Dr. Bronagh Keane
"Building confidence with a little smile magic"
Ireland's Toothfairy
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‘An ounce of prevention is worth more than a pound of cure’
Posted on 27/03/2022
When was the last time you visited the dentist?
Oh gosh I can’t even remember, years maybe? But sure, I’m not in any pain, so I’m grand like?
Healthcare, like many other fields, is always striving to improve its efficiency and effectiveness. In recent years there has been a huge shift towards more preventive practices with an aim to avoiding more invasive treatments. This applies to both your dental care and your general health.
Yesterday, I was reading that Warren Buffet, an economist in America, had this analogy for health: Imagine that you get your dream car bought for you but you only get one and it's to do you for the rest of your life. Would you run the petrol to the last drop? Let the tyres stay flat? Ignore emergency lights? I don't think so!
Most of the time there isn’t anything wrong with our cars and they get a full assessment every two years. Yet for some reason we think our bodies are invincible, ignoring the recommended checkup schedules and waiting for pain. Although sometimes pain, or one of those emergency lights in our body, isn’t sufficient for us to seek medical attention and look after this car. Even though we know this car is to do us a lifetime with no trade-ins available!
Most things in dentistry don’t cause pain until they need full on treatments such as root canals but lots of these can be avoided!
Oh my goodness how can I avoid invasive treatments? I hate the idea of ever having to get a root canal or even scarier an extraction! eeek
Easy! Get checked every 6 months. It takes 4 years on average for a tooth to require a filling, when the bugs have entered the dentine, (the second layer of the tooth under the enamel). But if this breakdown is detected when the bugs are still in the enamel, (white outer layer), more often than not it can be reversed by your dentist applying a fluoride paste.
“To be honest I actually knew”
One day in my final year of dentistry I was in the oral medicine clinic. I was doing my clinical examination on a 57 year old man and right there staring at me is an ulcer he tells me has been there for months. (Ulcers should always be checked if present for any longer than 3 weeks, the same as any lumps!) Immediately, I knew this was oral cancer. After the consultant broke the news and went through the next steps, he told me that he already knew. Well, that he suspected as much. He told us he had been putting off his check-up, waiting for it to become painful. Waiting until he was in pain! This is months after a doctor or dentist would have diagnosed his cancer. Pain is actually a very common thing for people to wait for but if you're in any way concerned, I’d highly advise against waiting.
This man was officially diagnosed with Stage Four Oral Cancer and two months later when I was on my summer elective, I saw this patient in St. James’ hospital. I saw him a month after he had had half his tongue removed and reconstructed. Unfortunately, he also had additional complications.
I often think back on his situation. I wonder what might have happened if he had gotten regular dental checks and developed a relationship with his dentist. He might have got checked sooner, the cancer may have been found sooner. Heck, it may have even been prevented. Who knows.
You may be sitting there thinking that you wouldn’t have let it get that bad, and please don’t!
I believe there are many diagnoses that could have had a better prognosis and less invasive treatment if they were caught sooner… Because an ounce of prevention is worth more than a pound of cure. Take care of your car and take care of yourself. You're worth it.
'Shark teeth’
Posted 12/03/2022
Getting your summer smile ready? Masks are off and we’re ready to party! Wait what…. masks are off? Oh sugar! All my friends got their smiles revamped on the sly behind the masks. I need my smile fixed ASAP... Actually, I saw an advert the other day for 10 dental veneers and a trip for me and my boo, flights and accommodation all included… only two grand! Think I'll do that, I’ll even get a week in the sun while I’m at it?
‘Lying in bed crying and there is no going back’
This is a classic example of dental tourism; traveling to another country for the sole purpose of obtaining dental treatment. Such procedures are usually packaged with flights, accommodation and take place in popular holiday destinations like Spain, Hungary or Turkey (hence the term ‘Turkey teeth’). Now don’t get me wrong, I can't say that all dentists in these countries are bad, but it's important to be educated on the booming industry and it’s important to ask how it’s done? And maybe even more importantly, how is it done so cheaply?
Let's start with a more relatable topic first: coffee! When I was in Spain over the summer a coffee was only €1.50, a negligible amount when you compare this to the whopping €3.20 I pay in Dublin. I hate to be misses obvious, but everything is more expensive in Ireland and there are a few reasons why:
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Ireland has a higher minimum wage.
