CONFIDENTIAL 9th October 2023 Wytes 94-96 Walworth Road Elephant & Castle London SE1 6SW Ms Mervelee Myers 16 Alma Grove Bermondsey London SE1 5PY
Dear Ms Mervelee Myers, Thank you for attending your assessment appointment on14 September at Wytes Dental. Further to your visit to the surgery I have had an opportunity to study your clinical presentation and x-rays (full mouth x-rays were taken in May 2023). The following is the summary of the report and proposed treatment plan. Please find a description of terminology at the end of this letter. On presentation you had no major complaints and have noticed an improvement in your gum health. Medically you suffer from high blood pressure and are diabetic. You are not taking your medications for your blood pressure and are under review with your GP. You have had some recent tests carried out including an ECG for which you are waiting results. For your diabetes you were previously not taking prescribed medication as advised by your GP, however, recently you have started taking Metformin and you have had a blood test to review your blood sugar levels. A clinical examination at your assessment revealed: • Clinically sound soft tissues. • The majority of the gum pockets are 4-5mm. • There are some localised pockets of 7mm and 9mm affecting LR5. There is increased mobility of the following: • Grade 2 (moderate mobility) – UR2 • Grade 3 (severe mobility) – LR5 We had an extensive discussion regarding your periodontal condition and I explained that since seeing you in 2021 you have had a vast improvement in the periodontal pockets. You are aware of some teeth with a poor prognosis including UR6, UL7, LR6 and you are aware that these teeth will likely need extraction in the future. For now, you would like to maintain these for as long as possible and you are aware of the risk of further pain, infection and bone loss around the adjacent teeth. The LR5 has a hopeless prognosis due to severe bone loss and increased mobility, again, you would like to keep this tooth for as long as possible and the risks are as above. Your oral hygiene is good, however, you mentioned that you are using the electric toothbrush 1-3 times daily and interdental TePes most days, but not every day. Even though there has been a great improvement in your oral hygiene since you first came to see me, I explained that since you are genetically susceptible to gum disease, with other predisposing factors such as diabetes, we need to improve your oral hygiene even further if possible. This will include the regular use of an electric toothbrush and interdental TePes as discussed. You have shown good technique with the use of interdental TePes. I also explained the bidirectional relationship between diabetes and gum disease which is why blood sugar levels are so important. I would like you to provide a report of your most recent blood tests and send them in if possible. I have recommended periodontal surgeries, however, since there needs to be an improvement with your blood sugar levels and oral hygiene, I would recommend this to be carried out first and then a reassessment in 8 months’ time. I would recommend 4 monthly maintenance with the hygienist and I will reassess you in 8 months’ time. Alternatively, you may decide: Not having any treatment, in which case periodontal disease will continue causing bone and gum breakdown which may complicate periodontal treatment and also lead to potential tooth loss. Loss of more bone may also make any potential dental implant placement more complex. There is also some evidence that periodontal diseases may be associated with systemic diseases such as diabetes and cardiovascular diseases. Thank you for attending your appointment. I look forward to seeing you soon but if you have any questions or queries in the meantime, please do not hesitate to contact me. Kind regards, Dr Rajvi Patel Specialist Periodontist BDS MPerio RCS (Ed) DClinDent Perio Treatment Cost Estimate At the reassessment any residual gum disease may need to be treated by further non-surgical periodontal therapy or periodontal surgeries, the cost of which will be discussed at the re-assessment. Periodontal surgeries are from £650 each (depending on the type of surgery and number of teeth involved) Cost estimates are valid for 6 months from receipt of this letter Procedure Cost Non-surgical periodontal therapy 4 monthly sessions required with hygienist £180 for each session Periodontal reassessment 12 weeks after treatment with specialist £130 What is periodontal disease? Periodontal disease is an inflammation of the gums, which if left untreated, can lead to bone loss around teeth. The main cause of periodontal disease is bacterial infection, however the severity and extent of the disease depends on patient susceptibility and on various systemic (e.g. genetics, smoking, poor oral hygiene, diabetes etc.) or local (e.g. teeth position, presence