DentistGoneBadd was a General Dental Practitioner for over 30 years. He clung on to his registration with the desperation of a spider swirling down a plug hole, until his pension ripened and he flushed it away. He now sees a psychotherapist and giggles a lot.
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Interviews

Interviews

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JUN
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Dental School

Dental School

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JUN
10
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Keeping Mum

Keeping Mum

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JUN
03
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DIY Dentistry

DIY Dentistry home cures

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MAY
20
1

Mental Health in Dentistry - my story

Mental Health in Dentistry

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jennifer pinder

Your Courage is an example to ...

I'm glad that you retired and have respite from the anxiety caused by being a dentist. I know the sense of relief that arrived the... Read More
Wednesday, 22 May 2019 10:39
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13
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The best irrigant is Empathy

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MAY
06
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Time Gentleman, Please

Time Gentleman, Please.

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29
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Dental Nurses - the Good, the Bad & the Giggly

Dental nurses - the Good, the Bad & the Giggly

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20
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Radiographs

Radiographs

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15
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The Lost Art of Complete Denture Making

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APR
07
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Raindrops keep falling...

Raindrops keep falling on my head.

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Mark A Speight

You're not wrong

Tuesday, 23 April 2019 17:11
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MAR
18
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50 ways to offend a patient

50 ways to offend a patient

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MAR
11
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Who gave Voldemort the apex locator?

Who gave Voldemort the apex locator?

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MAR
04
1

Teamwork

Teamwork

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Julie Deverick

Good read...

Thanks, a change in culture is difficult but can be achieved if we have the support you have obviously shown. The BSDHT/BADT respo... Read More
Tuesday, 05 March 2019 20:04
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17
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The Adventures of Dr. Den

The Adventures of Dr. Den

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At first I was afraid, I was Petrified...

at first I was scared, I was petrified

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Hitesh Mody

Life after GDC

Completely understand your post about stress when under a GDC investigation. As a follow on, I have been following the case about... Read More
Wednesday, 13 February 2019 08:39
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FEB
03
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Guess Who?

Guess Who?

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JAN
27
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Referral Letters

Writing Referrals by

Writing referral letters

The Definitive Guide To

Writing Referral Letters

By

@DentistGoneBadd

 

 

Basic Referral Writing

Let’s start with the essentials. Referral letters should contain the basics; name, sex (if any – I don’t like to ask really), date of birth and reason for returning….oh sorry, that’s sending a parcel back to Amazon. Long gone are the days of “Please see and treat,” so try and give the specialist you are referring to, a bit of a clue as to the reason for your referral. Throw in a couple of vague differential diagnoses if you can, just to demonstrate you aren’t completely gormless, with proper medical terms like ‘epidermolysis bullosa’ or ‘squishy lump.’ It’s probably best not to refer a patient just because you don’t like the look of them, tempting though it is.

Writing referral letters

Choice of Specialist

If you are worried about a lump, it’s best to send to a consultant lumpologist. But beware, some specialisms do cross over and consultants can get a bit elbowy and will fight over interesting lesions. I once witnessed a near fist-fight between an oral medic and an oral surgery registrar – both convinced they could write a paper about it. Every time, make sure you are referring to the most appropriate department. One department will treat a lesion with a spray and ineffective mouthwash, while another will cut it out and put an implant in its place.

 

Oral Surgery Referrals

Oral surgery referrals are probably the most common type made. It’s not quite clear why this should be. Fewer dentists get into trouble over oral surgery than perio neglect or root-treatments. I think that oral surgery is probably all a bit too gooey for a lot of dentals and the anticipation of complications is overthought. Because oral surgery departments are absolutely swamped, you have to make a convincing case. Warfarin patients are no longer a bar to treatment in practice, so throw in ‘difficult access’ and ‘a history of difficult extractions’ for good measure. ‘Proximity to the antrum’ doesn’t often wash. Since many oral surgery departments insist on you supplying a supporting radiograph, they can justifiably throw out the referral and tell you where to stick your jpeg when they realise it’s a lower molar you are talking about.

Writing referral letters

Orthodontic Referrals

These are probably a little more clear-cut, if you completely ignore IOTN, which I did. I doubt very much if it’s done now, but the acronym ‘FLK’ (Funny Looking Kid) in the margins of the old paper files, acted as a reminder to refer to the orthodontist once the overcrowding started to hurt your aesthetic sensibilities. I find FLK’s generally DO get orthodontic treatment, so providing they are reasonably competent with toothbrushing, and generally look as if they’re using the hairy end, send that referral. Again, don’t just ask to ‘see and treat’. Throw in ‘well-motivated,’ ‘optimal oral hygiene’ and ‘very stroppy mother’ to emphasise the need for action. Chuck in a couple of measurements if you can, and try and crowbar in a stab at a ‘division’ to show to the orthodontist you’ve given it some careful consideration.