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Rent is considerably more expensive.
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Dental supplies and equipment cost more.
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Insurance can be through the roof.
As I said before, and I can’t stress this enough, going abroad does not equate to bad dentistry. However, there are certainly a few things to look out for because when you match like with like, in regards to skills, insurance and materials, the price of any procedure abroad vs in Ireland should actually balance out. This means that anyone offering comparatively cheap treatments for the average of that country is most certainly cutting corners.
So how can I spot the good, the bad and the ugly?
Firstly, ask about legislation. What is the legislation in the country where the treatment will be carried out? Some countries don't require a dentist to carry out the consultation or plan the treatment. I heard from one lady who returned to the same dentist she went to ten years previous, but this time she didn't see the dentist until the day of treatment! Time is money, and in this case it had been taken to the extreme. The dentist wasted no time on anything other than the clinical procedure. Amazingly, they’re not required to do anything else. In Ireland on the other hand the dentist will carry out the consultation, treatment-planning, procedure and aftercare. And being as particular as I am, I have to say I wouldn’t have it any other way!
For the exact same time-saving reason, teeth are being way over prepared. This means that teeth are being reduced to tiny stumps leaving what looks like little prison-bars caging our tongues! These are firstly not veneers as veneers are cut (prepare) 180 degrees of the tooth, rather than crowns which are 360 degrees. Crowns are reserved for teeth with large fillings, root canal treatments or any tooth that is structurally compromised. They are not justified for purely an aesthetic enhancement of a perfect intact tooth. These aggressive reductions on the teeth are a quick fix to give the appearance of straight teeth or because the dentist hasn’t charged enough to spend time doing the careful and fine preparations required.
Aggressive reductions compromise the nerve which can lead to a higher rate of root canals and ledges at the margins for bugs to hibernate and cause gum disease. FYI gums are supposed to be pink, not flaming red, which is often associated with dental tourism or ’shark teeth’. The nerve and the gums are the basic foundations to dentistry, and just like a house if you have poor or compromised foundations the house will fall down!
‘Slow and steady wins the race’ - Robert Loyd
So Bronagh, what should one look out for if they do decide to go away, cause I want to spread the word?
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Well firstly I would recommend that you bring a friend fluent in the destination language or have a translator to make sure you understand all the risks, treatment options and follow up required.
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I would ask the dentist if they have insurance
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I would check the legislation in that country, to see if the dentist is required to complete the consult, treatment-planning and follow up care.
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I would ask where the dentist was trained and what additional training they have done to carry out highly skilled treatments such as cosmetic dentistry.
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Watch out for people who cut corners! Any dentist offering really good deals (cheap treatment) on the lower side of the average prices available in that country, is cutting corners somewhere. This can be; not spending the time to do a precise job, the crowns can sometimes be bulk bought and not bespoke or tailored to your tooth, or the use of plastic veneers/crowns instead of porcelain. A patient once told me their friend was given two options when getting their teeth done abroad, a cheaper one (plastic) or a more expensive one (porcelain)! Legit plastic tic tac teeth, my heart can’t handle it!
And last but not least, Irish dentists are recommended when training not to take on patients that have gone abroad and received dental treatment due to the complications often associated with the treatment. Thus you may have difficulty ever finding a dentist in Ireland post going abroad and you may have to continue to go abroad for all your dental work.
So whatever you do, make sure that you are 110% sure in your decision and have any questions unanswered.
Don’t look now….
Posted on 27/02/2022
When in the history of ever has that stopped people looking…? Whether it’s your friend saying that someone good looking just walked by or a needle coming at you, the FOMO is too real, you have to look!
Recently I went for my general check with the GP the other day. During this appointment I had to get my blood taken. In the small talk that preceded this dredd, the nurse asked me where I was working. “Oh you're a dentist, this will be a walk in the park for you… Don’t look . Is that what my glossy flush face is saying? Because my tummy still dropped and you telling me not to look just garnered my full and undivided attention.
