In the second of her series of articles for GDPUK, Hewi Ma of Brabners Solicitors discusses common legal pitfalls in the business of Dentistry.
In the second of her series of articles for GDPUK, Hewi Ma of Brabners Solicitors discusses common legal pitfalls in the business of Dentistry.
Jeremy Hunt revealed the contents of his 2023 Budget in the House of Commons last week. Amongst announcements on household energy bills, free childcare and corporation tax, the Chancellor unveiled surprise changes to the pension tax regime that could benefit anyone who is a higher earner.
While the landscape for dentistry has changed considerably since I started in the industry some 25 years ago, one thing has remained the same - our patients need to know we will look after them.
In the first of her new series of articles for GDPUK, Hewi Ma of Brabners Solicitors discusses common legal pitfalls in the business of Dentistry.
Jayne Gibson shares four key questions to ask yourself whether your plan provider is right for you or if it’s time to move on...
When you’ve been working with your plan provider for a while, it can be easy not to notice that you may not be getting the best service.
The long established income protection provider Dentists Provident, has released its claims statistics for 2022.
Following a record year in 2022 for patients on plan, and as more practices decide to introduce membership plans and join the Practice Plan family, we’re adding some extra pairs of hands to the team to ensure we maintain a great level of customer service.
Iain Stevenson, Head of Dental at Wesleyan Financial Services, shares key financial planning areas for dentists to address for the year ahead…
Practice Plan Head of Sales, Zoe Close, talks to CSR expert and coach, Mark Topley, about the part CSR can play in helping practices beat the recruitment and retention crisis.
General dental practitioners are largely paid to fix things. To examine, to diagnose, to treat and to review at whatever recall period is appropriate.
Donna Hall examines what practice teams need to look at when choosing the right plan provider to work with.
In this GDPUK exclusive interview, Guy Tuggle talks to Dental Therapist Eleanor Ridge about her recent trip to Malawi with Dentaid.
Michael Copeland, Dental Regional Manager for Wesleyan Financial Services, reveals sought-after financial nuggets when it comes to life after work for dentists…
As Managing director of Christie & Co’s medical division and a dental specialist, Simon Hughes has been working the UK dental market for nearly a decade. In an exclusive interview with GDPUK he gave his insights into the current state of the ‘business of dentistry’ in what is an increasingly complex market for practice sales.
Contract reform is on the agenda again – or maybe it never left. A recent paper in the BDJ from Rebecca Harris and Rachel Foskett-Tharby of NHS England describes the problem of the current dental contract as ‘wicked’ or ‘stubborn.’
Practice Plan Sales Manager, Zoe Close suggests that, contrary to popular opinion, we may be entering a time of great opportunity for dentistry.
In a football season where a statue has been raised in Plymouth of Jack Leslie, a black footballer, racism is in the news. Leslie played 400 times for Plymouth Argyle in the 1920’s and 30’s, scoring 137 times in the football league. Selected for the England squad in 1925, in the form of his life, he was inexplicably then dropped.
Suki Singh talks to dentist and Head of Indemnity at the BDA, Len D’Cruz, about the inevitability of complaints and how to prevent them from escalating.
Paul Barnfather, Specialist Dental Financial Adviser for Wesleyan Financial Services, shares how there is a cost when delaying financial planning for retirement.
Much separates the UK for the USA.
An ocean, obviously.
And language - ‘Two nations divided by a common language’- a comment variously attributed to George Bernard Shaw or possibly Oscar Wilde or even Winston Churchill.
I mean, who knew that the exhaust pipe on your car is a muffler and the bonnet is a hood? Chips/crisps, fries/chips, pants/trousers, jelly/jam – the opportunities for misunderstanding are endless.
When it comes to the differences in advice with regard to management of patients at risk of infective endocarditis (IE), the chasm between the UK and the USA is very wide indeed.
The American Heart Association (AHA) continues to recommend that antibiotic prophylaxis (AP) is given to those undergoing invasive dental procedures (IDP) and at risk of IE.
Those at increased risk of developing IE include people with
IDPs which should be covered by AP are defined as
The European Society of Cardiology (ESC) recommends that AP is restricted to those at highest risk of IE.
However, in the UK, since 2008, the National Institute for Health and Care Excellence (NICE) guidance has stated that “antibiotic prophylaxis against infective endocarditis is not recommended routinely for people undergoing dental procedures.”
The evidence for the use of AP before IDP’s appears to be lacking and causal links with bacteraemia’s from tooth brushing have been suggested. Despite research published in 2013 which found an increase in IE in the UK followed a decrease in AP prescriptions subsequent to the issue of the 2008 guidelines, the NICE recommendations have largely remained unchanged since then.
However, a recent paper in the Journal of the American College of Cardiology, by Martin Thornhill of Sheffield University and colleagues, provides evidence that an association between IDP’s and the development of IE in at risk individuals. Using diagnostic, treatment and hospital admission coding from almost 8 million case records, it was found that the chances of acquiring IE following extractions or other oral surgical procedures were significantly increased for those at high risk. Where AP was provided (in 32% of cases) there was a significantly reduced risk of acquiring IE. The low rate of compliance with the AHA advice about AP is possibly explained by a lack of understanding of the guidance or a belief that AP is the responsibility of the cardiologist, not the dentist.
The authors suggest that their findings “provide evidence to support the current AHA and ESC recommendations that those at highest risk of IE should receive AP before IDPs”, implying that the current NICE guidance is out of date.
NICE guidance to UK dentists continues to be that AP is not routinely recommended and that
“Healthcare professionals should offer people at increased risk of infective endocarditis clear and consistent information about prevention, including:
So - watch out for new guidance soon!
But for TMD, there’s a bridge over the pond!
The regular reader of this blog (there’s probably only one, I’m a born pessimist) may recall that the first in the series, back in January, discussed the management of tempero-mandibular disorders (TMD) and asked to whom patients should be referred. Given its links to other chronic pain conditions, a multi-disciplinary approach to care and management seemed appropriate.
And here’s a move towards that. A recent paper in the British Dental Journal – A commentary on Tempero-mandibular disorders: priorities for research and care – bridging from the US to the UK (Durham,J, Greene,C and Ohrbach,R) reviews work from the US indicating that ‘the current dental-focussed treatments for TMD must be re-conceptualised toward a multi-disciplinary, inter-professional team approach, involving specialists within the broader healthcare community.’ International co-operation to create registers to gather data on patients’ health and treatments should provide sufficiently large datasets to allow the development of clinical guidelines for patient care. Centres of excellence for treatment are proposed for treatment of TMD s and management of oro-facial pain. Already in the UK, a National Orofacial Pain Alliance has been set up, drawing together the expertise of oral surgeons and clinical psychologists.
So, as we move into fall, perhaps we can take a rain check on our dental differences with the USA, and wait to see how NICE has gotten on with some new guidance.
Regional Support Manager, Emma Flunt, reflects on some of the points raised in a recent Practice Plan workshop by Marcos White on adapting the patient journey to the digital age.
From listening to Marcos, I realised that’s it’s possible to use digital tools of some sort for the whole of the patient journey. In his practice he uses a 3D printer, digital design, milling, guided dentistry, a scanner, iPhones so images can be sent by WhatsApp to patients, AI (artificial intelligence) apps to show how good people’s teeth could look and a CBCT scanner which is a scan that can show both bones and soft tissues. Every part of the process has a digital element. He even uses digital language as he describes treatment planning and delivery as a ‘workflow’ which involves a combination of digital tools.
Porcupines – literally ‘spiny pigs’ - have a gestation period of about six months, which is completely irrelevant to dentistry but a useful introduction to the subject of recall intervals for dental patients.
Dental, Health examination
With most of Europe in the grip of a cost-of-living crisis, now is a good time to make sure you’re getting the best value from the money you’re spending.
Many people, even if they really love their job, understandably look forward to a life of leisure after retiring – and the sooner they can get there, the better.
Your NHS dentistry and oral health update
19 July 2022 (Issue 50)
An update from Sara Hurley and Ali Sparke
You don’t have to hang around on Twitter for very long these days to discover that there are some subjects you cannot raise without receiving a barrage of opinion and sometimes abuse from both sides of the argument. Accusations of being a (insert subject here)phobe are rife.
On 16th June 2022 the Employment Appeal Tribunal (EAT) handed down its decision in a case concerning a dentist claiming worker status. This is another in a long line of cases where dental associates have claimed that they are not ‘self-employed’, but instead have worker status.
There has understandably been concern amongst the dental profession that this decision will significantly impact the future of NHS dentistry. However, it is important to bear in mind that the EAT did not determine that the associate was a worker, only that the original employment tribunal’s determination that she was not had been incorrectly reasoned. The case will now return to the employment tribunal for rehearing.
Crucially, this is not a current case, in that the associate in question was working under a 2010 version of the BDA contract; a contract that since has been updated on at least two occasions.
Whilst some important points have been raised by the EAT, which may require dental practices to consider their current business model, it is important to bear in mind that the EAT has not been asked to consider the current BDA contract, which no doubt was updated as a result of the spate of cases on worker status in recent years.
In this article we set out the facts of the case and comment on the EAT’s decision; as we represented the dental practice in this matter, we have an insight into the facts and findings.