of plaque retaining restorations etc.) risk factors. Periodontal diseases progress at different rates in different individuals according to their susceptibility and their exposure to these local and systemic risk factors. What is a periodontal pocket? You may hear the term ‘periodontal pocket’ being used when discussing your treatment. This describes the gap between the gum and underlying bone. In healthy gums there is a small gap between the gum and bone, and this is termed a ‘closed pocket’. Since the gap is small, fewer bacteria are able to enter and cause gum disease. In areas of active gum disease where there has been some bone loss, the gap between the bone and gum increases and this is called an open pocket. More bacteria are able to enter this gap which leads to a higher risk of further bone loss. The numbers that you hear during your assessments describes measurements of periodontal pockets. The aim of gum disease treatment is to reduce open pockets to closed pockets. Although we are unable re- establish the original bone level, by closing periodontal pockets we reduce the risk of more bacteria entering the pocket. This reduces the risk of further bone loss around a tooth and therefore reduces the risk of future tooth loss. How do we close periodontal pockets? Initial therapy describes the first stage of treatment of gum disease. This will include oral hygiene instruction in order to improve brushing and reduce the level of bacterial infection. This will also include debriding or removing bacteria within the open periodontal pockets which you will be unable to reach with normal toothbrushing. This will be carried out under a local anaesthetic. What is a periodontal surgery? Gum disease surgery is treatment for residual open periodontal pockets that have remained after a round of initial deep cleaning. Not everyone will require gum surgeries and this will depend on the response to the initial cleaning, which in turn is affected by factors such as the initial severity of gum disease. The need for periodontal surgeries will be discussed with you at your periodontal reassessment Plaque score- the percentage of tooth sites with plaque present. Ideally we would like this <20% Bleeding score – the percentage of gum sites which bleed. Tooth prognosis: This describes the long-term survival of a tooth and aids in assessing whether a tooth will benefit from treatment. Mobility: How ‘mobile’ or loose a tooth is. This may occur after losing bone support around a tooth. Furcations: The portion of a tooth where it divides into its roots REPLACEMENT OF MISSING TEETH: Denture: A denture is an appliance which can replace one or more missing teeth and which can be removed from the mouth. Bridge: A dental bridge is a false tooth suspended by an adjacent tooth/teeth (abutment tooth/teeth). There are two types of bridges; a sticky bridge which may be ‘stuck’ using dental adhesive to the inside of neighbouring tooth or a conventional bridge where a false tooth is suspended off a crown which is then cemented onto the neighbouring tooth. The use of an adjacent tooth as an abutment requires a restorative assessment, as both the tooth itself needs to be sound (eg no cavities/decay) as well as its foundations (bone levels) Dental implant: A dental implant is a ‘screw’ which is placed into the jaw bone on top of which a crown is placed. The placement of dental implants depends on the bone levels. In gum disease patients, bone has been lost which means that bone augmentation may need to be carried out prior to dental implant placement. In addition, dental implants can only be placed in stable patients. If you are gum disease patient, this needs to be stabilised prior to placement of dental implants otherwise there is a higher risk of bone loss around the implant itself. Tooth notation In this report the teeth are described as follows: UR = Upper Right. LR = Lower Right. UL = Upper Left. LL = Lower Left The number indicates the tooth in each quadrant beginning from 1 for central incisors (front tooth) to 8 for wisdom teeth, e.g the upper right central incisor is UR1 and the lower left permanent first molar is LL6. 1 = Central incisor 2 = Lateral incisor 3 = Canine 4 = First Premolar 5 = Second Premolar 6 = First Molar 7 = Second Molar 8 = Third Molar (wisdom tooth)
Let the world know that I pay attention to detail. #facebook decided to terrorise #merveleemyers to close my account, so I lose my Defensive Practice to clear my name from #LEYFnCohorts and the Employment Tribunal regulations. Here’s my son #kevinmurray in the frame.
All reactions: 2Valdin Legister and Barbie Khan 12. Share On this day 5 years ago
Let me take pride in introducing my youngest grandchild to the Employment Tribunal, #LEYFnCohorts and #faceboook. Tell Facebook I am not scared of the Terrorism. I have been fighting discrimination in the UK from 2004. Just ongoing Windrush Generation stories.