You see, people always assume that being a dentist I must be a super relaxed patient. But news flash: I am a nervous patient, that asks loads of questions and cross checks everything. So contradictory to what most people think one of the reasons I became a dentist was not to inflict pain, but actually because I completely relate the need to to have all my questions answered, the need to be reassured and the wonderful sweaty palms syndrome. So as someone who has been on both sides, here are my top tips to help you at your next dental visit. If you follow these few steps everything you hear or remember from your last dental visit will be forgotten when you leave your next.
“Do one thing every day that scares you.”- Eleanor Roosevelt
Yeh, we hear you Eleanor but can you give us a second to hear these magic tips please and then I might consider what you're saying. Okay, continue. Great well the fact you are even still reading is step one completed! So take a moment to congratulate yourself. Go on, run over to the mirror, I am brave! One second I need a glass of water, all this excitement has got my heart racing. Which coincidentally brings us to our next tip! You know this is always one of the first things to be overlooked when we are nervous, is to drink water or skip a meal. Being dehydrated gets the heart racing and leaves you feeling light headed. This is why you should remember to stay hydrated before visiting the dentist. (Just remember no sparkles or dilute, plain water only please and thank you!) Hey, even better, try to arrive 5- 10 minutes before to sit down, relax, ask for a glass or water or whip out your chilly bottle.
Okay so my next suggestion is a little old school, but I am a BIG in person sort of person. I think a great thing to do if you are nervous and have some time, which I understand won’t suit everyone, is to pop into the clinics. Instead of emailing around asking for availability or price lists. Get a feel for the staff, the clinic, the general ambiance. I think it's great to get a feel for the place before booking an appointment for a few reasons:
Firstly, I think the key to any good treatment experience is rapport. With nearly 8 billion people on earth there are bound to be some personalities that suit us better than others - and that's okay - some personalities make us more relaxed and comfortable.... others not so much. Take for example my GP. I rave about her to everyone but when I described their patient approach to a friend she was like 'oh no my GP is…..' And don't get me wrong, we both love our GPs but for very different reasons that suit our own needs.
That's why if you get to the consultation point of your journey you really should feel comfortable with the dentist. Otherwise you might be wasting your time! You won’t be able to fully communicate your concerns, goals and ask all your wonderful questions.
Secondly, I think attending the practice before can be beneficial so you don’t have the added stress of wondering how long you need to get there, following google maps and oh yeh, let’s just throw the cherry on top of when you miss your turn. Oh my, I can feel my heart racing again and breatheeeee. You know that basic life function? Well it actually just so happens to be another great tool for remaining calm before or during a dental appointment!
Focusing on your breathing calms down your nervous system and I don’t know about anyone else but focusing on my breathing requires my full attention. And so, if your full attention is on your breath, you won't be worried about what the dentist is doing. It's a win win.
Alternatives to this are to bring earphones so you can listen to music or a podcast. Or another option is asking your dentist if they can guide you through each and every step. It sounds daunting I know, but some people benefit from knowing what the dentist is doing. Like we said, anxiety is the fear of the unknown. Not for everyone, I know, but you can take from this piece what you think will work for you.
That’s it? This sounds so easy!? I know! So before you right off your dental health, or if you are sitting at home looking for the courage to book, don’t think about what you have heard or past experiences and focus on the next step. Finding a dentist that suits you and the rest is easy. You got this. Best of luck!
Sensitive Souls
Posted on 13/02/2022
Pain no gain…. A saying as old as time and not applicable when it comes to bleaching aka whitening our teeth. And no, just because I said bleach, this doesn’t mean that the stuff under your kitchen sink is going to painlessly whiten your teeth, or safely for that matter. Just like it won't kill coronavirus if you drink it. That might… actually most definitely will, cause pain. Sorry I am sidetracking, Bronagh focus! One of the most transforming steps of a smile transformation is always the whitening processes. It's amazing and a little side bonus you don’t need to worry about facetuning your teeth to match your friends sparkly white, on a not so sparkly sunday morning. Also why do you feel you need to facetune for others what you won't do for yourself? But that’s a question for another day. Today if you're ready, I want to help you decide how to obtain your very own smile glow-up in a safe and effective way.
Would you rather: long lasting sensitivity or long lasting white teeth?