Before we review the case, it is helpful to remind ourselves of the test for worker status. A person is a worker if they work under;
The latter is often referred to as a ‘limb B’ worker. You also have to bear in mind that a person can be self-employed for tax purposes, but a limb B worker for employment purposes.
What the tribunal will ask itself:
When looking at the first point, the courts will look at the substitution/locum clause and whether there is any ‘fettering’, or limitation, on that clause. The more fettering there is, the more likely the dentist is required to perform the work personally.
For the second point the tribunal will consider how much control the practice has over the associate; how much the associate is integrated into the practice.
The dental practice is a corporate with locations across the country. The dentist had originally worked in Oxford, before moving to their Kensington practice 2021. The dentist was working under a contract that said:
In the event of the Associate’s failure (through ill health maternity paternity or other cause) to utilise the facilities for a continuous period of more than 14 days the Associate shall use his best endeavours to make arrangements for the use of the facilities by a locum tenens, such locum tenens being acceptable to the Primary Care Trust and the Company….
The dental practice argued that this locum clause meant the dentist was not required to provide the services personally. Whilst the dentist had never sent a locum herself, evidence was provide to the tribunal of other dentists within the business utilising the locum clause, for example for sickness and maternity leave.
However, the contractual term only imposed an obligation to send a locum after 14 days of not utilising the facilities. The practice in response gave witness evidence that dentists within the business, as across the profession, were entitled to send a locum at any time.
The tribunal accepted that the locum clause meant the dentist was not required to perform the services personally and her claim was rejected.
By the time the case came before the EAT, the Supreme Court had handed down its decision in Uber. Whilst the Court of Appeal overall decision was the same. The Supreme Court made it clear the test is a statutory test not a contractual test. The focus should be on the reality of the of the working relationship, not the contractual one. Whilst the contract can be helpful, the courts must look at what happens day to day.
The EAT relied on this case when determining this appeal and found that the tribunal judge had relied on contractual interpretations over statutory provisions.
The EAT went on to find that the tribunal judge was wrong to find there was no fettering on the right of substitution in this case. They considered the following were such fetters:
In the opinion of the EAT, the above all amounted to fetters on the right to send a substitute, meaning the dentist was required to perform the services personally.
The EAT did not consider the second part of the test, which has been remitted to the tribunal to consider the point by a fresh panel. This means the dentist has not yet been found to be a worker; only that she was required to perform the services personally.
The BDA has since updated its template to state:
The question now is whether the above amendment is sufficient to avoid worker status.
Julia Furley, Barrister and Laura Pearce, Senior Solicitor
No doubt we have all followed a car down a road, with billows of smoke emitting from an open window, and wondering whether said vehicle was on fire. Similarly, who hasn’t been walking down a pavement and been nasally insulted by puffs of bubblegum or apple pie and custard from an enthusiastic vaper?
See also this link for vaping ...
Further link here re vaping, f...
Stephen Barry, Specialist Dental Financial Adviser for Wesleyan Financial Services, shares the lesser-known risks when it comes to the cost of living crisis, where you may see a reduction in the purchasing power of your money…
Emma Flunt talks to Simon Gallier about why he decided to leave the NHS, for the second time, and turn his 95% NHS practice to private and how he’s now feeling about the future…
Back in the past, I used to hate dental materials lectures. It all seemed so irrelevant. I just wanted to know the material worked. I couldn’t get excited about the chemistry. Oh, I remember the important stuff.
Wesleyan Financial Services’ Kabir Ahmed interviews Kevin Culliney, Partner at Densura, to discuss the key occurrences that are changing the face of dental indemnity…
Walking to dental school one day, I met one of our professors, carrying a cage.
A conversation ensued.
‘May I ask what is in the cage, Professor?’
‘You may, Mr. Hellyer – it’s a monkey of the species Macaca Irus.’
Two years on from the start of the pandemic, Phil Barlow, Specialist Dental Financial Adviser for Wesleyan Financial Services, looks at how COVID-19 has impacted the dental property market and what that means for those looking to sell their practice in 2022…
There can be very few dentists who turn patients away because the challenge is too big. Even if they can’t complete treatment themselves, they’ll at least point the patient in the right direction.
Amongst the many salaries that your GDC registration fee helps to fund is that of Daniel Knight. He has the title of Stakeholder Engagement Manager, where he leads on student and new registrant engagement.
Birmingham-based specialist financial services mutual, Wesleyan has announced it will be supporting 15 dental students from disadvantaged communities with scholarship funding worth over £65,000. Each student will receive scholarship fees of £1,500 per year for the first three years, as well as regular mentoring and practical support both before and at the University of Birmingham.
The need for skilled dentists is more urgent than ever due to the pandemic. Dental surgeries were closed for months in lockdowns and many people are still avoiding routine check-ups for fear of COVID-19. This means people often need more complex treatments for advanced tooth decay and gum disease when they do see a dentist.
Nathan Wallis, Chief of Staff at Wesleyan said: “We’ve always been committed to supporting dentists through every step of their careers, from their first appointment right through to retirement, and we are proud to support 15 students, at the start of their professions. Not only do we care about our communities and the challenges of social mobility, but we also understand that access to funding is critical to getting started at university.”
Professor David Adams, Pro-Vice-Chancellor and Head of College of Medical and Dental Sciences, from University of Birmingham said: “Undergraduate dentistry students study for five years, instead of the usual three for many other subjects; by choosing to go into a field where they can help others, they are making a huge financial commitment. The scholarships from the Wesleyan Foundation will help to ease the pressure on students who would have otherwise struggled to get started at university.”
The scholarships form part of the University of Birmingham’s Pathways to Birmingham (P2B) programme, which has helped over 5,500 young people from underrepresented backgrounds study at the University over the last 20 years. The P2B programmes are targeted at young people who are the first in their family to go to university, are from low-income households, live in a postcode where few people go to university, have a disability, have been in care and/or are estranged from both parents or guardians.
Wesleyan, the specialist financial services mutual, launched the Wesleyan Foundation in 2017 as part of their commitment to supporting great causes that are important to their customer base of doctors, teachers and dentists, and the communities in which they live and work.
Zoe Close speaks to dental recruitment specialist, Emma Anastasi, about ways to recruit top team members in your practice… One of the many ways in which COVID-19 has changed our world has been the impact it’s had on workforces worldwide.
I have a friend who is a proper scientist. You know the type, PhD after their name, and understands all the stats stuff like Cronbach’s alpha, Spearman’s r and the Wilcoxon Rank Sum test. Their area of research was water quality and they spent 3 years gathering data from the outfall from sewage works. Three years collecting dirty water samples and theirs is the prefix of doctor and the suffix PhD.
Collecting waste water has become a bit of a trend during the Covid pandemic. The BBC reported that fragments of the virus’ genetic material can be identified from sewage, even when there are only asymptomatic cases in the area. Identification is not easy because of other contaminants but clusters of infection may then be identified before symptomatic cases appear and preventive strategies targeted earlier than would otherwise be possible.
And if the virus is shed from one end of the gastro-intestinal tract, then it’s almost certainly at the other end too. We know that the virus gets up your nose and gathers round your tonsils. Never in the field of public health, has so much sneezing and gagging gone on in the bathrooms of this country as we test, test, test, desperately hoping for that single pink line to appear on the test kit. But what about that fluid that dentists spend their time fighting against? What about saliva?
There have been multiple research papers published in the past months, about the link between saliva and Covid, many fast tracked for dissemination in the fight against the disease. A recent study from the US confirmed that the virus was present in the saliva of both asymptomatic and pre-symptomatic patients. A quite specific review suggests that as saliva is easy to collect and saves the need for swabs-on-sticks-up-the-nose, which are uncomfortable and pose a risk of bleeding in some cases, then saliva testing for evidence of the presence of COVID-19 might be a more acceptable test mechanism. The review found that passively collected saliva had a high sensitivity rate to detect Covid in asymptomatic and mildly symptomatic patients when compared to naso-pharyngeal swabs. Passive collection – drooling, basically – means there is no contamination of the saliva from coughing or nasal discharge.
So there’s Covid in spit – who knew? All those prevention strategies for aerosol generating procedures must have been worth it. But as the Government appears to remove all restrictions to normal life, how long before all those restrictions on dentistry are removed? Abandoned to the whims and fancies of the asymptomatic, untested – ‘it costs money, guv’ – maskless patient. Do we assume everyone is Covid positive, just as the basis of universal precautions is that everyone carries HIV or Hepatitis C? Back to normal then, with current screening depending largely on questions regarding symptoms and test results.
When carriers of Covid can be asymptomatic and there’s no longer testing freely available, questions about symptoms and test results appear to have limited use. There may be a future for a simple saliva test, to check what precautions are necessary before treating any patient. But I suspect that would be considered discriminatory and ethically unacceptable.
What then can be added to the standard procedures to help prevent spread of Covid? A pre-operative mouthrinse reduces the viral load in saliva for between 15 and 45 minutes. Maybe a 30 second swish of Chlorhexidene or hydrogen peroxide will become the norm for everyone.
