keep it that way all year long.

Preventing decay starts at home, so the more child-friendly your dental supplies, the more your child will love keeping up with their oral hygiene routine.

Establish a Back-to-School Dental Routine (and Make it Fun!)

Children (and adults!) should brush their teeth twice a day for two minutes to maintain good oral hygiene. Children under the age of 8 should have their toothbrushing supervised. Children under the age of 8 lack fine motor skills needed to brush their teeth effectively, so it’s important for parents to help. Establish a fun morning and evening routine that allows you to help your younger child. It is recommended that children over the age of 3years, use toothpaste containing between 1,350-1,500 ppm fluoride and to not rinse after brushing.

Pack Healthy Lunches (and a Water Bottle)

As you pack your child’s lunch, remember that sugar is added to many food products. Check food labels for added sugar and by swapping sugary foods with healthy, whole foods like crunchy vegetables, pieces of fruit and hard cheeses you can reduce the risk of decay developing in your children’s teeth. You will also want to skip crackers and chips since these foods contain simple starches that break down and get sticky, which can also cause decay. Replacing juices, sports drinks and fizzy drinks with plain water will reduce the risk of decay further and also the risk of erosion (which is a form of tooth wear caused by acid in the diet) which is dramatically on the increase in children.


Schedule a Back-to-School Dental Exam at Broad Street Dental Practice

Are you ready to start the school year with a smile? Our experienced dentists at Broad Street Dental Practice are experienced in paediatric dentistry, friendly, and welcoming to kids. contact us today to request back-to-school-dental exams for your toddler, child or teen.


Broad Street Dental Surgery


Implant Surgical Guide

A surgical guide as the name suggests serves as a guide to place implants accurately in 3 dimensions i.e. bucco-lingual, messiah-distal and apiece-coronal.

Here I am showing a simple surgical guide that has been produced from an initial wax up (there are more accurate guides available). It is constructed of hard acrylic and can also has barium sulphate incorporated into it so it can double as a radiographic stent.

With the guide in place, the long axis of the teeth are marked a small pilot hole is made in the centre of the tooth and old implant drills can then be used to enlarge the guide window. A window can also be made in the buccal aspect of the guide to aid vision and insertion of the drills in the mouth.

This can be worn by a pt during a CBCT to confirm the correct angulation and position of the final restoration.

surgical guide

Andrew Farr

FDI – Implant Retained Dentures

Managing the edentulous patient can be at times, very difficult. Following extraction of the dentition bone is remodelled and resorbed, muscles and ligament insertions become closer to residual ridges. This can in turn lead to an unstable and unretentive denture due to a lack of bony support.

When treatment planning for the edentulous patient, it is useful to classify the edentulous ridge. Ridge classification can aid both the dentist and patient in communicating any difficulties and the likelihood of a successful outcome.

3b. Adaption of Cawood & Howell classification with explanation (1).compressed

The optimum conventional dentures should be both aesthetic and functional with good fit and stability. The McGill consensus statement 2002 and York Consensus statement 2009 say that the “Minimum standard of care” in the edentulous mandible is two implant retained dentures. Working in both the private sector and primary care/community sector I find the both statement of little use. From my experience the patients who can afford two implants tend to be well educated and well informed regarding diet, oral hygiene and are regular dental attendees – they are less likely to be edentulous. Those in need are less likely to be able to afford two implants and the prosthesis.

For a mandibular implant retained denture – a minimum of two implants should be placed and four in the maxilla. The ideal position in the mandible would be the canine region and in the maxilla it would be the canine and second premolar region allowing for adequate bone and other anatomical features.

Locators, bars and milled bars can be used to improve retention, stability and support. These are a good option if an optimally made denture is still unretentive or is lacking support.

At Broad Street Dental Surgery we can provide dental implants to aid and improve the support of dentures as well as replacing single and multiple spaces.

Tissue level implants with locator attachments in situ

Dentist Andrew Farr 

Broad Street Dental Surgery


Hereford Tooth Decay Worse in The West Midlands

Dental decay amongst five year old children is more prevalent in Herefordshire than any other county in the West Midlands. The Dental public Health Epidemiology Programme for England published in May 2016, show that 41.3% of five year old children in Herefordshire have had experience of or currently have dental decay. Compare that to our closest neighbours Worcester (27.3%) or Malvern Hills (17.7%) Shropshire (21.5%) then it is clear that Herefordshire is failing in the dental health of it’s children.