Writing referral letters

Periodontal Referrals

This type of referral is usually done in panic five minutes after you have just unexpectedly lost a BPE probe down a previously scoring ‘1,’ so do try and keep the panic out of your letter. Make it sound like you’ve been closely monitoring things for a considerable period of time and really emphasise that when you first saw the patient, most of the damage was already done. ‘Despite my oral hygiene instruction’ also shows that you have been caring, but don’t get too down about having to refer and being condemned by the periodontist. The specialist will probably only see the patient for twenty minutes max anyway, and will never see them again, immediately throwing the patient into the ‘Pit of Hygienists.’

Writing referral letters

Endodontic Referrals

Endodontic referrals are becoming incredibly popular and you are highly unlikely to get one rejected, since they are often made to private specialists. Don’t bother trying to refer to your local dental hospital. The sun will have died well before your patient gets to the top of the list. Besides, dental hospital endodontists are exceptionally picky about what they treat. My local dental hospital won’t treat any tooth beyond a first molar. They aren’t that clear why, though I suspect it’s because trying to get to a seven is a bit ‘too fiddly.’ Failure in endodontics is a growing area of litigation and if you are an NHS dentist in particular, don’t risk ANY root-treatment – refer. You can throw a lot of information into your referral letter – sclerosis, unusual anatomy or “There’s a prominent squiddly-do on my radiograph” – but it doesn’t matter. These are endodontists. They have to pay for swanky microscopes and German Sportwagen. They’ll accept anything.

magnification

 

Implant Referrals

See Endodontic Referrals. Patients think they are the same thing anyway.

 

Prosthetics Referrals

Tricky. Prosthetics specialists are a dying species. Their natural habitat in the 60’s and 70’s was gummy, but since forestation with teeth, the need for them has diminished. The few prosthetists left, tend to pack together at dental schools, desperately attempting to procure close relationships with implantologists, borne out of their innate instinct to survive. Having said all that, I have had more referrals rejected by prosthetics specialists than any other type. To be absolutely honest with you, whatever you say in your referral to a denture specialist, they’ll write back with “We would recommend extending the flanges and see no reason why this cannot be carried out in practice. Now leave me alone. I need to bury my nuts for the winter.” Good luck.

Writing referral letters

Community Clinic/Paediatric Referrals

This is where you send all of your ‘challenging’ patients, or those that take an hour to do an enamel-only incisal edge composite on. Terms you should include in your letter are ‘wriggly,’ ‘anxious,’ ‘fearful,’ ‘phobic’ and ‘gagger,’ though be careful you don’t end up making it sound like a Facebook advert for happy hour at the local S&M Club. Make it absolutely clear that this patient needs sedation. Forget about suggesting GA. The clinicians at these emporia don’t stop talking about the risk of death from the time the patient enters the place having found it after previously mistakenly walking into the adjacent STD Clinic. If your local clinics have their own referral forms and it gives you the option to have the patient back if they refuse sedation, tick ‘NO!!!’

Writing referral letters

Restorative Specialist Referrals

 

Quite a few restorative specialists lurk in dental schools, but despite this, they try not to have anything to do with teeth. There is only one important, indeed, CRITICAL sentence you need to include in your referral letter, and that is: “I am ALREADY monitoring the diet and wear.”

 

Oral Medicine Department Referrals

 

You will normally refer to the oral medicine specialists as a means of backing up your diagnosis, which is almost certainly, atypical facial pain/burning mouth syndrome. Often, you would save a lot of time by giving a nightguard or benzydamine hydrochloride rather than wasting your time on a referral letter.

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JAN
21
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Fake Dental News by @DentistGoneBadd

Fake Dental News by @DentistGoneBadd

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4332 Hits
JAN
14
0

Pointless?

Pointless

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JAN
07
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The GDC

The GDC's financial situation

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DEC
27
0

2019 Horoscope

2019 horoscope by @DentistGoneBadd

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2897 Hits
DEC
17
0

Dear Santa by @DentistGoneBadd

Dear Santa

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2144 Hits
DEC
03
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Looking Back

Looking Back

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NOV
23
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Reading the Warning Signs

Reading the Warning Signs

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NOV
12
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Clawback

Clawback

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OCT
29
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Balancing Views

Balancing Views

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OCT
22
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Breaking Bad News

Breaking Bad News

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4325 Hits
OCT
14
1

How the GDC struck a Dentist off by mistake

You Couldn’t Make It Up

(How The General Dental Council Fouled Up – BIG TIME)

By

@DentistGoneBadd

Anyone who read my blog of a couple of weeks ago, which attempted to satirise the General Dental Council’s recent online opinion survey, will probably not be surprised by the alacrity with which I have jumped on the opportunity to outline the following episode, which beset an unfortunate general dental practitioner a few days ago.

The following events are true. The main action took place on Friday 12th October, 2018. The names of the “very professional” GDC employees have been withheld and the name of the protagonist has been changed. With a deferential nod of acknowledgement of the recent Royal Wedding, I will call the protagonist, who is very well known to me, Eugenie. I thank her profusely for granting me permission to relate her sorry tale to you. 