Rubber dam is of course another weapon in the armoury of the dentist to reduce contaminated aerosols in the surgery Those of us of a certain age will recall the enthusiasm of Keith Marshall’s ‘Dam it, its easy’ courses. There’s surely an opportunity here for an entrepreneurial educator to set up some hands-on dam refresher courses.
And since condom sales fell by 40% during lockdown, there may be some good opportunities for sponsorship from manufacturers as they seek alternative outlets for their rubber. Presumably there will be fewer contaminants in the wastewater, too.
With the end of the tax year fast approaching, there’s no better time to start thinking about spring cleaning you finances.
Paying particular attention to your tax-free allowances and reliefs is always a good place to start. Aaron Prested, Specialist Dental Financial Adviser for Wesleyan Financial Services, answers key questions around making the most of this tax year:
Throughout the 30 years of my career there have been peaks and troughs regarding the NHS dental system. Actually, the peaks (to me at least) have really only been less deep troughs, but I’m sure you will understand what I’m saying. Most of time the profession has seemed to just get on with it and accept what the various contracts have offered, and learnt to work within them (or around them in the case of a minority). What has always happened when we end up in one of the troughs though has been for dental practices to largely and stoically maintain their NHS commitment, despite the pips being squeezed that bit more firmly each time. There have always been a few practices who have moved out of the NHS to private, but the majority have stayed put.
I have my own reasons for considering why practitioners don’t opt out of the NHS and I think it boils down to the following (in no order of importance). There are likely to be other reasons that I haven’t considered so apologies If I have omitted any alternative reasons an individual may have who is reading this.
Fear of the Unknown
Fear of not having enough patients/work
Concern that there will be a proportion of the populous that cant afford private fees
An underlying need to satisfy their own socialist tendencies
Lack of confidence in their own abilities
Fear of loss of the NHS Pension
Too late in their career.
I can’t take each one of these points and discuss them as this would take too long and bore everyone senseless. However, these are the reasons I had for not taking the leap sooner in my career. Everything I felt would go wrong (for the dentists) with this contract has done, and pretty much in the way that many of us predicted right at the beginning.
It is also clear that there are those who have been able to make the NHS work very well for them (usually in a financial manner), but I am not going there in this blog.
It is very apparent though at the moment that there has never been such an uprising of dissent from the profession post Covid, and there is an increased sound of the rattling of a profession’s collective sabres toward the powers that be. I’m informed the private plan providers are gearing up to deal with an ever increasing number of practitioners who are nearer to making the jump to private dentistry than ever before. It seems that the support that was given to practitioners throughout Covid that was initially seen as generous, has now come with the sort of interest payments a government will always put on its help.
For those of us that made the jump a while ago, I can honestly say the grass is not only greener on this side, but the park-keeper isn’t some jobsworth who has no clue and enforces ever more draconian and financially difficult rules when you stray onto the grass. Actually its not really grass anymore, but a dustblown patch of earth, but it has deteriorated over so long those playing on it don’t actually notice anymore.
However, for the first time in long time, I think the profession is more united in its outlook than it has been. Whilst there is still the obvious fear of the unknown, more NHS practitioners are realising that they are unable to shore up a completely broken system and longer. They are hopefully also realising that it isn’t their fault that they haven’t got the resources (both financial and mental) to care for patients but the responsibility of the State to fund this, not them.
I’ve given up trying to count how many times a new contract has been proposed, piloted and then prototyped before being seen as unacceptable to the DHSC. More dentists must be realising that the only thing that will be acceptable to the powers in Whitehall will be the entire population being treated for less than the current NHS budget. The current crisis is showing that this is patently impossible despite the best efforts of the profession, and I suspect that FINALLY there will be a tipping point in the profession that will lead to a mass exodus of caring practitioners leaving the NHS.
At the moment, there seems to be a distinct lack of concrete offerings from DHSC as to what a new contract will contain, but only the most deluded of us would suggest it’ll be better funded for less onerous working conditions. Cynically, one would say (yet again) that this is exactly what the powers that be want, but they have to make the dentists go private of their own accord so as to avoid the government getting the bad press. I somewhat cynically think the DHSC are paying lip service to the profession by making a show of negotiating with the BDA, but in reality using successive low level civil servants on a fast track to somewhere much more important to their careers in order to practice their techniques and to see if they toe the line. I actually asked on one recent webinar with the DHSC negotiator what time his mum was going to call him in for tea…..
I think the profession has to now consider it is at the point where both sides are not really going to agree. The profession can no longer work under this pressure and provide what it is contractually obliged to do; and the government will not increase funding to the degree that is needed to improve the service and access. I think it will need such a complete rethink of how dentistry works in this country that I cant even begin to suggest an option other than a core service. However this course service would have to be funded at the current level, which we all know isn’t going to happen, as core service will be a further excuse to cut the budget rather than fund dentists appropriately for the business risks they take and the skills they have.
We should take heart that the profession now has the upper hand, but if only it chooses to realise. There are not enough of us and to increase the numbers would take years and years (and look how that has ended up with overseas dentists returning home and the GDC not able to sort out the ORE). We are still the only people who can provide the service we do, and its time for use to remember this and embrace it fully. We have to remember we are only human and cannot care for every single person at our own expense. We have to also look after our own mental health and well-being so that we can properly concentrate on delivering the high standard of care we were trained to do, and not what a system is forcing us into.
It’s time to play the endgame and win.
For far too long, relations between dentists and their regulator have been fraught, to say the least.
This may be a situation that in practice suits the GDC very well, but appearances matter. In November last year, the General Dental Council [GDC] revealed the results of some research that it had commissioned. The aim was to ascertain dental professionals’ views on the GDC. It would be very reassuring for GDC leaders to be able to demonstrate that criticism of the regulator comes from a small and unrepresentative section of the profession. The results did not fit that narrative, indeed the GDC, experiencing a moment of insight, commented that the findings “don’t make comfortable reading.”
As reported on GDPUK at the time, negative perceptions of the GDC had actually risen from a bad 45% in 2018, to a worse 58% in 2020. To add to an already grim picture, responses also showed that over time, an increasing number of respondents felt that the GDC was actually getting worse. The finding that “students were more likely than dental professionals to associate positive words with the GDC”, could be said to offer evidence that the more dental teams came into contact with the GDC, the less they liked it.
By the GDC’s standards a veritable charm offensive followed, with Chief Executive Ian Brack and Executive Director Stefan Czerniawski explaining how they would be working to improve matters. It was announced that the recently installed Chair, Lord Harris, was starting his term by meeting key stakeholders. With the vast majority of UK dental care delivered in general practice by general practitioners and their teams, an outsider might expect that this would be reflected in some of this activity.
Since taking over from Bill Moyes, Lord Harris has written four blogs for the GDC which have been sent with its periodic emails and are also available on its website. In his first blog there was indeed reference to meeting some of those key stakeholders. He had met the English CDO, as well as the BDA, BADN and SBDN and been at the launch of the College of General Dentistry. He went on to express the view that “professional regulation is a privilege”.
By the time of his next blog Lord Harris had met the CQC and HCPC (Health and Care Professions Council) and was looking forward to meeting COPDEND and the Dental Schools Council to discuss education. He added that his belief that we should see (presumably the GDC’s) regulation as a benefit, had been reinforced.
The third blog announced a programme between January and April of meeting students and trainees which would be an “opportunity to hear from students in the early stages of their dentistry careers.” There was also a section about the benefits of regulating the whole dental team. He added that he would “continue to meet representatives of the dental professions in the next few months”
The beginning of February saw publication of the fourth blog. Lord Harris had now met with Healthwatch, and rightly pointed out that “understanding the views of patients and the public is critically important”. “However” he added, “the GDC also wants to engage with people at the start of their career in dentistry”. They had met nearly 400 students and trainees, representing dentists, hygienists, and therapists, and were “finding them helpful to build understanding of our role and hear from members of the future dental team”.
GDP’s are trained to be observant, so readers will have spotted by now that in relation to the amount of care delivered, they barely register on Lord Harris’s radar. There was also a focus on those younger team members who the GDC’s own survey had revealed, were the group with a less poor opinion of the GDC.
Following publication of Lord Harris’s fourth blog, GDPUK contacted the GDC’s communications team with an enquiry about the Chair's meetings with GDPs and related groups. To provide some context, emails to the Department of Health and NHS England on the day of the 50 million dental funding were all answered within a couple of hours. If a respondent was unable to help they suggested a suitable colleague. It did not take long to get an answer that specifically dealt with each section of our request. GDPUK also asked the BDA about meetings with Lord Harris. A comprehensive reply came within 90 minutes.
With absolutely no response from the GDC, a follow up email was sent the next day. With the same result. After 3 emails sent on separate working days, and not even an acknowledgement, a colleague who has had similar difficulties provided an alternative contact to the one on the GDC’s website. Finally, a response confirming that our emails had been received came within a couple of hours, and not long after this, another GDC official provided their response to our enquiry. The Chair would appear to have had a busy diary which will continue over the coming weeks with many meetings. The most GDP related one to add to those in his blogs would appear to be the Association of Dental Groups (ADG). Scheduled were meetings with professional bodies including hygienists, therapists, dental technicians and dentists as well as indemnifiers.
To be fair to the GDC, when a subsequent enquiry was sent, it was responded to the following day.