Tooth decay damages your teeth and leads to fillings or even extractions. Decay happens when sugar reacts with the bacteria in plaque. This forms the acids that attack the teeth and destroy the enamel. After this happens many times, the tooth enamel may break down, forming a hole or ‘cavity’ into the dentine.

Every time you eat or drink anything containing sugars, these acids attack the teeth and start to soften and dissolve the enamel. The attacks can last for an hour after eating or drinking, before the natural salts in your saliva cause the enamel to ‘remineralise’ and harden again. It’s not just sugars that are harmful: other types of carbohydrate foods and drinks react with plaque and form acids. (These are the ‘fermentable’ carbohydrates: for example ‘hidden sugars’ in processed food, natural sugars like those in fruit, and cooked starches.) Always check the ingredients.

Having sugary or acidic snacks and drinks between meals can increase the risk of decay, because your teeth come under constant attack and do not have time to recover. It is therefore important not to keep having sugary snacks or sipping sugary drinks throughout the day.

Children – at the age of 5 lack the manual dexterity to brush their teeth correctly and need supervised brushing. The Delivering Better Oral Health 2014 Toolkit recommends that all children between 3-6 years should brush using toothpaste containing more than 1,000ppm of fluoride. Children at a higher risk of developing decay should use a “pea size amount” of toothpaste containing between 1,350ppm – 1,450ppm fluoride.

Children at the age of 5 also lack the required funds to purchase sweets, fizzy drink, fruit shoot drink and other high products containing high levels of sugar. Parents therefore must take on the responsibility of caring for their child’s dental health with regular dental check – ups, good diet and good oral hygiene.


Bring your child as early as possible to visit the dentist. We need to reduce the incidence of decay amongst 5 year old children in Herefordshire to at least the level of our neighbours before we become the shame of the West Midlands.

Andrew Farr BDS(Hons) MJDF

Broad Street Dental Surgery


Dental Abscess – Don’t Risk Your Life

This is just an experience that I would like to share. Whilst I was working for an emergency dental service over a weekend, a patient attended with a “swelling.” Little did he know but this swelling was extremely dangerous and required urgent attention!

The patient was not registered with a dentist, he had a fractured tooth in he lower jaw which had been painful a “few months ago” but had since settled. The swelling to the lower jaw had rapidly become worse over the past 48hours and now he was struggling to swallow.

The patient had developed a diffuse dental abscess relating to the lower left molar tooth. This had spread down, under the jaw bone, had raised the floor of the mouth and was now crossing the midline over the patients throat and airway. He was developing a Ludwig’s Angina.

Immediately I contacted the on-call SHO for the local maxillo-facial department. The patient was immediately admitted to the maxillo-facial ward and ssurgical drainage of the abscess was provided. the patient had drains in place for a week and IV antibiotics.

This case shows the importance of regular dental check-ups and that any toothache/pain should not be ignored. By delaying dental treatment and ignoring the early signs of pulpitis/apical periodontitis the patient had placed himself at risk.


Ludwig's Angina 4
The spread of infection and it’s effects (1)

Andrew Farr Dentist BDS(Hons), MJDF









Eucalyptus Oil instead of Fluoride Toothpaste!

At Broad Street Dental Surgery we pride ourselves on prevention, oral hygiene, diet advise and fluoride advise. Today was just like a normal day at the surgery until the very last patient of the day was half way out the door, then just out of the blue did the old Columbo “Just one more thing Mr Farr”

Mrs S. then produced a small bottle from her coat pocket – Eucalyptus oil blue gum for “teeth and gums” and a “healthy alternative to toothpaste” Mrs S. asked for my opinion and if it was better for her teeth than her normal fluoride containing toothpaste.

Being from a scientific (and quite sceptical) background where we are continuously and rightly reminded of evidence based dentistry I did just want to throw the product out of the window! With the level of decay that I see in children in the Primary setting I feel quite strongly about fluoride, topical fluoride and follow Delivering better oral health: an evidence-based toolkit for prevention

Fortunately for my ease on the back of the bottle in very small writing the bottle said “this product is not intended for the prevention and treatment of dental decay or gum disease.”