Eugenie is a GDP currently working in general dental practice in a dental corporate. Her precise location she would like to also keep secret, but she describes it as ‘Moderately gentile, Middle Earth.’

Eugenie has been an NHS dental surgeon for 30 years and after a career as a full-time GDP, she decided earlier this year, to take early retirement and “escape the nightmare of NHS corporate dentistry.”

Eugenie being ‘exceptionally anally retentive’ (her words), she put in the appropriate pensions paperwork to the NHS Business Services Authority, informed her employer of her intentions and also the local NHS Area Team.

The latter irritated her somewhat, since she received communications twice from the Area Team, asking her if she was taking ‘24 hour retirement’ – her Area Team being unable to fully comprehend and understand the phrase “taking full retirement.” The Area Team also asked twice if she could confirm she had told her ‘employers’ of her intentions – the Area Team also failing to remember the concept of self-employed associates.

Being mindful that the GDC had taken over £900 quid off her earlier in the year for 12 months of exquisitely executed administrative services, Eugenie wanted to get her money’s worth and decided to retire on December 31st, 2018. Remember that date, it is important. That date was disseminated to all those that needed to know at the business end of dentistry, and she decided as a conscientious i-dotting and t-crossing individual, she would also inform the GDC of her desire to be removed from the General Dental Register on……come on, I told you to remember the date…yes, correct, the 31st December.

Ten days or so after submitting her letter, the GDC sent a form back to her via email, for ticking and signing and posting. Eugenie was surprised to find that she didn’t have the final say as to whether she could remove her name from the Dental Register. It was up to the GDC to decide if she had a valid reason to leave and the letter advised her that she would be informed of the GDC’s decision on whether to remove her name, in due course. Eugenie speculated that this was possibly to prevent someone in a spot of forthcoming bother, from removing his or her name before the GDC had the opportunity to strike them off themselves.

On the form, Eugenie was adamant that she made it clear she was removing her name due to retirement AND noted on the form, her desire for that procedure to be carried on after….come on…..anyone….31st December, 2018.

Skip forward to last Friday, 12th October. Eugenie was on an ‘early’ and by 9.45am had seen a bridge prep, a filling and two examination patients. It was the custom at the corporate practice Eugenie works at, for reception staff to hand letters to dentists at lunchtime, or earlier if the letter looked like it needed early attention. On Friday, the head receptionist handed Eugenie an unopened letter marked ‘General Dental Council.’ Eugenie nearly tossed it behind the computer monitor for later perusal, suspecting it was a letter confirming her removal at the end of the year. But something, fortunately, made her open it, because it was a letter from a ‘Registration Operations Officer, dated 10th October informing Eugenie that she had been removed from the Dental Register as from 9th October – TWO DAYS EARLIER. This mean that Eugenie had not only worked illegally as a dentist that day, but since the previous Tuesday. In other words, she had been, without her knowledge, breaking the law for four days, with, presumably, invalidated dental indemnity insurance.

She was chilled to the bone when she looked at the GDC register online and found she definitely wasn’t registered.

The practice manager was called. Eugenie and the manager agreed that she had to stop work immediately and her day was cancelled. The next patient, sitting patiently outside her surgery was fortunately very nice about the fact that she had wasted a forty mile round-trip, and happily rebooked.

An understandably irritated Eugenie then rang the GDC and spoke to a ‘very nice lady’ who eventually told her that on neither Eugenie’s letter or returned form, had she informed the GDC of her retirement date. After Eugenie’s protestations that she knew she had put the date on both pieces of correspondence and following the GDC representatives’ ‘consultations with colleagues,’ the GDC lady apologised for the ‘mix up’ – she had apparently been ‘looking at another person’s letter’ when she had given the previous statement that there was no date on Eugenie’s correspondence. The GDC lady said that a member of the Registrations Team would ring her back.

After one hour, at 10.45am, there was no call and Eugenie rang again, this time speaking to an equally pleasant GDC worker. She couldn’t apparently raise the Registrations Team and so Eugenie left her with the chilling message “I’ll be back.”

At 11.45am, still no joy, but this time the original person Eugenie had spoken to, answered the phone. She said the Registrations team were at that very moment looking into the matter and would definitely be in touch in the afternoon. By this time, Eugenie had decided not to leave the practice until the GDC had telephoned on her mobile, not wanting to be caught out having to take a call in the car. She said she spent the whole morning whining to colleagues and swearing a lot, as well as threatening the Registrations people by email with ‘action’ if she was not reinstated immediately.

Around midday, a sheepish, very polite gentleman from the Registrations team telephoned Eugenie and apologised profusely for the mix-up and reassured her that she would be reinstated immediately and that her name would reappear on the register online, after midnight.  