GDP’s may be left wondering whether following last years uncomfortable feedback, the GDC’s chosen approach to them is one of engagement, or quarantine.
Experiencing a moment of insig...
Posted on LinkedIn
There have recently been many worried rumblings in the profession amongst principals about the issue of vicarious liability and non-delegable duties of care concerning their associates after the case of Rattan (Rattan V Hughes  EWHC 2032 QB). In this particular case it was found that a principal who hadn’t actually treated a patient was still liable for the negligent treatment by dental associates.
Last night (03/02/2022) on Dragon’s Den (BBC1 8.00pm), an entrepreneur walked away with an investment of £50,000 in her company selling cosmetic dental products – charcoal toothpaste, bamboo handled toothbrushes and home whitening kits. The company, SmileTime, is generating over £1m in sales annually online, and probably more after last night’s TV exposure.
The evidence of the efficacy of charcoal based oral products appears to be lacking. A recent paper in the BDJ stated ‘Charcoal-based dentifrices, in the absence of supporting scientific evidence, may be considered to be a fashionable, marketing 'gimmick' based on folklore.’ SmileTime’s website, however, claims that their tooth whitening kit (using ‘advanced active whitening ingredient called PAP that whitens and brightens your teeth without any pain or sensitivity’) is ‘scientifically proven to whiten and brighten teeth after a few uses as shown in the clinical trial study by the Journal of Applied Oral Science.’
So let’s look at this evidence for their tooth whitening kits. The study was published in 2017 and carried out by a team at Witten/Herdecke University in Germany. The active materials under test were a non-hydrogen peroxide bleaching agent phthalimido peroxy caproic acid (PAP) and calcium lactate gluconate (a remineralisation agent), available as an over the counter (OTC) product called iWhite. iWhite is a brand sold by Sylphar, who supported the quoted research project with funding for the materials and compensation for the participants. A disclaimer states, however, that ‘the company was not involved in the study design, the data collection and analysis, the decision to publish or the preparation of the manuscript.’
iWhite is intended as a self applied bleaching gel, using trays provided in the kits. After some explanation of the legalities of the use of hydrogen peroxide as a dental bleaching agent, the authors introduce PAP and calcium lactate gluconate (as a remineralising agent) as a novel OTC bleaching agent. For the research, they recruited 40 participants (the paper doesn’t say how they were recruited) and randomly divided them into an active group and a placebo group. The active group received application of iWhite and the placebo group received iWhite but with the active ingredient removed.
All participants were examined, confirmed as disease free and had no teeth lighter than VITA Lumin shade A2. Using the shade guide (numbered 1-16), the blinded examiner recorded tooth colour at baseline, immediately after gel application and 24 hours later, under similar light conditions (not defined). The middle one third of each upper and lower anterior tooth was used to select the shade and an average score was produced for each participant. All participants were supervised during application of the gel by the researcher.
According to their results, the mean shade score fell significantly (i.e. whiter) by about 2 points for the active group immediately after application and after 24 hours. There was no significant change in the placebo group. That’s the scientific evidence.
But there’s a few anomalies. Forty one percent of individual teeth showed no shade change. This means the gel is not as effective as it might be or, even under supervision, was unequally distributed in the one-size fits-all trays. The product is sold to be used unsupervised at home. The discussion states that the examiner found no mucosal irritations immediately after application nor 24 hours later. However, the results section states that the examiner found 5 subjects with gingival irritation in the study group and 3 in the placebo group after application. At baseline, hypersensitivity was measured by blowing air on the teeth. After 24 hours, hypersensitivity was measured by asking the subject. Even with that ambiguous method, hypersensitivity was recorded in 4 subjects. There’s no description of how the ambient light was controlled, surely important in discussing anything to do with shade and colour. The authors state that ‘the colour stability after bleaching has been largely confined to weeks or months’ – but they didn’t measure that.
On the whole, it’s all a bit wishy washy. One examiner? Why not 2 for a much stronger conclusion? Only one application? That’s because ‘the products may cause irreversible damage if used on a long-term basis.’
And I’m not convinced by the stats. A shade guide is basically a stack porcelain or acrylic teeth, named subjectively for convenience A1 to D4. You could name them white, whitey, whiter, whitest, yellow, yellowy, yellower etc etc. By ascribing numbers 1-16 doesn’t make them numbers. They are still simply labels. And just as you can’t create an average of white, whitey, etc, you can’t create a mean or average of these number labels. The mean is therefore meaningless which undermines the validity of the whole paper. But I’m happy to see if greater statistical minds come along to correct me!
Even if I’m wrong on that, the study certainly doesn’t show that the product ‘whitens and brightens your teeth without any pain or sensitivity’ as claimed on the website. The study does not show that ‘PAP formulas have been scientifically proven to whiten and brighten teeth after a few uses as shown in the clinical trial’ as claimed on the website. The study does not show that ‘results will last anywhere between 2 weeks and 3 months,’ as claimed on the website.
I can find no other in vivo research of the use of PAP as a bleaching agent, although a recent in vitro study found non-peroxide mouthwashes had minimal bleaching effect.
I guess the jury is still out.
But, as they say on Dragon’s Den, I’m afraid I’m definitely out.
There have been a few common phrases around recently that would not have been heard some years ago.
‘You’re on mute!’ in the first year of lockdown and ‘Have you had your jab yet?’ in 2021.
This year it is ‘Have you heard about Wordle?’
Wordle for those who have yet to discover it, is a web-based word game, with a 5x6 grid of boxes. Participants enter a five-letter word into the top line and are then informed, by the highlighting the relevant letters, whether the choices are either in the correct place for the word to be guessed (green) or present in that word but in the wrong place (a shade of sickly khaki). Using that information, the process is repeated on the descending lines until either the correct word is found or the 6th guess is incorrect. A new game is set each day.
Diagnosing tempero-mandibular joint disorder (TMD) strikes me as similar to playing Wordle, but without ever getting to line 6 with the correct answer. All responses to questions are about as helpful as those squares of sickly khaki.
‘Does it hurt when you open your mouth?’
‘Does it click when you open wide?’
‘Oh yes, listen …… and it drives my partner mad at meal times.’
‘Do you grind your teeth in your sleep?’
‘Oh yes, and it drives my partner mad to 2 in the morning.’
‘Do you clench your teeth at all?’
‘Occasionally, when my partner’s mad at me.’
‘Do you get headaches?’
‘Well, my partner and I aren’t getting on too well at the moment, so yeah, I guess I do.’
‘Have you had any knocks to the head recently?’
‘Look, I said we’re not getting on too well but its not as bad as all that!’
And so it goes on, checking for tenderness to palpation and whether the occlusion looks OK and writing ‘TMD?’ in the notes and offering generic advice about self-care, all of which is available on the NHS website, such as don’t chew pen tops, eat soft food, take some analgesics and if it doesn’t get better, see you GP, who might refer you to a dentist (who might make you a soft bite guard).
According to a recent paper in the Journal of the American Dental Association (JADA), dentists in the USA offer similar advice. One hundred and eighty five dentists were recruited to record details of a sequence of patients attending with TMD. They recruited 1,901 subjects who fulfilled their criteria for entry to the study. Almost half of these had had painful TMD for at least 3 years and diagnoses included combinations of myalgia, arthralgia and headache. A quarter had only muscle pain and 10% only joint pain.
Treatments offered were mostly non-invasive and reversible:
Three quarters of dentists in the study recommended an intra oral appliance of some sort and two thirds recommended referral to ‘allied care providers.’
And there’s the rub. To whom does one refer? Who are the allies in the management of TMD? Outside of a large conurbation with a dental hospital, I suspect most end up with the local maxillo-facial surgeon. But how often is surgery required? Orthopaedics, maybe – that speciality which diagnoses and treats ‘a wide range of conditions of the musculoskeletal system, (including) bones and joints and their associated structures that enable movement - ligaments, tendons, muscles and nerves?’ I’m not sure their interest stretches superior the hyoid and anterior to the atlas and axis. Oral medicine? Physiotherapy? Osteopathy? Aromatherapy?
It is perhaps not surprising that a further paper in JADA found that TMD is linked with other chronic conditions such as chronic back pain, myofacial syndrome, chronic stomach pains, migraine, irritable bowel syndrome, fibromyalgia and depression. They conclude that their review ‘supports the idea that clinicians, including dentists, treating patients who had received diagnoses of TMD should be attentive to the presence of signs and symptoms of other chronic pain conditions that could require collaborative care across medical specialities (for example, neurology, rheumatology and psychiatry.’
The temporomandibular joint is the Cinderella of all joints, falling between the specialities which may be able to help. Since 1892, it has clearly failed to be recognised as part of the ‘anatomical arrangements of the human body.’ Yet 80% of dentists report treating up 3 patients a month with TMD.
TMD therefore is not uncommon and these papers show that its diagnosis and treatment is a complex, multi-disciplinary exercise and not one to be passed down like the rows of a Wordle puzzle, eliciting sickly khaki responses in the hope of finding a successful result of 5 green squares.
Paul Hellyer BDS MSc
You thought 2020 was bad? Well, 2021 wasn’t THAT far behind.