All reactions: 7Valdin Legister, Andrea Nembhard and 5 others 3. 5. Share
On this day 5 years ago
Valdin Legister is with Mervelee Ratty Nembhard. · Put in your order, the General tomatoes will be ready soon. #eatwhatyougrow……#growwhatyoueat……. Nav, preparing to take on this world!!!All reactions:75You, Andrea Nembhard, Hilary Nembhard and 72 others1012ShareOn this day5 years agoActiveMervelee Ratty Nembhard · Shared with PublicTime 4 choir practice. Maybe I learn #2pensongs re Facebook Discrimination? #MerveleeMyers_FactDay10: What a woe mi nation? & Brimstone…!ShareOn this day5 years agoActiveMervelee Ratty Nembhard · Shared with PublicLet me leave Fake Book with this info abt #Jamaicans, we have Brer Anansi #survival instincts. #MerveleeMyers_FactDay10!2ShareOn this day5 years agoActiveMervelee Ratty Nembhard · Shared with PublicBates Wells Braithwaite, were U aware JohnFenton was an #imposter, pretending 2 be part of Ur CO? #MerveleeMyers_FactDay10.1ShareOn this day5 years agoActiveMervelee Ratty Nembhard · Shared with Public
#MerveleeMyers_FactDay10: LEYF Nurseries know they are making a damn fool, saying they have no #data except the ET bundles? 1. Share On this day 5 years ago
Daily Express Russell Grant – Taurus: Don’t get caught up in superficial considerations. Just because your romantic life doesn’t look like anyone else’s does not mean you should be embarrassed. The sooner you bless your circumstances, the better. The conventional life is boring.
Evaluation: I went and ask for my #3husband hand in marriage already. So let them stay there planning for me? This bloke don’t half know, what’s best for him, so I will have to give him a nodge here and there?
I was born and raised at #Townhead. If it is in big rat, it’s in mouse-mouse.
#FactDay10: If cyberspace want to know if Mervelee Myers is a #visionary, check my Facebook memories? That’s why LEYF Nurseries – #LEYF pay FB to block me…
Taurus: You’ve defintiely been putting in those extra miles so it’s good to see that your efforts are coming to the attention of those in power. Happy work stars are now enhancing your career prospects. Call to hear why you’re taking that step back.
I guess I can close this chapter in my life & say I done my little bit to #Celebrate the life of my #LittleYoungCousinJanet Beeput. Time to close another chapter in the life of another of my #Family, but the #Memories will continue to live on!
Oliver 2moro & I may have a spare ticket? Found £5 in the bus in broad daylight! Was honest enough to ask the last person I saw at the spot if it was hers? 1 a my Yardie Lady say 2 me fi put it in me Pocket, so I started a conversation bout hoping it is my Lucky Break? She was singing from the same Sanky about wanting to win loads of Money so she can tell sum Peeps a few home truths & board the Flight fi YARD! She from Kingston & me from Back-a-Cow-Tail WESTMORELAND…! Lawd a Massey if only me Luck could TUN UP fi true?
All reactions: 11. 2. 5. Share On this day 10 years ago
Time to salute 1 of the 1st Independent Woman of my era from Townhead – Grung Road. The locals called her Ms Campbell & she was the wife of Mass Tat Sinanan. Sorry to say I don’t even know her other name & I am blaming this on the fact that she never resided in my Voting & Population Census areas. She was God-Mother to my breda Amly & this meant she was a person of unblemished & exemplary standards to be afforded such an accolade from my straight laced Parents?
Ms Campbell ran her Business Empire from the back of her family home and I am very sure she did give Owen aka Hurry-Hurry Sinclaire a run for his money. She travelled to town regularly to stock up on supplies to satisfy the needs of her many customer. Anyone who was anyone from far & near went to Ms Campbell for a bit of retail therapy. It was also a case of one’s name being good, so one can trust & pay later.