What confused Eugenie was that this particular Registrations officer gave her a totally different explanation as to why the mix-up had happened. The first GDC worker said that the wrong registrant’s application had been accessed initially, while this Registrations man was saying that while Eugenie’s first letter to the GDC clearly stated the date of deregistration had been seen and noted, a second registrations officer had processed the GDC form without seeing the original letter and that form did not state the date. To Eugenie’s recall, she did date the form, the need for the date being critically important.

On having an early finish on Friday, Eugenie fired off an email and recorded delivery letter to the GDC, asking for a scanned or hard copy of her returned form – a form they still had in their possession and had apparently accessed on Friday. This letter was mainly to check and reassure herself that she wasn’t actually going insane, so sure was she that she had put the date carefully on the form, which the GDC were adamant she hadn’t.

Eugenie checked online on Saturday morning and found that her name was back on the Dental Register.

So all’s well….or is it?

One of the primary roles of the General Dental Council is to, (to quote the recent survey):

“Maintain(s) a register of dentists and dental care professionals, and check they meet requirements.”

I dunno, but I would have THOUGHT that if there was any ambiguity with regard to a dental professional’s intended removal, they would have double-checked with the practitioner. The GDC had responded to the original request for removal by sending the form to Eugenie, so surely that correspondence could have been looked at? After all, it is the most final act in a dental professional’s working life.

The other question regards the first GDC worker’s statement that she had been looking at another registrant’s letter! What???? Another letter on Eugenie’s file belonged to another registrant? I mean, GDPR and all that, surely???

I REALLY hope you all took the opportunity to fill in that survey, and if you did, you give them Hell when they start the telephone survey.

Happy retirement, Eugenie xxx

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Recent comment in this post
Dr. Andy Bates

Rejected by the Survey

I'd have liked to give my views - But the the first question " Are you *Male * Female * Prefer not to say" I responded "Prefer not... Read More
Tuesday, 16 October 2018 09:58
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OCT
01
0

GDC Survey: by @DentistGoneBadd

The GDC Survey

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SEP
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Periodontology in practice simplified by @DentistGoneBadd

PERIODONTOLOGY IN GENERAL DENTAL PRACTICE

PERIODONTOLOGY IN GENERAL DENTAL PRACTICE

A New, Simplified Classification System For General Dental Practitioners

By

@DentistGoneBadd

 

Introduction

We present here, the results of a thirty-five minute workshop on new periodontal classifications compiled by the only few General Dental Practitioner’s we could find that were even remotely interested in gums and jawbone. This is the first time GDP’s have been bothered to categorise (or take notice of) gum conditions and we feel it will be a more useful day-to-day guide than those new classifications issued recently by the American Academy of Periodontology and the European Federation of Periodontology. The workshop was carried out during a Curry Club Thursday at the Salisbury Wetherspoon’s.

Methodology

Brian wrote everything down on a beer mat because the screen on his iPhone stopped working after his ios12 update went pear-shaped. We wrote down everything we could think of regarding perio, without Googling it, not that Brian could anyway.

Classifications

GINGIVAL TISSUES

  1. 1. Perfick

The patient has no inflammation, deposits or staining. This has nothing to do with you or your ‘diligent’ care. Either the patient has been to another practice, or is just extremely lucky. Treatment – NHS – none required.   Private – One to two sessions with the hygienist.

  1. 2. Bit Gammy – But Not Worth Getting The Scaler Out

The patient has a little bit of plaque or stain that is forgivable bearing in mind the goofiness she presents with and having to control the three kids that are currently all trying to make a human pyramid on the nurse’s chair. Teeny bit of bleeding when you bodged it with the BPE probe, but no calculus. Treatment – NHS – MAYBE a polish. OH advice – “You’re missing a bit – get an electric.” Private – Two to three sessions with the hygienist.

 

Gum tissue by DGBadd

 

  1. 3. Quite Gammy

The patient has dirty-filthy-muk-muk everywhere as usual – I say everywhere, it’s mainly on the lower linguals of three to three (there MAY be other stuff but you didn’t look anywhere else). Some crowding is hindering OH, but the patient doesn’t really make an effort. Neither do you really. Treatment – NHS – get the blunt hand scaler out. No air scale since the phantom of the practice has bent all the inserts (how DOES that happen?) Private – Three monthly scales. This proves to the GDC disciplinary panel that you were providing continuing care.

  1. 4. Incredibly Gammy

Even YOU can’t ignore the dirty-filthy-muk-muk between the 6’s and you are too scared to push the BPE probe in too far in case you hit a ‘3’ and end up having to do a full perio chart (even if you COULD find a perio probe). Treatment – NHS – See what you claimed previously and see if you can get a Band 2 perio out of it. Order an air scaler and hide it so it doesn’t get either nicked, bent, or boils the water as it passes through. Private – This pays the hygienist nurse’s wages for six months.