We need to talk about how dental practices manage their enquiries. Unfortunately all too often they are not treated with the attention and nurturing they deserve.
Let me explain what I mean by that in 4 simple steps…
Over the past 20 years, I’ve been working within the UK and American Dental Industry to support dental practices growth through a number of different engagement and marketing strategies. However, over the last couple of years, I’ve noticed that something has drastically changed. Suddenly getting new, high-value patients has become increasingly difficult, expensive and confusing. So what’s happened?
A personal opinion, by Michael Watson.
Where I live, on the borders of Essex and Suffolk, has gone from a quiet rural community where dentists just got on with the job of treating their patients to the centre of a movement, Toothless in Suffolk, which aims to go nationwide as Toothless in England.
Two of their aims are to have an NHS dentist for everyone and reforms to the NHS dental contract that will encourage dentists to provide NHS treatments. Both of these will require more associates, who to put it simply are not there.
Throughout 2021, the British Dental Association [BDA] has been at the forefront of moves to tell politicians of the challenges facing dental services across the whole of the UK. It joined with Healthwatch England in calling on the Chancellor to provide vital funding for the recovery and rebuild of services, a move backed by 40 cross-party MPs.
David Hallsworth, a solicitor at BLM specialising in healthcare claims, discusses a potential surge in future dental claims as a result of thousands of children missing crucial check-ups during the pandemic.
Practice Plan’s Sales and Marketing Director, Nigel Jones, caught up with Mark Topley of Purpose Driven Business Ltd, to talk about corporate social responsibility, what it involves, and how dental practices are incorporating it into their businesses…
Zoe Close, Practice Plan’s Head of Sales, talks about the years of experience her team has in converting practices from NHS to private dentistry– and how they can help you achieve your dreams…
Practice Plan’s, Zoe Close, shares her thoughts on what dentists need to consider when making the move away from the NHS…
I have seen the soft campaigning in the form of opinion pieces and social media posts by dentists active in various positions in the British Dental Association (BDA) in the weeks and months before the General Dental Council (GDC) announced their new Chair to replace Dr William Moyes who is due to step down soon. The question that forms the title of this piece was running in my mind.
Since I retired a couple of years-or-so ago, I’ve had many dentistry-related dreams/nightmares. Many of these dreams find me suddenly planted back in a surgery somewhere, working on difficult patients with tricky clinical needs.
Once upon a time, as all the stories, good, and bad, start, a dental surgeon would have a chair of some sort in his (almost always his) south facing sitting room and ply his trade. George Bernard Shaw in the 1897 play “You never can tell” describes such a set up in the home of Dr Valentine, a “half crown” dentist. The half crown refers to the standard treatment fee, not his clinical technique.
It seems odd at my age, writing the words ‘Dental Hero,’ but Simon was one of them, even though he was only a handful of years older than me. Simon was my first ever dental boss, and he ran two practices, one in the Cotswolds and a newly acquired practice in a large Worcestershire town.
These days, if I get any phone call on my mobile from a number I don’t recognise, I reflexly activate the speakerphone and start the voice recorder up on my watch.I used to get quite tense and angry when I received these calls. At my own practice a few years ago, we fell victim to a scam operated by UK-based scammers. We didn’t lose much money, but that was just by pure luck.
Two years ago, a bit like anything the General Dental Council does lately, our oil-fuelled central heating boiler was condemned. It was old and tired, was wasting money and was basically unsafe – yes, am still talking about the boiler, but, you know, there are parallels there.
Backup is without doubt the most important element of your IT Infrastructure, without a robust backup process in place in your practice your patient data is at risk, and if you lose your patient data, your whole practice is at risk – 60% of businesses that lose their data close within 6 months
I was fifteen and I was on my first ‘date.’ We were in the Grove Cinema, Winson Green, Birmingham. For some stupid reason, which looking back was actually probably reasonably refined psychological reasoning for a 15-year-old lad playing to what he thought might appeal to girls, I had decided to take Jackie (‘twas not her name) to see ‘Love Story,’ the saccharin-drenched blockbuster of that particular year.
So, it’s been a heavy few days for the General Dental Council, clinging desperately on to its reputation as a law-abiding health regulator, while being dragged into a murky, treacherous quicksand, by its own past misdemeanours. The following isn’t a full list of the GDC’s antics, by any means.
For the last 18 months I have been campaigning to get the government to change the policy to stop giving out dried fruit as part of the School Fruit & Vegetable Scheme.
GDPUK news was one of the first places to publish details about Raisin Awareness.
Following on from Marcus Rashford's incredible #EndChildFoodPoverty campaign, Sustain are lobbying for the School Fruit and Vegetable Service to be extended to include Key Stage 2 pupils so that it will reach all primary school children.
Campaigners celebrate reinstatement of school fruit and veg - Sustain Web
Public Health Minister Jo Churchill said to journalists that the School Fruit and Vegetable Scheme will resume as normal in Autumn when all children return to school. While we wait for official confirmation, this is not the end of the campaign for more fruit and veg in schools. The scheme should be expanded to all children in primary school and improved to include higher standard British produce.
Now that Sustain are calling for the expansion, I am asking the dental bodies to add their voices, and suggest that together we can approach the called-for extension as an opportunity to raise dental concerns and make this positive change at the same time. I'm hoping that we can use this to eliminate the dried fruit, if and when the scheme expands.
Sustain are delighted to get dental bodies involved, and have agreed to rewrite the calls to action to include dropping dried fruit from the SFVS scheme, and I have drafted a new version with Nigel Carter. We will also be detailing this in a joint letter to DHSC & Department of Education.
Many dental organisations including BDA, BSPD, OHF, BADN, BSDHT & BADT have offered their support.
In my correspondence with Jo Churchill at DHSC I was informed that their stumbling block is delivery logistics (the reason they say that they cannot swap from dried fruit).
I am currently arranging local vegetable delivery to my village primary school (on those 6 raisin days a year) with the hope of reproducing nationally - to overcome this. I am planning to use the Sustain network of local vegetable growers and sellers to provide the national supply web needed, whilst getting dental practices to link up to primary schools to initially pay for this veg and also long-term to input Oral Health Education.
I know that this can be overcome if we are determined.
I wonder if you, the GDPUK community, would also consider supporting this as a collective and as individuals?
There will be a number of ways you can get involved - look out for specific details of what and how in a series of articles coming out in the dental press, and I will also keep you updated with this blog.
If we can’t change it from the top down, let’s do it from the ground up.
Christmas Was February
As a committed Labour Party member it is quite something to be impressed by a Conservative Party Minister and Secretary of State for Health, but I have to say this is precisely the case. The recently published proposals on fluoridation represent a clear intention to act. There’s a lot of talk around reducing inequalities and levelling up but precious little action. This is different, it’s a clear intention to support communities and improve oral health and preventing the consequences of poor health, pain, sleepless nights, extractions, poor self-esteem.
Last week, the NHS made a plea to victims of abuse to contact the health service for support. The call came after it was shown that calls to support lines had almost halved since the lockdowns started. It was suggested that because domestic abusers were also at home more, there was less opportunity for victims to seek help.
OK, that’s a poor example of poetry, it is not even poetry but merely a poor attempt at some rhyming to a beat-ish!
I have absolutely no doubt that if I were still in NHS dental practice now, I would be fretting about hitting the 45% target before March 31st. And the reason I’m so confident in my target-attaining inabilities, is that in all the years I worked under the bizarre UDA system, which I will be forever convinced was designed and forged in the bowels of Hell by Donald Trump’s policy advisors, I never hit my targets.
Before I retired, I naively anticipated that the day after my last clinic, all my anxiety would melt away, like the Cadbury’s Flake I found under the spare wheel of my car the other day.When I fantasised about reaching my retirement, I pictured myself floating on air, with not a care in the world, other than trying to figure out which colour bin to put out on a Monday night. Earlier this week, I finished therapy.
What an honest and riveting es...
There is always a risk in asking the question “How can you tell a good dentist?” Some people reading it will take offence, others may feel threatened, a few will read and conclude half way through that there is no point in continuing. Hopefully there will be the persistent ones who will take some time to ponder the question and even come up with an answer or two, if you do please feel free to share.
I learned something earlier in the week that made me realise I know NOTHING! The ‘something’ was mouth related and I was made to feel that every dental professional on the planet knew about it, but they excluded me from the secret. I’ll tell you the secret a little later. You will be…AMAZED! Or maybe not.
It is now (February 2021) almost a year since dental practices were first told to stop face to face appointments as part of the response to the COVID19 pandemic during the first UK wide lockdown in March 2020. I clearly recall the Prime Minister’s address to the nation on 23rd March, a day when I should have been in India with my father to celebrate as he turned 80 years old.
Last Friday (Feb 5) Health Policy Insight published[i] the draft of the Government's forthcoming White Paper on Health, which was reviewed extensively in the media over the weekend. The main news in it for dentistry was that the paper included proposals to hand over control of water fluoridation to the health secretary and away from local councils. The move was widely welcomed in the profession especially by the CWF network (@network_cwf), the national organisation of dentists supporting water fluoridation.