I explained what is fluoride and it’s benefits and risks.

What are the benefits of fluoride?

Fluoride can greatly help dental health by strengthening the tooth enamel, making it more resistant to tooth decay. It also reduces the amount of acid that the bacteria on your teeth produce.

Children who have fluoride when their teeth are developing tend to have shallower grooves in their teeth, so plaque can be more easily removed. Plaque is a thin, sticky film of bacteria that constantly forms on your teeth.

The addition of fluoride to water has been researched for over 60 years, and water fluoridation has been proven to reduce decay by 40 to 60 percent.

Clearly the best form of decay prevention is good oral hygiene and diet. By reducing the amount of sugars/ refined carbohydrates in your diet which “feed” the cariogenic bacteria in your mouth and brushing with fluoride that helps to remineralise enamel and is in itself bactericidal.

Is fluoride safe?

Many reports have been published throughout the world about fluoride. After many years, the scientific conclusion is that fluoride toothpaste and correctly fluoridated water, salt and milk are of great benefit to dental health, help to reduce decay, and cause no harmful side effects to general health. Studies have not found any evidence that fluoride added to water causes harmful side effects.

People who are against fluoridation claim they have firm evidence that fluoride added to water is harmful. However, scientific analysis has not supported their claims.

Worldwide, over 300 million people drink fluoridated water supplies. Many millions more use fluoride toothpastes regularly. In the USA for example, well over half of the population have fluoridated water supplies. This has led to improved levels of dental health which in turn benefits general health.

Mrs S. was happy with our discussion. She was given information so that she could make an informed choice on her dental health. The Eucalyptus oil wasn’t thrown in the bin as such but Mrs S. will use it from time to time.

The battle against decay continues!





Denplan Excel and DEPPA

On the 5th January Broad Street Dental Surgery were accredited as a Denplan Excel dental practice. In this day and age of regulation, CQC and with an emphasis now strongly weighted on prevention and educating patients we felt that the Denplan Excel programme with it’s DEPPA assessment tool would suit the practice perfectly.

The DEPPA assessment tool provides an instantaneous online report showing the patient’s Oral Health Score (OHS) alongside a detailed (and evidence based) assessment of their future risk for caries, periodontal disease, tooth surface loss and oral cancer.

The simple colour coded system clearly show the risk level of the patient and also provides general advice. DEPPA provides an additional tool for the general dental practitioner to communicate effectively with each patient and can be used to reinforce good habits as well as encouraging change. It seems very similar to the NHS pilots currently being trailed and reinforces the need for the need to risk assess each patient. from a Medico-legal angle providing a detailed DEPPA assessment of each patient outlining their Caries, Periodontal, Tooth wear and Oral Cancer risk would be a very useful adjunct to any clinical records.

During the Denplan Excel Accreditation process, practice policies, cross-infection protocols and procedures, clinical records, treatment planning, IR(ME)R, health and safety and CPD were all examined in some detail. This provided an excellent preparation for future CQC inspections and also provided us with excellent feedback that we were operating at “best practices” standards.


For any practice involved with Denplan and considering the Excel programme, I would recommend it. It has helped to develop and grow the practice by attracting new patients and enabling broad Street Dental Practice to stand out a little from the crowd!

Think before you Drink!

At Broad Street Dental surgery we have been introducing our local nurseries to the dental environment and also providing basic oral health education and advice. The dental nurses at the practice spent some time creating a very simple but effective display showing the amount of sugar in many of the most common drinks consumed by children and adults today.


The amount of sugar in each drink was weighed and displayed beneath each product and was displayed in the waiting room of our dental practice. Even though the quantity of sugar is labelled on each drink, the quantity of sugar still caused much debate and astonishment amongst our patients.

This simple display clearly demonstrates the continuing need to educate patients with regards to sugar and diet and a need for clear labelling. Making traffic light labelling compulsory on all packaging or showing sugar content in teaspoons on the front of packaging as described by Jamie Oliver in his “Sugar Rush” TV show would clearly be a vast improvement to the current labelling system allowing patients to make an informed decision on the products that they and their children consume.