  1. 5. Acutely Gammy

Punched out interproximal gingivae, necrotic look, breath that would stop a charging rhinoceros in its tracks at 100 metres. This is the first time you have asked if the patient smokes or is under stress. Treatment – NHS – Metronidazole and smoking cessation advice – SORTED! Private – The patient doesn’t return after the Flagyl.

Gum tissue acute by DGBadd

  1. 6. Pregnancy Gammy

You can breath a sigh of relief. It’s not you, it’s hormones.   Treatment – NHS – A quick prophylaxis. Private – You can’t, she’s exempt. It doesn’t seem right.

  1. 7. “Brushed Too Hard This Morning”

This does not exist. Occurs because the patient uses a brush like a Brillo Pad and doesn’t try and get in between the teeth. This is YOUR fault.

Gum tissue hard brush by DGBadd

PERIODONTAL TISSUES

  1. 1. Bone Loss, But Patient Knows About It

You have inherited this patient from another practice or a colleague, so breathe a sigh of relief. Pre-existing bone loss, but patient is on top of OH. Treatment - NHS – Give the patient a pat on the back. Private – Two-monthly scales with the hygienist under local.

  1. 2. Bone Loss, But You Didn’t Know About It

As you are flicking around the lower incisors with a blunt sickle, you notice the lower right one is a bit wobby. You sneakily apply a little bit of lateral force with the scaler to all the teeth and discover ALL are a bit wobbly. Treatment – NHS - As you were, but in the notes, emphasise that you reinforced the need for interdental OH and daily TePe use. Private – Refer to the hygienist and on the prescription note “Hygiene has slipped a bit.”

Gum tissue splint by DGBadd

  1. 3. Bone Loss, You Knew About It And Splinted It

Your pathetic broken splint is cutting into the patient’s tongue. Treatment – NHS – You casually mention the phenomenon known as ‘Immediate Dentures’ and hope the patient doesn’t listen to local commercial radio and catches an advert for dental litigation lawyers. Private – Not appropriate. The hygienist is a stickler and might report ‘concerns’ to the authorities.

  1. 4. Terminal Bone Loss

You check how long you have treated the patient and then check your dental indemnity subscriptions are up-to-date. Treatment – NHS – Ask lots of questions about gum disease in the patient’s parents and plant the seed that the condition is inherited. Private – If the patient asks if they need to see the hygienist, either say you haven’t got one, or price the patient out of it. You really don’t trust that hygienist. Her eyes are too close together.

  1. 5. Chronic Periodontitis

Also known as ‘chronic’ periodontitis. Has been there forever and you haven’t really addressed it. Treatment - NHS - Pull yourself together and do something about it before you retire. Private - NOOO! You keep checking the hygienist’s scrubs pockets for digital voice recorders.

  1. 6. Acute Periodontitis

Also known as Peri Peri Periodontitis. You diagnose that a bit of Nando’s chicken has got stuck and irritated the gum. Treatment – NHS – Pull the bit of chicken out (preferably with your eyes closed – Ewww Ewww Ewww) and claim Acute Mucosal. Private – Squeeze in with the hygienist and get them to pull the chicken out. Charge £60.00.

  

PERI-IMPLANTITIS

  1. 1. Also known as “What the Hell? I didn’t know that was even possible.” Treatment – NHS – Arrange the following words in order: Touch Barge Pole Don’t A With. Private – Refer back to the implantologist.
  1. 2. Advanced peri-implantitis. Same reaction. Treatment – See above, but TWICE as fast.
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10
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Simpler Times

Simpler Times

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3664 Hits
AUG
26
0

Only Dentistry Can Save the Earth

Carbon Footprint

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13
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Pump up the Volume by @DentistGoneBadd

Pump up the Volume, a plea to the Chief Dental Officer (England) by @DentistGoneBadd

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JUL
16
0

The New Health Secretary by @DentistGoneBadd

The new health secretary

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JUN
24
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Increased Dental Litigation

Increased Dental Litigation

(Is It ALL Down To Patient/Lawyer Greed?)

By DentistGoneBadd

“This theory which belongs to me is as follows. Ahem. Ahem. This is how it goes. Ahem. The next thing that I am about to say is my theory. Ahem. Ready?”

Anne Elk (1973) Monty Python’s Flying Circus


It was a glorious September afternoon in 1966. The sun was streaming through gleaming windows. England had won the World Cup, and I had just moved to an exciting and brand new senior school. The classroom had spanking new desks with inkwells, filled with free ink you could draw up into your refillable Parker fountain pen. All was well with the world.

Mrs Wojciechowski, who was also our form teacher, was beginning our first ever French language lesson. I was trying hard to concentrate and confess I missed the meaning of ‘je m’appelle,’ because Peter Hadley who was sitting next to me, was crushing and drowning wasps in his inkwell, with what I regarded as an inferior fountain pen – the sort that scratched, rather than flowed Quink luxuriantly on to the page. Another failing of his pen was that as a tool for Vespidacide, it was failing miserably, one poor creature valiantly struggling to get itself out of the inky torture chamber. Not knowing at that point that Peter Hadley was a distant relative of a notorious Birmingham crime family and was destined to become the school’s head ‘hard-knock,’ I nudged him out the way and offered the tip of my pen to the bedraggled Hymenoptera, so that it had a means of escape from an indelibly inky death.