Andrew (now Lord) Lansley’s 2012 reforms, when he was health secretary, handed control of the measure to local councils, which led, in October 2014, to a decision by Southampton City Council to scrap plans to fluoridate its water. This followed a vigorous campaign by ‘Hampshire Against Fluoridation’ and tentative plans to introduce the measure in other areas such as the North West of England and Hull were quietly dropped. Speaking in the January 14 Commons debate on dental services during Covid-19, health minister Jo Churchill said she was ‘extremely sympathetic’ towards the measure, so we may expect its revival perhaps.
In his report[ii], the late Professor Jimmy Steele said the first priority of any NHS system should be ‘a strong, co-ordinated public health system’, something that has not been possible with it being devolved to individual local councils,
The Lansley approach, which was controversial in the Conservative/LibDem coalition, was to take power away from ministers and put it in the hands of administrators. NHS England was given ‘power without responsibility’ to quote Stanley Baldwin’s description of the press in the inter-war years[iii]. But Ministers were still held accountable to Parliament for the NHS; ‘responsibility without power, the worst of all worlds’ as then Home Secretary David Blunkett, described it in 2002.[iv]
Without going into any detail, the document says there will be ‘enhanced powers of direction for government’ to ensure that ‘those overseeing the health system’ are held to account. For dentistry this could mean that the focus moves from NHS England’s obsession with delivering UDAs to MPs’ demand that anyone who wants to see an NHS dentist can do so - a shift from activity to access.
Secondly the Lansley approach was to promote competition within the service, hence the over-long process of commissioning new services, typically a year or more and, arguably, the botched orthodontic recommissioning exercise.
The pandemic showed, though the commissioning of urgent dental care practices, that the NHS can move rapidly when circumstances demand and so it should be in the future.
In responding to the January 14 debate, health minister, Jo Churchill said that ‘a transformation in dentistry is necessary.’ She continued: “There is a huge opportunity to deliver a greater range of health advice monitoring and support, using dentists and their teams.”
The demise of the Lansley system could give her the opportunity to achieve this.
[ii] NHS dental services in England: An independent review led by Professor Jimmy Steele, June 2009
[iii] ‘power without responsibility – the prerogative of the harlot throughout the ages’, Stanley Baldwin speech on newspaper proprietors March 17, 1931
[iv] Speech by home secretary, David Blunkett to Labour local government and women’s conference Cardiff, February 2002
We are all (well most of us!) now actively involved in prevention and risk assessment.
We stay at home, keep our distance, wash our hands and wear masks. We know some people are at higher risk of serious complications and death from COVID than others, so we shield the elderly and those who are clinically vulnerable, and we require our medics, dentists and care workers to wear PPE and engage in comprehensive disinfection routines to protect them and their patients from the close contact they have to have in their essential work. Our vaccination programmes have initially been targeted at those who, by nature of their inherent risks or lifestyle risk factors, are in most danger.
It is the coming of age of risk assessment and prevention, a time when the public accept that the inconveniences of doing the right thing are essential to ensure a better future.
I strongly believe that NHS dentistry post-COVID will take on this challenge: the one that says prevention comes first, and to prevent you must first to know your susceptibility and what you personally can do to protect your health. Treatment is a fix, not a cure and whilst essential to get patients out of pain, should not be the focus of a modern health service. Advanced restorative treatment on an unhealthy periodontium should not be paid for out of the public purse.
A study has just been published from Qatar on the impact of perio disease on COVID outcomes. Qatar has electronic health records containing medical and dental data (definitely something for the NHS to aspire to!) which facilitated the analysis of confounding factors. To quote the press release here:
The case control study of more than 500 patients with COVID-19 found that those with gum disease were 3.5 times more likely to be admitted to intensive care, 4.5 times more likely to need a ventilator, and almost nine times more likely to die compared to those without gum disease.
Blood markers indicating inflammation in the body were significantly higher in COVID-19 patients who had gum disease compared to those who did not, suggesting that inflammation may explain the raised complication rates.
Professor Mariano Sanz, one of the study’s authors, noted that oral bacteria in patients with periodontitis can be inhaled and infect the lungs, particularly in those using a ventilator.
“The results of the study suggest that the inflammation in the oral cavity may open the door to the coronavirus becoming more violent,” said Professor Lior Shapira, EFP president-elect. “Oral care should be part of the health recommendations to reduce the risk for severe COVID-19 outcomes.”
Causality, which is very difficult to prove, is not claimed here, and as always, whilst confounding factors have been adjusted for, those with perio disease often also have other health issues. Maybe the periodontitis is just a manifestation of a tendency to inflammation, and the COVID response simply results from that. However, the evidence for periodontal disease raising your risk for other systemic diseases is indisputable and growing.
The crunch is this: gum disease is the easy part to deal with: it is not invasive, expensive or harmful. When you can stop the disease in its tracks, why risk COVID complications? Why accept the heightened discomfort and dissatisfaction with your teeth, and the tooth loss that results from periodontitis? Knowing that gum disease is associated with diabetes, CVD, kidney disease, dementia etc, why would the susceptible patient not choose health over bleeding?
Now is the time to talk prevention: to explain to the susceptible periodontal patient how they are more vulnerable than others in the population; to identify and share the lifestyle factors which put them personally at risk of the disease; to explain the potential impacts on their systemic health, and persuade the patient that it is up to them to take the decision to work with you to take charge of their future.
OHI Ltd, UK provider of PreViser and DEPPA technology
In this exclusive interview, Laura Hannon shares with readers how the BDA Benevolent Fund has continued to support the profession in times of unprecedented challenges.
Admittedly, it wasn’t that often, but I did socialise occasionally before the eternal lockdown cycle kicked in. At the corporate I joined after I sold my practice in 2013, I was introduced to a new phenomenon - actually socialising with dental people that I worked with. Previously, I had shunned mixing with ‘dentals,’ but this lot were very different.
Hambley Trading Limited are looking to supply dental professionals, experienced in the delivery of local anaesthesia to patients, example prototypes of the SINCROTM system for them to examine and assess and compare with their current choice of syringe delivery device.
A questionnaire relating to the handling characteristics may be completed and returned electronically which will entitle the respondent to a FREE box of SINCROTM [50 syringes] after the device is launched into the UK dental market.
For a limited number of early respondents there is also the chance to be awarded a £25 Amazon gift voucher, so get your response in quickly.
I once got a Grade 5 for CSE maths. In the 60’s and 70’s the Certificate in Secondary Education was in the tier below ‘O’ levels. It was primarily taken by kids who didn’t pass the 11 Plus to go on to grammar school, and I was one of them. CSE’s generally, and the exams in mathematics in particular, were a bit…basic to say the least. “John has two apples, and Susan then gives him one apple. How many apples does John have? Please show your working out.” After I got Grade 5, I steeled myself to retake it. At the resit, I failed completely and was even ungraded.
There’s little doubt that THE hot topic in the UK media currently, is the delivery of COVID vaccines to the population of the nation: I say the nation, I’m excluding those who think the pandemic is a hoax and that Bill Gates has contaminated the vaccine with microchips that will turn them into that infuriating old Microsoft Word paperclip assistant “Hi, it looks like you are a moronic conspiracy theorist writing anti-vaxxer propaganda, how can I help?”
That opening line from the song “The Living Years” resonates with anyone who has lost a parent, grandparent, teacher or mentor and comes to appreciate that, “we are all prisoners of what our predecessors held dear”.
One of my prepared talks (post-covid bookings are now being taken!) includes me reading a paragraph from one of the required textbooks of my undergraduate years, Immediate and Replacement Dentures. Chapter two, “The patient as a person”, has a section called “The quiet mind”, this starts with a definition of the normal patient which reads, “The normal patient is one in whom the loss of teeth follows previously satisfactory dental treatment”. When presenting, I pause and read it again emphasising loss of teeth, normal and satisfactory.
The reactions of the audience, if I am fortunate enough to have attracted one, is varied, the baby boomers nod and smile in remembrance, Generation “X" shake their heads in disapproval, Millennial (Generation “Y”) are cross and want me de-platformed, Generation “Z” need to be revived after the trauma and demand post-presentation counselling.
Not only do I believe that subdividing groups of people into “Gens” in order to predict their behaviour is akin to astrology for sociologists but it can also prove confusing and futile. There are rarely true generation gaps in a profession like Dentistry where changes are introduced slowly and incrementally. Teaching of undergraduates reflects the previous doctrines filtered through the published research, the experiences of the, as yet, unpublished opinions and the perhaps more dogmatic, heavy hands of department heads.
All this of course is filtered and influenced by that relatively new group, the educationalists, or specialists in education, whose views on the manner of teaching delivery may have a significant bearing on what, how and why knowledge is delivered by whom, where and when.
I was moved to write this piece for two reasons. The first was another in a long line of consultations from dentists who are deeply unhappy in and with their chosen profession. Almost all of them tell me that they felt they were too young, usually 14 to 16, when they made the decision to study dentistry and that their undergraduate training, whilst fine at the science of dentistry, hadn’t prepared them for the reality of life in (UK) dentistry.
My other stimulus was reading David Epstein’s book, “Range”. In it the author examines the virtue of early specialisation with many hours of deliberate training in one field compared with the value of being a generalist.