I was in Tesco the other day and I was in the health aisle picking up toothpaste. It honestly baffles me how they can create so many different toothpastes when it has one simple function, I nearly left the aisle doubting my own choices with all the different buzz words and packaging, and I am a dentist! The range of choice was reminding me of the hair care anxiety you get, when you're trying to pick the right shampoo but you just want someone to tell you which one is the best, so you can be on my merry way. Well the answer is simple when it comes to toothpaste, it is always SENSITIVE based toothpaste, NO whitening, NO charcoal, NO dirt or whatever the next thing is that comes trending on the market. Sorry not sorry. And this isn’t because I don’t believe in whitening teeth. My own teeth are at the top of the shade guide. It’s just that in the EU whitening products are not licensed to have a percentage higher than 0.1% compared to 10-16% with supervised teeth whitening with dentists.
It’s a big difference, right? But I’ve used whitening toothpaste before and I know they work. Well, tell me this, are you teeth sensitive? How fun was your last clean? Because I didn’t say that they would whiten your teeth for a brief 24 hours, but how they do it, is the question. Since it is not possible to get even a tiny lift in color with 0.1% hydrogen peroxide, they lift the color of your teeth that one shade, by physically scrubbing off the top layer of your teeth. Like a bitty exfoliator on your skin, which by the way I also highly recommend against.
This mechanism of scrubbing off to whiten your teeth, thins the enamel. The enamel is the surface structure of your teeth and is responsible for your teeth being white and protected from hot/cold/sugar. So repetitive use of whitening toothpaste and charcoal toothpaste causes sensitivity and yes YELLOWER teeth in the long run.
Okay so now that they’re ruled out, what are my options? Tell me about Zoom whitening. You know the one with the light. I saw my friend after that the other day and their teeth were glowing. So the reason your friend's teeth were glowing after this treatment is because their teeth were sooooo dehydrated. The light is reflected differently causing your teeth to appear whiter for up to 7 days until they rehydrate and lose their brilliance. This dehydration process is the main reason that so many people have an association with prolonged sensitivity issues after whitening treatment. In combination with the activating light being drawn to the darker components of the teeth, to try whiten them. Little does the light know, that's the blood and nerve supply causing irritation. I don't know if white teeth are worth it.
But wait I haven’t described the most effective, predictable and safe one and it's half the price of the one with the light. The only thing it isn’t is immediate. It is not an in out job. It involves using whitening trays at home overnight for a period of about 6 weeks, but if you can’t sleep with them in 4 hours a day is enough. The nice side of this is, it’s a progessive approach that you have more control over the whiteness as the patient. Unlike the light could have you looking like Ross Geller! Any sensitivity is transient and gone the following day. 85% of people say it lasts 5 years, versus 2 years with the light and 24 hours with toothpastes. This whitening does not damage or alter your teeth as it only breaks down the stains of your teeth.
So like everything it's a process. It is not about not racing to the finish line, because slow and steady always wins the race to get long lasting results. This is how you get people wondering why you look 10 years younger!
Smile Makeovers Made Easy?
Posted on 06/02/2022
Is it that easy? It couldn’t be…. it is! Align (straighten), Bleach and Composite bonding. The most popular, conservative and easy way to achieve your smile transformation goals. Do you ever look at social media and think there is so much information out there yet not really at all. I always find this when it comes to dental treatment and skincare. So what does the A-B-C involve? I feel like I have heard of this bonding before, so will someone please give us the tea?
Make your smile your logo
After people enquire about enhancing their smile, it’s often quickly followed by a modest ‘but I still want to look like me, just be more confident about my smile’. Of course you do! You're one of a kind that that’s what makes us all so special. We don’t want to look like clones of someone else, we want to be a refreshed upgrade, like we do with our phone or car . This is why in recent years there has been a movement away from the quick fix cosmetic route of placing veneers, regardless of how crooked your teeth. Now the aim is to preserve your teeth and character by getting your teeth in an ideal position. I always recommended patients to consider straightening and whitening if you aren't happy with the position or color of your teeth prior to bonding or veneers to minimize the up keep in the future. Tell me more….