I suddenly heard a scream that sounded like a French woman shouting ‘murderer,’ but later realised I was in fact witnessing my first ever French swear-word - ‘merde,’ to be precise. I looked up to see Mrs Wojciechowski (French-born, despite her name) bearing down on our twin desk with a wooden ruler in her hand, and quicker than one of my Maryland bridges falls off, she had whacked the back my hand with the EDGE of the ruler, with all the might that her 4ft 6in frame could muster.

This episode was not only painful and a miscarriage of justice, but humiliating to boot and for the rest of that year, Mrs Wojciechowski looked at me with a deep loathing, like I had presented my dentist with the post-crown for recementing after I had retrieved it from the bottom of the Armitage Shanks two days after swallowing it. Upon realising I was under constant surveillance by Mrs Wojciechowski, I made sure I was never near a wasp, bee or inkwell ever again in that school.

I switched to a BIC not long after.

“My theory is along the following lines. Ahem."

We all know inherently, that it is becoming more and more difficult to avoid complaints these days, bombarded as the public is, with targeted Internet adverts and radio advertising. Even looking up and typing ‘dental complaints’ in Google as research for this article, brought up a host of dental litigation firm’s adverts on my Facebook page and various online news sites I read regularly, within an hour.

I strolled into a colleague’s surgery the other day to catch the end of a radio advert by ‘THEM’ – you know, the Cheshire-based mob, enticing dental patients to use them for all their dental litigation needs. I was appalled – I never listen to radio in the surgery – I just inflict my old-bloke’s iTunes playlist – from the Bee Gees to The Eagles to Snoop Dogg on my nurses day in, day out. It’s the reason I oppose permanent nurses, it means they don’t fatigue and burn out on my repetitious Barbara Streisand and Pussy Riot.

I couldn’t believe that these litigation firms were so ‘in-your-face’ with their radio ads, but my colleague confirmed that she heard them at least a couple of times a day and she often talks loudly over them to distract the patient in the chair from memorising the phone number.

Not only are civil claims mediated by the specialist dental litigation firms rising at a seemingly exponential rate (if you don’t believe me, look at your indemnity organisation’s annual subscriptions year-on-year), but cases brought to the GDC’s Fitness to Practice (FtP) process are also rising faster than caseworkers can write ‘dishonest’ on a charge sheet even if you haven’t been charged with dishonesty. From 2010 to 2014, FtP cases rose by 110 per cent. What the rise in civil and GDC cases is now, in the four years since 2014, is difficult to ascertain, but I feel it’s not outlandish to bet that the same rate of rise is probably not far out.

Most of us will know someone who is currently experiencing a spot of bother with the NHS Area Team, the GDC, or more likely, some chancer who has been taken in by a law firm who has found their supply of whiplash clients has suddenly dried up. A colleague of mine has recently been pursued by a patient claiming damages for a dry socket. Sheesh.

But, is the increase in patient expectations, fuelled by the easy access to no-win-no fee legal services, the only reason for the large rise in dental patient complaints?

“Ahem. This theory which belongs to me, is as follows. Ahem. Ahem. This is how it goes. Ahem. The next thing that I am about to say is my theory. Ahem. Ready?”

Well, here goes.

We all know nowadays, that the most important issue surrounding litigation is the paperwork. Have you recorded the BPE? Have you recorded why you are taking radiographs? Have you recorded why you aren’t taking radiographs? That’s what we’re obsessed with – getting the paperwork right so the statistical algorithms down at the NHSBSA don’t flag us up, or so we have a nice neat piece of work to show your defence organisation when they summon you for a day long grilling at a plush lawyer’s office in Lincoln’s Inn Fields.

But the whole reason you have ended up in trouble is that the patient wasn’t happy with your treatment (or some pig of a dentist who never liked you dropped you in it, but that’s another matter).

Have we taken our eye off the ball?

<

So. I would ask the question: Have we taken our eye off the ball?

“My theory is along the following lines. All brontosauruses are thin at one end, much MUCH thicker in the middle, and then thin again at the far end. That is the theory that I have and which is mine, and what it is too.”

Before 2006 and the introduction of the UDA-based ‘new’ contract, we all had, every few weeks, a sample of completed patients pulled by the Dental Reference Service and dragged into some God-forsaken community dental clinic, to have their work checked. The Dental Reference Officer (DRO) would check that you had a) carried out what you had claimed for, and b) done it nicely and hadn’t missed anything.

Admittedly, quite a few patients didn’t attend as requested (despite the fact they had consented to do so in the small print), but as a recent graduate, I was always quite on edge knowing that my work was going to be scrutinised by dentists that I considered by be my elders and betters. Dentists had the option of attending the DRO’s examination. In the main, I chose not to go. On one occasion, I did go.