I am not sure if I have come to any definite conclusions. What I know is that I never wanted to be anything but a dentist and it took me 25 years to accept that I didn’t enjoy being a “wet-fingered”, micro-managing surgeon. With hindsight I can see that I spent too long climbing up the wrong wall, my ladder looked perfect, others were envious of my achievements and success, but it didn’t make me happy, indeed quite the opposite.
A proportion of dental graduates are not suited to the careers available to them and would walk away if they could. Unfortunately the pressure from parents and peers, not forgetting the financial implications, means that leaving is the social equivalent of not turning up for your own wedding. For many who persist this means that further down the road comes a moment where they wake up, unhappy, wondering, “is that all there is?”
Epstein quotes Winston Churchill whose words are used to encourage unhappy, unsuited people to show “grit”, “Never give in”, he said, “never, never, never, never”. What nobody tells you is that he finished the sentence by saying, “except to convictions of honour and good sense.”
What could be done? Could we go down the American route of an honours “Bachelor of Medical Science” degree followed by a three-year dental programme taking 46 weeks per year of proper work? A 21 year old is in a better position to make a career decision than a 17 year old and other pathways are available to those who are unsuited.
Would a better career path in general Dental Practice work? Perhaps a three-year post-grad programme with spells in different independent and corporate practices, NHS, specialist and private with clear transitions, supervision and significant mentoring. Some years ago there was a brave move to start an independent vocational training scheme, which foundered after the intervention of the NHS who were opposed to anything that they could not fully control.
What we have can be inconsistent and does not help everyone. Dentistry is unsure of itself. Is it still a speciality of medicine? Does it want to truly embrace teamwork, if so exactly what model works best? Or is it straddling the divide with one foot rooted in the disease model and the other trying to run away along the road of cosmetics?
Are we failing the next generation? Will more and more unsuited young people be ground beneath the NHS wheels?
You say you just don't see it, He says it's perfect sense,
You just can't get agreement, In this present tense.
Madam DentistGoneBadd looks to the future.
Do you remember 2020? That was the year that toilet roll was more sought after than gold and an inadvertent sneeze in a supermarket could get you battered to death by an angry mob armed with batons of sourdough.
December 21, 2020 – Hong Kong, Harrogate and Gothenburg
CareCapital Advisors Limited, an equity investor focused on the dental and oral care industry, announced on December 21st an agreement to acquire Neoss Limited. CareCapital is one of the largest dental investors in the world, having invested more than US$1 billion in the sector, and provides a patient and collaborative environment for dental entrepreneurs and talented executives to realize their customer-centric visions. Neoss is a leading global dental implant company committed to designing intelligently simple solutions that provide reliable and cost-effective patient care with excellent long-term results. The Neoss brand is synonymous with innovation and quality, which has underpinned Neoss’ market leading performance in 2020 despite the coronavirus pandemic.
In conjunction with the transaction, Dr. Robert Gottlander has been appointed President and Chief Executive Officer of Neoss. With over forty years of dental industry experience, Gottlander has a proven track record developing and commercializing dental solutions.
Neoss has developed a range of market-leading dental solutions and “intelligently simple” procedures designed to deliver better patient care and shorter procedure times that enhance practice productivity. With a rich portfolio of intellectual property and long-term clinical data, Neoss’ peer-reviewed and published clinical support validates the efficacy of its solutions.
Dai Feng, Co-Founder and Managing Director of CareCapital, stated, “We are excited to welcome Neoss and Robert into our family. Both are dental trailblazers that, coupled, will elevate the Neoss customer experience and advance the Neoss mission. The company’s well–established brand, history of innovation, clinical validation and solid market position fit well with Robert’s customer-centric principles and passion for innovation.”
After graduating from the University of Gothenburg School of Dentistry, Gottlander joined Nobel Biocare, where he held several senior executive leadership roles. Throughout his 27-year tenure, he led the team that established clinical and educational concepts for modern dental implantology, co-developed and launched Procera, the world’s first successful CADCAM system, and developed new concepts combining implants and digital dentistry. Gottlander then joined Henry Schein, Inc., where, as Chief Marketing Officer of Global Dental, he led the global initiative as strategic planner for prosthetic and implant solutions, guiding product offerings worldwide and creating commercial sales and marketing strategies. Gottlander went on to serve the dental industry on a consulting basis. Throughout his career, Gottlander has created numerous industry-university partnerships, architecting research projects and educational programs to improve dental implant and digital technology innovation.
After two decades of service, Dormer will retire, in line with his long-standing personal intentions. Dormer will remain with the company in an advisory role to ensure a smooth transition.
“I am thrilled to be joining the Neoss team,” asserted Dr. Gottlander. “Building on its esteemed heritage in Gothenburg, the birthplace of modern dental implants, Neoss shares my aspiration to pioneer dental innovation that improves patient care. I applaud the team at Neoss and Mr. Dormer for his leadership, who, together, have created a prominent global brand. I am looking forward to partnering with CareCapital to expand on that legacy and accelerate the long-term growth of the business through astute customer service and intelligently simple innovation.”
“I am excited to collaborate with CareCapital and Robert to further advance Neoss’ technology,” added Fredrik Engman, Co-Founder and Chief Technology Officer of Neoss. “The support and dental knowhow that this transaction brings, will benefit our staff to enable better service for the needs of doctors and patients.”
A long-term investor focused on the global dental and oral care industry, CareCapital is committed to providing a patient and collaborative environment for dental entrepreneurs and talented executives to realize their customer-centric visions. CareCapital invests heavily in technologies, training, brands and enterprises that span the entire dental industry. CareCapital’s dental business portfolio encompasses dental education, digital orthodontics, imaging, implants, biologics, ceramics, distribution, software, DSOs and research hospitals.
Founded in 2000, Neoss offers intelligent dental solutions that are intuitively simple to use. The company’s products are designed to allow dental professionals to provide reliable and cost-effective treatments to their patients with excellent long-term results. Leading with ingenuity and integrity, Neoss develops smart treatment solutions and works closely with each practice to drive Intelligent Simplicity, making the complex less complicated. Headquartered in Harrogate, UK, with research and development based in Gothenburg, Sweden, the company has established a global footprint with longstanding presence in key markets.
3 in 5 of us will not purchase your service unless there is a compelling finance product to help spread the cost. 1 in 3 of us will not even consider your organisation unless you are offering finance.
The expectation to be offered ways to pay for a service or a product is now deeply rooted in our buying habits. The availability of credit is the consumer’s best friend and woe betide any retail organisation, who fails to recognise the significance of this. Credit has underpinned the spending boom across many essential and non-essential products and services over the last few years. It even has its own economic term – subscription economics!
The principle of affordability and payment choices extends to dentistry of course. Offering flexible payment options will undoubtedly help you improve your return on marketing spend through higher conversion to treatment and therefore drive more profit to your bottom-line.
Now you may already have a finance provider. If so great as we are preaching to the converted. What you may not realise is that there is only one finance provider 100% dedicated to dentistry, Chrysalis Finance. Since [date] Chrysalis Finance has been serving the healthcare industry in the UK and now has an unrivalled market leading position and reputation. So, over the years we haven’t just got to know credit inside out, we also understand your business and your specific challenges in a hugely competitive market. Our levels of service and product availability reflect this.
First of all, Chrysalis has an extensive product range covering several interest-free and interest-bearing payment options from 6 to 60 months, offering more choice to your customers at a time when help to pay for dental treatment has never been more important or welcome. Unlike some providers, who have curtailed interest-bearing loans, Chrysalis has maintained their full product menu.
Secondly, Chrysalis, by working with a panel of lenders, will always be able to offer your customers the best chance of being accepted for a loan. We believe that keeping payment options as accessible as possible is essential during these difficult times. Our acceptance rates are high and will remain so. Great peace of mind for your patients and good news for the growth of your business.
Thirdly, offering payment options is one thing but it has to be coupled with a simple, hassle-free process. Chrysalis makes it easy. Our eligibility checker is instant and an application takes less than 1 minute to make. We also give you access to a portal, through which you can follow an applicant’s progress, make an application on behalf of one of your patients, review a range of statistics and reporting and access our on-line resource library. To make the process as seamless as possible we can integrate our application process into your contact management software making the delivery of payment options part of your patient pathway.
Lastly, we recognise that you will want to share the good news with your patients that you have chosen to work with Chrysalis Finance to offer them payment options. We will provide you with dedicated marketing and communications support to help you advertise effectively and legally and we will train your front-line staff on when and how best to introduce the service.
Whilst we are confident that we are already offering an unrivalled service, we know we need to keep innovating to continue providing you with excellent support. We will shortly be launching a soft eligibility checker, which you can embed in your website to enable a patient to check if they are eligible for credit in the event that they need treatment from you. We are also working on a new credit and debit card payment service, which will be offered at market busting rates. Two more reasons, if more were needed, to contact us now on the following numbers.
Telephone: 0333 32 32 230
Office opening hours:Monday to Friday 9:00am - 5:30pm
I still don’t know how I ended up in dentistry. My own childhood dentist certainly inspired no dental aspirations. The only thing he engendered was a soul-gripping dread whenever I was dragged up City Road, Birmingham, to his terraced house practice. The man had no empathy whatsoever and shouted at me when I gagged on his un-gloved nicotine-stained fingers or what I assumed were child-killing cottonwool rolls.