It was customary for us children to make pilgrimage to visit God-Parents so they can live up to the pledge they made. I usually loved accompanying my breda to visit Ms Campbell not just for the goodies we get to take home, but for other reasons too. One such was the way she would try to call my breda by his 3 names & never succeeded in saying them right, then she’d laugh out loud and say “I don’t know where Mass Ivan got these names from…”
On reflections I am thinking that Ms Campbell may have stammered, but am not sure? Ms Campbell made her mark by doing her own business & never stood by & expected her husband to support her & provided her every needs. I am sure if she had taken the decision to rely on Mass Tat, he would have complied. But she became a role model for other women by becoming 1 of the 1st women to establish herself as an entrepreneur. Ms Campbell became the fore runner for others like Bev McIntosh aka Big John’s wife & Ms Pearl Johnson. They were amongst others who were to become the back bone in supplying us with foodstuff at one time in Jamaica’s history when food did a married to all manner of things before they could get into our pots to feed the hungry masses. God blessed the Entrepreneural Spirits of the likes of Ms Campbell who was one of the beacon amongst STRONG BLACK WOMEN of her times. 3. Share. On this day 10 years ago
After my put up pon & dung… I encountered 1 hell of a time travelling pon LT? OmG I decided not to walk cauz a di inclement weather & ended up suffering fah my Obstinacy! Never got home until nearly 3 hrs on the road? Well wat fi duh, like most tings in Life, I doan hab much of a choice? 5. Share. On this day 10 years ago
The entire week I have pushed myself to the LIMIT working on my Pet Project bcauz its time to celebrate Multicultural Diversity as this impact our lives in this Diverse country which is Great Britain! Built myself up only 4 it 2 cum crashing down pon me when dis Faccy-Faccy Kin JignarWarMouse cum pass dem rassclaat plc wid me! Me feel like telling the dutty crablouse bout dem Muuma White Fowl, but me bite me lips 2 a MPT cauz me memba sey dem hab di hangle & me heng on pon de blade a de Backra Missis Machete! Dem wind me up a ready & mek me lose me cool & me swear to everything Dear to mi dat dem not gwine hear me lass wud nuh matta how hard dem try again? 1. 5. Share. On this day 13 years ago
Done my exam today so back on the radar of FB. I am packing away my books and forget about studies. I stole this from a T shirt and am embracing it totally. “I was born intelligent but education ruined me”. Will adapt this mantra till the study bug get hold of me again (rofl). 5. Share You’re All Caught Up
Let the world know that I pay attention to detail. #facebook decided to terrorise #merveleemyers to close my account, so I lose my Defensive Practice to clear my name from #LEYFnCohorts and the Employment Tribunal regulations. Here’s my son #kevinmurray in the frame.
Let me take pride in introducing my youngest grandchild to the Employment Tribunal, #LEYFnCohorts and #faceboook. Tell Facebook I am not scared of the Terrorism. I have been fighting discrimination in the UK from 2004. Just ongoing Windrush Generation stories.
All reactions:
7Valdin Legister, Andrea Nembhard and 5 others
3
5
Share
On this day
5 years ago
Valdin Legister is with Mervelee Ratty Nembhard. · Put in your order, the General tomatoes will be ready soon. #eatwhatyougrow……#growwhatyoueat……. Nav, preparing to take on this world!!!All reactions:75You, Andrea Nembhard, Hilary Nembhard and 72 others1012ShareOn this day5 years agoActiveMervelee Ratty Nembhard · Shared with PublicTime 4 choir practice. Maybe I learn #2pensongs re Facebook Discrimination? #MerveleeMyers_FactDay10: What a woe mi nation? & Brimstone…!ShareOn this day5 years agoActiveMervelee Ratty Nembhard · Shared with PublicLet me leave Fake Book with this info abt #Jamaicans, we have Brer Anansi #survival instincts. #MerveleeMyers_FactDay10!2Share
Daily Express Russell Grant – Taurus: Don’t get caught up in superficial considerations. Just because your romantic life doesn’t look like anyone else’s does not mean you should be embarrassed. The sooner you bless your circumstances, the better. The conventional life is boring.
Evaluation: I went and ask for my #3husband hand in marriage already. So let them stay there planning for me? This bloke don’t half know, what’s best for him, so I will have to give him a nodge here and there?
I was born and raised at #Townhead. If it is in big rat, it’s in mouse-mouse.
#FactDay10: If cyberspace want to know if Mervelee Myers is a #visionary, check my Facebook memories? That’s why LEYF Nurseries – #LEYF pay FB to block me…
Taurus: You’ve defintiely been putting in those extra miles so it’s good to see that your efforts are coming to the attention of those in power. Happy work stars are now enhancing your career prospects. Call to hear why you’re taking that step back.
I guess I can close this chapter in my life & say I done my little bit to #Celebrate the life of my #LittleYoungCousinJanet Beeput. Time to close another chapter in the life of another of my #Family, but the #Memories will continue to live on!
Just a word of Warning…? I have been Fucked up Many Times in the Past, so if U send me any Links – No Matter how Genuine…? Plz don’t feel offended if U don’t get a Response, cause U know wat I nah CLICK pon nuh Link, U get Me! The PCB are Busy Monitoring & I aint Giving nubaddy nutn fi PPI!
All reactions:
2Judith Gordon and Princess Tenegnework Aynalem Lawless
They tried to Silence her, but couldn’t? Now she has a Bright Future ahead of her! How Many More of Us are been Silenced in the Name of Political Correctness I Wonder…?