And frankly, these checks focussed the mind. I was never accused of missing perio during that time, though I was once criticised for leaving a sub-gingival ledge the size of Chiswick on the distal of an upper six. Knowing that ANY patient could be pulled in for post-op examination by a DRO meant you left nothing to chance, even if you did note it. The DRO’s rebuke over the ledge, to my FACE, was like Mrs Wojciechowski’s ruler across the back of the hand. I have been very wary of ledges ever since. They have a nasty sting. I've missed LOADS of other stuff, but ledges are at a minimum.

I have no evidence for my theory, but I do wonder if the increasing litigation, particularly with regard to periodontal problems, could be as a result of there being no, what I would call ‘proper,’ check on the work carried out by dentists. (And this is by no means confined to NHS dentists). Even when cases against dentists go forward, patients are RARELY actually examined.

Anyway. That is my theory. That is what it is. Do we need to go back to DRO checks?

I would frankly, welcome them.

Epilogue

In 1983, after I had been at dental school for a year – some ten years after leaving school, I attended a summer garden party with my wife. Across the garden, I noticed a pair of latecomers. An elderly, tall, burly, Eastern European looking man with a shock of white hair, and a petite little lady of similar vintage, hanging off his arm. I instantly recognised Mrs Wojciechowski.

Encouraged by my wife, I approached her. My former teacher clearly didn’t recognise me ( l like to think I had by that time turned into a swan), so I introduced myself as one of her former pupils.

She said three words to me (this is absolutely true) and walked away:

“Oh **** off!”

And it wasn’t in French.

Quotations from Episode 31 Monty Python's Flying Circus BBC 1973
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I’m Sorry, But I Think You Need Therapy

europe

By @DentistGoneBadd


This is where I stand.

A few years ago, before David Cameron adopted the foetal position and waved the white flag to the advancing UKIPS, giving them the Brexit referendum, I was stopped by a ‘kipper’ in the high street of my adopted home city. I was asked if I wanted to forever remain ‘dominated’ by some ‘faceless European bureaucrat who would force us to consume straight bananas and live in dimly lit buildings powered by puny Dutch lightbulbs, or put the ‘Great’ back in Britain.

I answered thus:

“If I were the Prime Minister and had unlimited funds, I’d build a motorway bridge from here (the Midlands) directly to Paris.”

It was a nonsense answer – the sort that Donald Trump would have given – but I thought it got my point across. I am, and always will be, a European - a citizen of the world. I think Brexit is madness, and at a time when the world is becoming more and more fragmented, I strongly feel we need unity.

I’m Sorry, But I Think You Need Therapy

In the past couple of weeks, two of my closest dental friends – both from the EU, have indicated that they are thinking of returning to their countries of origin, having worked in UK dentistry for several years. Both were worried about the uncertainty surrounding their rights to residency – an issue still not absolutely clarified by the UK Government.

Another East European friend has recently left my corporate practice to go into independent dentistry, unable to cope with the madness of the NHS, UDA system. This has left the corporate practice critically short of clinicians and attempts to bring in either a permanent dentist or long-term locum has failed. (OK, fair enough, it IS a corporate after all). Many foreign dentists I have met have all been working for a UDA rate much lower than their home-grown counterparts and it is them in the main (it appears to me) that are prepared to work at a rate UK-born dentists would turn their noses up at.

One former corporate practice manager told me recently that she was told to offer prospective dental associates different UDA rates – foreign nationals being offered two pounds per UDA less than their UK counterparts.

Associate Shortages

I know of a number of NHS practices locally, which are currently struggling to find fully qualified associates of either UK, EU or other origin and this of course contributes to the lengthening of waiting lists and reception desk grumbling. With unattractive salaries on offer, particularly from the corporates, it is no wonder some practices are struggling to recruit. I once put myself on a few dental jobs websites and despite pleading to be taken off, am daily bombarded with all manner of associate jobs, from part-time to ‘whatever you can manage.’

Besides EU nationals going home as a result of Jacob Rees-Mogg, in 2017, a private Freedom Of Information request obtained from the General Dental Council showed that foreign dentist numbers dwindled in 2016, since nearly 40% of dentists who were found to have impairment of their fitness to practice originated from the EU or outside the UK and EU. This represented just over 3.7% of the total ‘foreign’ dentist workforce as contrasted to the 0.2% of naughty UK dentists based on 2018 registrant figures.

A search of the number of dental therapists in trouble with the GDC finds no such comparable statistics. Apart from one therapist in 2005 who was erased for performing a filling without a dentist prescription and one in 2013 who forgot to pay her Annual Retention Fee, there has been an exceptionally low rate of fitness to practice cases brought against therapists.