“Wear a smile and have friends, wear a scowl and have wrinkles” - George Elliot
A - So why do I say that? As mentioned we now aim for minimal intervention. While braces may seem invasive they are a one stop shop, providing a once off treatment that never has to be re done (provided you wear your retainer, of course!). In my experience there are few things in life that are a once of payment for a lifetime subscription. The reason it is favorable to start here regardless of the rest of your smile journey plans is to avoid your teeth being cut down to infamous stubs everyone is scared from seeing on social media. Preparations for crowns, veneers and bonding should be minimal. There are now many options for straightening teeth these days. My favorite being traditional fixed ‘train track’ braces or Invisalign aligners. Traditional are available in tooth coloured ceramic or metal. So when people ask me which is better, I say; neither are invisible, both are discrete and you need to choose based on what suits your lifestyle. Are you going to be taking out the aligners every time you meet your friends and forget to put them back in? Do you have a tendency to lose your keys, like I do, cause then you’re probably going to lose the Aligners! But then on the other hand you might have a wedding or conference coming up that you want to be able to take the aligners out for and not have fixed braces on for. There are so many things that only you can decide.
B - 85% of people say that professional whitening lasts 5 years. But is it safe? Professional whitening is safe and does not alter the tooth structure, as it removes stains by breaking them down through a process called oxidation. Bleaching is a crucial step to consider before investing in any further smile enhancements. Composite bonding, crowns and veneers do not whiten. They are match the color of your teeth, whether that is your old natural color or new whitened color. To maintain the whitened shade you have achieved on your teeth it is recommended to whiten one night every month or two to before a date, wedding or business meeting.
C - The most trending word in the history of social media, composite bonding also known as bonding. Bonding is essentially the addition of white filling material to either the whole front surface of the tooth, this is a composite veneer or to the edges of the teeth to make the teeth to give them a more finished and polished result to your final smile, this is edge bonding. When we talk about the A-B-C we are talking about the edge bonding. Since this is the final step, the teeth are in their correct position and complement each other, so there is no masking of crooked teeth with large amounts of bonding and the risk of chipping has been reduced.These are two important factors for achieving long term results with bonding.
When patients are preparing for their smile journey they always ask, and how many teeth do you think I will need bonded? It is a step by step process, and often patients are so delighted with their straight, white teeth (which requires basically no maintenance) that they only want one tooth instead of 8 teeth bonded or just skip bonding altogether! This is why even though the C is all the rage, it alone is a quick fix requiring more maintenance. It's important to consider the A and the B because they're the behind the scenes to achieve your optimal smile makeover.
But at the end of the day you're the boss and you’ve got to love the smile you're in!
Innovation versus social pressures
Posted 30/01/2022
Who’s watching the Sex and the City reboot, And Just Like That….? This evening I finished the episode where Carrie and Anthony attended the facial aesthetic practitioner, I was flicking through Instagram and I came across a comparison of The Golden Girls aged 53/54 versus The Sex and the City Characters aged 54/55. It was highlighting how we now view women at this age differently. But why? Why has this happened? Is it societal pressure? Or is it the progression of women's independence and their want to look good for themselves?
Research shows that women age about 10 years faster than men
Prior to this episode I was discussing a similar topic with a friend. I was having the age old never-ending-debate with myself: Do I want long hair or short hair? I had the preconceived idea that I should switch back to long while I'm young because, you know, ‘"old" people can’t have long hair'. But my friend quickly challenged me on this idea (and snapped me out of my ridiculous mindset) letting me know that women, historically, cut their hair short when they married - so as not to attract men. Short hair was a kind of sign that women were taken and this is why we have typically associated shorter hair with older women. This, of course, is now an outdated idea as women have become ever more independent from the identity of marriage. So when I saw this Instagram comparison to Golden Girls I was immediately drawn to the hair styles despite the aim of the post to emphasize the social pressures on women to get injectable treatments.
But really what is the difference between Temporary Fillers, Botox and Hair Styles? None are permanent, and they are all versions of self enhancements, to help us feel better about ourselves. In many countries the stigma of these tweaks is long-gone. Someone can now casually drop that they're popping in for a Botox top-up, or even better, as Anthony did by inviting Carrie along, bring a friend. But why are other countries still seemingly ashamed of these helping hands? Personally, I think there is so much publicized 'bad' work out there that when people mention facial aesthetics they instantly think of an ice queen or trout pout or that time Samantha Jones got a chemical peel with no preparation or planning... But then, think about it when you have a bad experience versus a good experience, which stays on the tip of your tongue for longer? Bad experiences get way more airtime, while the good ones barely catch wind. Leading to people crediting a new moisturizer when they're complimented on their fresh glow to avoid the stigma. It’s funny to think that one of the must have golden ingredients of skin care is hyaluronic acid, exactly the same as a temporary filler. So one could also wonder why people even care whether it’s on or under the skin.