Dr Nigel Carter OBE, Chief Executive of the British Dental Health Foundation, highlighted why the charity is adding their voice to the calls for change: “The effects that sugar consumption is having on children’s dental health cannot be understated. Shockingly, a recent study found half of eight year olds have visible signs of decay on their teeth and a third of children are starting school with visible signs of tooth decay.

“Tooth decay is the number one reason for hospitalisation in children and that 26,000 primary school aged children were admitted to hospital due to tooth decay last year, with children tooth extractions costing the NHS around £30 million per year, the key cause being tooth decay. This cannot be allowed to continue.”

Early tooth decay can have no obvious symptoms, but your dental team may be able to spot a cavity in its early stages when they examine your teeth. This is why you should visit your dental team regularly, as small cavities are much easier to treat than advanced decay.

If you are unsure if you or your child has the early signs of dental decay the please book an appointment at Broad Street Dental Surgery

Andrew Farr  Dentist BDS MJDF



Toddlers Toothbrush Tantrums!

I was emailed this question a few months ago and with all the media relating to a Sugar Tax thought it quite relevant. The fact that a sugar tax will help with the reduced consumption the need to maintain good oral hygiene with fluoride toothpaste still heavily out weights any taxation.

“My toddler hates brushing his teeth and it is often a struggle and tears before bed. Is it absolutely necessary to brush a toddler’s teeth everyday or can I do every other day if he is rejecting the toothbrush?”

By the age of 2½ – 3 years a toddler will usually (but not always) have all of their milk teeth (deciduous) through. That’s 20 teeth, 10 in the upper jaw and 10 in the lower. These deciduous teeth begin to exfoliate around the age of 5½ however the molar’s will not be lost until 11-12 years of age, so these teeth need to be looked after and maintained for many years.

A recent study by the Royal College of Surgeons “The State of children’s Oral Health in England” found that almost a third of five year olds in England are suffering from dental decay and that the average child with decay has at least three teeth affected. Moreover, dental caries is the number one reason why children aged 5-9 years are admitted to hospital in England, even though it is completely preventable through regular brushing, adequate exposure to fluoride and limiting sugar consumption.

The government tool kit Delivering better Oral Health recommend all children brush twice daily with fluoridated toothpaste, brushing last thing at night and at one other instance. Children aged 0-3years should use toothpaste containing no less than 1000ppm fluoride and children 3-6years should use toothpaste containing between 1350-1500ppm of fluoride (the levels can be found on the back of your toothpaste).

Children’s teeth are more susceptible to decay than adult teeth. They have thinner and less resilient enamel. Brushing your toddlers teeth twice a day is important for your toddler’s oral health.

Fluoride helps to battle the effects of sugar and remineralises (re-hardens) the tooth surface. Their teeth would have undoubtedly been exposed to sugary foods which can manifest as intrinsic (such as milk, fruits) and extrinsic (confectionary, chocolate). Plaque starts to colonise the tooth surface and establish within 24 hours of brushing. Dental plaque bacteria can ferment both intrinsic and extrinsic sugars to acids. The acid produced dissolves the enamel of the teeth. All carbohydrate-containing foods (intrinsic and extrinsic sugars and starches) have the potential to contribute to tooth decay. Each time we nibble a food or sip a drink containing carbohydrates (intrinsic or extrinsic sugars or starch), any decay-causing bacteria present on the teeth start to produce acid and demineralisation commences. This continues for 20 to 30 minutes after eating or drinking, longer if food debris gets trapped between the teeth or remains in the mouth.

Brushing a toddler’s teeth can be challenging, try to make it fun. Brush your teeth together, allow your toddler to brush your teeth and to play with the brush. If your toddler can see that you are getting worried, then it will only increase their anxiety.

Try different flavoured toothpastes, different themed toothbrushes like their favourite cartoon character. Try explaining the importance of brushing your teeth and if you have other sibling brush their teeth first making it more of a family event. With a positive, fun environment I am sure that your toddler will soon enjoy brushing their teeth. If you have any concerns then visit your dentist and they will be able to show you some good techniques.

The image shown is of the new BugBrush which we stock at our practice and is a great tool to aid with maintaining your little-ones oral hygiene.

All children should attend a dentist as early as possible. Even before the first tooth erupts! They can acclimatise to the surgery, equipment and staff and before you know it they’ll be in and out of the chair demanding stickers!