These days, since I work in a corporate, I meet very few therapists, but I have a very high opinion of them from personal experience. I will admit, I was forced into it because I couldn’t find an associate to move out into the sticks where my practice was located, but I employed a dental therapist in my own practice for a while a few years ago and her work was very good - providing a top-notch client service as well as taking patient appointment pressures off me. Her employment was also economically, a ‘no-brainer,’ being cheaper than employing an associate at 50% renumeration. I also trained with a mature dental therapist in the early 80’s. She flew through the dental course with ease, knocking spots of her classmates.

A Solution?

With many practices searching fruitlessly for fully-qualified post-vocational training dentists to replace fleeing dentists (for whatever reason), I wonder if we are missing a trick? Why not put these underutilised dental professionals to full use? Even the corporates haven’t caught on to this yet – presumably because they haven’t done the sums fully. Dental therapists can perform a wide range of tasks that can leave the corporate associates more time for searching for materials or stabbing the practice manager in the back. The only fly-in-the-ointment would be the stroppy associate who resents writing a prescription, but they can always be blackmailed with ‘OK. Do you want to do a radiograph audit after 5.00pm?”

In independent/NHS practice, remuneration would be a simple matter of a salary or hourly rate. In corporates, a nod to the associate’s prescription input would have to be acknowledged, so that he can get on to providing Band 3 mouthguards for someone who may have heard a vague click in their left TMJ in 1998.

Having said all that, I WILL miss my European colleagues if they do decide to go.

When I first met her, one of my EU friends was trying to pick up some British colloquialisms, mainly taught to her by her dental nurse, a girl with a mischievous sense of humour.

I arrived with my wife at the new house she was occupying with her now (British) husband. We had a lovely traditional meal from her home country, but then she apologised for the lack of furniture, and although we were perfectly comfortable at the dining table, she pointed to a couple of ample beanie’s in the lounge area and asked “Or would you prefer sitting on the douche-bags?”

David Cameron, what did you do?

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Marian Greally

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Dentistry Is Not Immune From Harbouring Sexual Abuse. We Must Be Vigilant Too.

Dentistry Is Not Immune From Harbouring Sexual Abuse. We Must Be Vigilant Too.

As a Brit, I was both ashamed and proud of the revelations coming out of Westminster this week - ashamed that a small number of our elected representatives could act in such a grubby and misogynistic manner, but also proud of the way that the whole decades-long business is being exposed and acted on in an open way, even if it has been fuelled and inspired by our free press.  There was something typically British and admirable in Sir Michael Fallon’s quick decision to resign from his post as defence minister, as opposed to my disdain for the USA’s Orang-Utan in Chief who has a considerable number of accusations of sexual assault outstanding against him and is a self-confessed and unashamed “pussy-grabber.”

It’s become obvious from the ubiquity of the ‘metoo’ hashtag (#metoo) 

this week, that few walks of work life are free from sexual innuendo, threats and frank abuse and I have been wondering at what point the medical and dental professions will stand accused of similar behaviour either in the present or the past.  What follows, has bothered me for years. There was nothing I could do about it at the time, and nothing I can do about it now, but I felt it was time to at least illuminate the fact that dentistry is not immune from the abuse of women.

I trained in the eighties in a fairly well-known dental school. There was a reasonably affable relationship between the students and lecturers – there were some lecturers who were frankly, evil bastards and there were some who treated you as sentient adults and although you wouldn’t go out for a pint with them, you would say “Good morning” to them in a corridor without ducking into the nearest toilet facility.

Some lecturers (and yes, it IS males) however, had a closer than affable relationship with female students and it is one that I need to focus on.  This married lecturer was a reader in restorative dentistry and was a phantom head instructor.  He always seemed to have a pally relationship with the female students and before long it was rumoured that he was having an extra-marital affair with a young student in the year below me.  The affair became quite open within the dental school and he would often turn up at finals nights and exam celebration nights at Med Club.  I didn’t follow that closely, the ins and outs of the relationship, but since it was so well-known, I assume that the dental school authorities turned a blind eye to it since the female hadn’t protested.

A few months after I qualified and left the dental school, friends of mine who were still at the dental school separately told me that the lecturer and been frequently ‘bothering’ a new and attractive dental student in a sexual manner, to the point where the young woman went to the head of the restorative department to report it. 

She was later called to the Professor of the department where she found herself confronted by the Prof and the lecturer in question with the threat that if she were to take her complaint any further, they would ensure that she would fail finals.

I was told a few months later, that the young woman managed to find herself  a place at another university and transferred.  She apparently took her complaint no further.

I believe the head of the department is long retired (or hopefully dead), but the lecturer in question has risen to the heights, is nationally known, and is in active charge of students.

I didn’t know the victim, or even if she would have wanted to have taken this incident further.  The fact that I didn’t?  I am ashamed. 

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Don Gibson

Abuse

Wow. Unbelievable. I noticed an attempted close relationship between one of our female students and one of the prosthetic techni... Read More
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Julia Easton

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Couldn't find these on SOE! My favourite in the days of paper notes was CPITN (complete pain in the neck)
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