The most exciting, challenging and significant relationship of all is the one you have with yourself. - Carrie Bradshaw
Although, I do have to say I was a bit taken aback with the doctor's bedside manner in 'And Just Like That'. (Not knowing who he’s treating and preying on a grieving widow). But his information about hollowing and sagging wasn't wrong. With age, our faces undergo bone remodeling and fat redistribution and in the last decade there has been a shift from masking the symptoms of this, to now rewinding the clock. This process of rewinding the clock aims to restore each individual's youth according to their needs. And I hate to break it to women out there, but we age faster than men, so no haters please and no need to be ashamed of the helping hands, if men aged the same, I'm sure they'd dabble more frequently too! But men have thicker skin, which also produces more sebum, providing moisturizing effects and have a slower rate of fat redistribution as well as bone remodeling.
So even though facial aesthetics are common amongst both men and women it's no wonder it's more prevalent amongst women, we are trying to make up for what mother nature forgot to give us. And now it’s all starting to make sense where the mother and the son relationship trope bloomed from, mother nature was playing favorites!
The aim isn’t to look like a completely different person. It’s to be able to look good for your age. Be able to look in the mirror and feel fabulous about you. And just like that….. This has all become possible with the innovation of the ever improving industry of cosmetic medical treatments.
Why I took to social media
Posted 23/01/2022
Why do you do it? Is it not such a pain to do? I’d be so embarrassed!
Things I hear all the time as a dentist that’s active on social media, and at that they are all very valid points and questions for those of you that haven’t heard my why.
As he sat there sobbing I knew there was a bigger problem
I always think it’s funny that there are so many moments that bring happiness, sadness or shock. We think they're all unforgettable but inevitably we forget most. This is one of those special few that will be forever branded on my brian.
I was ten months into a year-long temporary contract with the HSE, covering maternity leave. Like any other day, the first hour of the day was the emergency clinic. A mother had attended with her sobbing four year old son. He had ten ‘bombed’ out teeth, bearing in mind that a four year old only has twenty teeth, but not this child. He had already been treated in Crumlin Children’s Hospital under general anesthetic only 5 months earlier, to get the other ten teeth removed, and now he needs the other ten taken out. Toothless for crucial developmental years until his adult teeth start to appear at six. Two years where his speech and eating will be affected, on top of the inevitable psychological impact .
Now I hear what you are probably thinking cause it was what I was thinking. The child is under the care of his parents and the child's health is being neglected.
It was wracking my brian to how this could have happened. I began by bringing it back to basics. I discussed the diet and the frequent exposure to sugar. ‘Okay but he has to have his glass of 7up every day’ his mum told me, genuinely distraught, that he needed to go back to the children's hospital to go under general anesthetic (FYI this kid has no underlying health conditions, that he needs 7up). When I asked her why, she told me that after the general anesthetic he felt faint and the doctor told the nurse to get him a glass of 7up and now she doesn't want him to faint. So she’s been giving it to him every day, ever since. She weighed it up, and based on her knowledge of the possibility of him fainting, trumped his dental health. She was not aware that the faintness was associated with general anesthetic wearing off. She acted in what she thought was his best interest, based on the knowledge she had; she just didn’t have nearly enough. It was at that moment I reflected on my life as a dentist’s daughter, who studied dentistry for five years. What seems to be common knowledge is not so common, and there is little to no exposure to information on ‘basic’ dental health care.
‘Without knowledge action is useless and knowledge without action is futile.’- Abu Bakr
The thought of history repeating itself haunts me. Even though I know I can’t stop it from happening again, I took to social media, in hope that if I help even one person become more informed and happier about their choices, then that is good enough result for me. In a field that is renowned to be boring, I believe the way to get people interested and engaged with dental health and it’s connection to their body is through social media, by making it accessible and fun for everyone.
So far I have thoroughly enjoyed this journey, helping and connecting with people and I look forward to seeing what the future holds. To be a part of this journey check out my instagram, podcast or see me back here next Sunday.
Sending love
Ireland's Toothfairy