“If you think you’re a leader and no one is following you, you’re just out for a walk.” Peter Drucker.
I hesitated before putting finger to keyboard on the subject of leadership. A Google search shows in excess of 2 billion results on the subject. What can I possibly add to that? The answer is to only share my take on the subject, which in spite of all the papers, videos, courses and hot air is still poorly addressed and understood.
Two years ago, in those carefree pre-Covid days, I researched, wrote and presented half a dozen talks on leadership in the hope that I might in some way help to improve things in my nano-field of influence. One of the main points that I made then is that we often look at the wrong people for examples of good leadership. Certainly the procrastination and self-interest shown by politicians and business leaders does little to stimulate recommendation or inspire imitation to those owning, running and working in small businesses.
So what is it leadership? One sidestepping answer to that is, “I’m not really sure but I know it when I see it.” In his landmark book, “Good to Great” Jim Collins expected to find the leaders of successful large companies were “those with high profiles and big personalities who became celebrities”. In reality they were often “self-effacing, quiet, reserved, even shy individuals with a paradoxical blend of personal humility and professional will”.
Dentistry and other professions used to attract large numbers of the latter but I do see growing amounts of attention seekers who appear to believe that success is directly proportional to Instagram posts and can happen almost overnight. Perhaps I am becoming jaded but the retreating tide of 2020 plus the year to come will show just who has been swimming without a suit.
Another regular way of talking about leaders is to compare and contrast them with managers and, until a decade or so ago, I was as guilty of that as the rest. Then it struck me that in the field of small and micro businesses it is impossible to be a good leader without managing; and it is equally impossible to be a manager without leading. Shoving individuals into defined silos doesn’t work, we must all wear different hats to suit circumstances. There are some, but very few, absolutes, there must be overlaps in some areas.
In my experience with successful leaders in dentistry and other small businesses I have found several characteristics that they all share to a certain extent. In many these traits are not instinctive but have been learned by experience and acceptance.
Warren Bennis wrote in, “Becoming a Leader”, “I don’t know if leadership can be taught but I know that it can be learned”. He described “The Cauldron of Leadership” as formative events, critical struggles or serious challenges that force leaders to learn, grow and think differently about themselves. The cauldron theory is fine, but can be traumatic, and you are better off paying attention to what is happening and reflecting and considering what you have learned.
If I have managed to make you think about the boxes that you tick, or not, in your leadership roles then my work is done.
To your success.
"Management is doing the thing...
As a kid, I was scared of riding on the pavement. I lived in the middle of Birmingham and there were always beat policeman around. One evening, I cycled back from Scouts. It was quiet and there were few people about. As I reached my home – on a busy main road – I experienced a sudden surge of bravado and chanced cycling across the pavement to my door, when a copper emerged out of nowhere from an off-licence. He gave me a five minute dressing down regarding how I was endangering human life and how I had disgraced my uniform.
It was a black day anyway.It had been announced earlier that morning, that Freddie Mercury had died, so I wasn’t particularly bathing my colleagues in the joy-bringing light of my sunny-disposition. I was sitting in my surgery at lunchtime, reading a newspaper (This was the early 90’s, when YouTube was merely a glimmer in Tim Berners-Lee’s eye), when four glum-looking nurses trooped in.
Last week, Pfizer and BioNTech announced a breakthrough in the fight against the SARS-CoV-2 virus. Pfizer proclaimed its initial Phase 3 data showed its vaccine is 'more than 90% effective'. The news was hungrily devoured and then regurgitated by the national press in an excited fanfare. The BBC reported Health Secretary Matt Hancock as saying the NHS will be ready from December to roll out the new coronavirus vaccine if it gets approved.
Two important ‘documents’ hit the inboxes of dental professionals this week, one was an update on the Standard operative procedure – Transition to recovery from the ODCO and the other was a survey put out by the General Dental Council. One was something you really needed to take in, the other was something you had a choice of participating in, even if it was just for a laugh.
I am thoroughly ashamed. I have struggled to resist seeking solace from psychological props like alcohol or drugs, for many years, but I’ve recently realised that I am, in fact…an addict! I’ve become totally addicted to dental groups on Facebook.
When UK dentistry restarted back on June 8th after such a long break, I naively thought that it might be a fresh start for the relationship between dental staff and patients. In my mind’s eye, I pictured a beautiful slow-motion reunion between dentist and patient on a beach, against a background of crashing waves, accompanied by a sweeping orchestral soundtrack of music lifted from 1970’s Love Story.
Retirement from dentistry isn’t all that it’s cracked up to be. It’s not all waking at ten, eating a big breakfast bowl of Rice Krispies while you listen to PopMaster, taking a leisurely shower, eating lunch and in the afternoon watching the wife working in the garden while you keep an eye on Trump via YouTube.
There are still dentists and dental care professionals who haven’t returned to work after dentistry resumed in a limited way during the summer. Those dental professionals who have still had no patient contact for months are concerned about the return to work and the change in circumstances in practice. I interviewed one such practitioner.
Just imagine if the newspapers weren't interested in dental disasters
Fair enough, it’s patient choice, but I do wonder whether patients who travel abroad are FULLY informed about treatment options and the potential consequences of treatment.
For several years it was my honour to be the opening speaker at the annual scientific meeting of the BDA Western Counties Branch, Young Dentist Group (YDG). The challenge for me in, say, 2016 was to try to share some perspective on changes in dentistry. In 2016 it had been 43 years since I embarked on my university studies, rolling that back another 43 years would take us 1930. I wondered what someone from those interwar, great crash and depression, times could have said to me that would have had any relevance to me in my post-qualification years. Eventually I chose to major on the letter “H” and look for similarities rather than changes.
Another “H”, neurosurgeon Henry Marsh, has written one of the best medical autobiographies that I have read. In “Do No Harm: Stories of Life, Death and Brain Surgery” he writes of the cases he has treated successfully and otherwise and the lessons he has learned. He describes his mistakes both surgical and human and the frustrations of his life with an honesty and insight that I can only envy and attempt to imitate.
Back to the YDG where, in my fifteen minutes in the spotlight, I attempted to describe the roles of Humility, Hubris and Humanity in success and failure. My naive younger self believed that the path to success was mostly straight with the occasional glitch of disappointment. Before Dental School I presumed that my skills would grow and develop in a largely logical and linear manner, much like building a wall with Fletton bricks. I hadn’t anticipated the possibility of quantum growth, where I would feel stuck at a level of inadequacy before suddenly acquiring, whatever it took to move up to the next level of competence.
Nor did I realise that there could be levels of competence that I would never, achieve and to which I could not even hope to aspire. Perhaps it was a good thing that I realised, early on, that my own skills and my temperament would always be limited. I could also see that there were those who were naturally, instinctively skilled, even artistic. Journeyman level is honourable enough as long as you have the humility to acknowledge and accept your own limitations and to develop your skills as far as you are able.
There are far more problems in all walks of life caused by hubris. Defined as excessive pride or self-confidence, there can be a natural tendency with new graduates to run before they can walk and pride will come before a fall. With the fall should come learning of limitations, awareness of boundaries and hopefully acknowledgement of what we don’t know.
Henry Marsh describes the “Keynote Speakers” in his subject who, “Clearly had amazing results way beyond anything that I could achieve. People for whom self doubt is never an issue and whose post-op scans never showed a trace of residual tumours.” He then talks about Hubris driving him on, the risks of over confidence and the disasters that arose. I am reminded of the Key Opinion Leaders (KOLs) associated with newer Short Term Orthodontic and other techniques who are paid by companies and make claims and encourage use of one particular system whilst trying to maintain a veneer of independence.
Finally, we reach humanity, which I defined as the quality of being kind, thoughtful, and sympathetic towards others. In our early years this can be an overwhelming urge to help everyone and to treat each case to its limits. Experience should show us our limitations but there are some who do not acknowledge they have any, or are so intent on treating cases that they put the treatment before the patient. Marsh says, “On reflection you only get good at doing the very difficult cases if you get a lot of practice but that means making a lot of mistakes at first and leaving a trail of injured patients behind you. I suspect that you have to be a bit of a psychopath to carry on or at least have a pretty thick skin. If you're a nice doctor you'll probably give up, let nature take its course and stick to the simpler cases."
Perhaps our desire should be to become good surgeons rather than great surgeons. It can be difficult to balance pressure from patients to do something, especially if you have been looking for a case to do. The enthusiasm on the Monday to find a patient who matches the technique learned on Saturday’s course has led many to regret their actions.
Knowing when to treat, and not to treat, or instead to refer is a big skill itself and requires complete detachment from, and yet total compassion for, the patient and what is ultimately in their best interest. Awareness of Humility, Hubris and Humanity may help us to sleep at night.
This is not a plug for my friend’s laboratory. This an unashamed plug for UK dental laboratories. Because if we don’t support them in some way or another NOW, there won’t be any UK dental technicians left to complain about your lab tills to.
Being such a fan of the airway, I resolved at the beginning of my dental training that I was never going to be a butterfingers and compromise a patient’s right to breathe, by accidentally dropping anything down the throat. I was an even bigger fan of the butterfly sponge in the early days of post-qualification.