A Dental Year In Review
I won’t pretend for a second that the news stories breaking around dentistry in 2019 came up to the standard of those surrounding the world of politics. We didn’t have the dental equivalent of a Prime Minister resigning, the new one willingly calling a general election and that Prime Minister’s Pinky and Perky twin across the water being impeached. But it wasn’t completely without drama. The GDC, in particular, being the gift that keeps on giving.
The Daily Mail carried on its tradition of providing cheap and easy to read non-verifiable CPD, by highlighting the results of a Cochrane Review which found there was no clinical difference between patients receiving regular scheduled scaling and polishing against those not having a ‘scrape and brush-up’ (not the Mail’s term, my patient Mrs Cholmondsley of Milton-on-the Truss’s term for what our hygienist did to earn a living). The Dundee meta-analysis of two studies involving 1711 patients found that there was no difference in the two groups with regard to the development of early signs of gum disease. There was a noticeable difference in terms of calculus build up but the researchers didn’t think the build-up was significant although it was remarked that they didn’t know whether this build-up was more important to the patient or the dentist. As a dentist I always worried about munge building up around the gum margins, and fortunately Professor Damien Walmsley agreed with me. I also worried about stories like these in the general press, just in case people like Matt Hancock inadvertently see them while searching for their latest polling figures. It hasn’t happened yet, but just you wait for the government to reduce the number of scales NHS patients are allowed per year, with a concomitant reduction in fees.
Meanwhile also in January and in the same vein, the Journal of Clinical Periodontology published the results of a study which revealed that pregnant women are one and a half times more likely to go into labour prematurely, if they have gum disease. So here’s an idea – why not ensure pregnant women have closer periodontal supervision during parturiency by carrying out regular scale and polishes…oh!
But if the dental profession has less work to do because we ARE banned from doing scales, that will hopefully neutralise the effects of the inevitable reduction in EU trained dentists leaving the UK as a result of Brexit. The General Dental Council presented evidence that up to a third of EU qualified dentists on the dental register may quit UK dentistry after Brexit because of…Brexit and its associated uncertainties. Some of the EU-trained dentists also cited the difficulties of working under the NHS and dental regulation as reasons for leaving. I think these Europeans have their heads screwed on. Who could blame them for shunning a system which pays them a piddling amount for one filling and exactly the same amount for half a dozen fillings. Brexit means Brexit. Exploitation means exploitation.
Also in January, the British Dental Journal published a large-scale study of 2,000 practitioners which showed that almost half of dentists admitted that job stresses were exceeding their ability to cope. The study found that the most stressful aspects of their work was related to regulation and fear of litigation from their patients. It probably doesn’t help the mood of GDP’s that they’re being told that some of their ministrations are pointless (see above), that at some point a litigation lawyer might blame them for premature births and their workload is going to increase in 2020 when Manuel and Helmut escape back to the mainland.
February saw the revelation that practitioners were more likely to be struck off the GDC register if they didn’t have any legal representation at hearings. A Freedom of Information request to the GDC by Dental Protection showed that nearly two thirds of dentists who were erased from the dental register didn’t have a legal advocate speaking on their behalf. My first thought about that story was “What kind of fruitcake would go to the GDC without legal representation?” Having been a career-long member of one of the original ‘big two’ professional indemnity organisations, the thought never entered my head that such representation may be denied. But apparently, that’s not the case. Even though they often offer cheaper ‘cover’ to dentists, there are defence organisation or insurers who may decline assistance to dentists in personal conduct matters. You pays your money and you takes your choice. I personally preferred to pay a not insignificant amount per month in the hopes that if I got into trouble I would get Rumpole defending me rather than rely on my own inane ramblings that come out more like Elmer Fudd than Perry Mason.
Big news this month was that ‘British Teeth’ helped win an Oscar. Rami Malek won an Academy Award for his role as Freddie Mercury in Bohemian Rhapsody wearing prosthetic teeth made by dental technician Chris Lyons for British-based Fangs FX. Much to the mild annoyance of British dentists, Americans often use the denigratory term ‘British Teeth’ to describe not only our teeth, but British dentistry. Just a slight snag – Freddie was born in Zanzibar to Parsi parents. So they were more like Persian Pearlies than our pride and joy.
Birmingham University hit the dental headlines with its new dental model that reproduces the feel and ‘behaviour’ of real gums and the tongue. As well as helping to teach students how to examine the mouth safely and check for disease, the models reproduce the ‘feel’ experienced when checking pocket depths. In my opinion, this must be a welcome and invaluable teaching aid. The first time most dentists had to check for pocket depths was on a patient. Nobody can tell you how it feels to use a pocket probe or how much pressure to place on the tip. This probably explains the squeamishness of a lot of dentists trained up to now, in tackling pocket depths. You simply didn’t know when to stop pressing – wait until the patient’s eyes rolled back into their sockets or simply sobbed and/or threatened litigation.
I warned you about this back in January. In April, the RAINDROP study carried out by the University of Newcastle proposed that ‘routine’ scaling and polishing of teeth should be stopped from the dental budget since the money would be better off being spent elsewhere. I personally felt this was poppycock. Since many NHS scalings, I would suggest, are completed on a Band 1 treatment with an examination, how is money going to be saved? The Nash gets a bargain out of dentists anyway for this service and money-saving will only be executed by cutting the fee for an examination I reckon. I repeat. I told you back in January and you wouldn’t listen, would you?
The GDC was seeking views on its consultation for its strategy for 2020-2 – “Working with the dental team for public safety and confidence.” GDC chair Bill Moyes boldly claimed that the overall decrease in GDC expenditure pointed to a significant reduction in the dentist’s Annual Retention Fee. My advice on that is – don’t hold your breath. Highly unlikely. I bet you believe in the tooth fairy as well, don’t you?
The Government’s Migration Advisory Committee announced that dentists would not be on the Shortage Occupation List, despite the BDA’s evidence that 63% of dental practices are experiencing difficulties in recruiting dentists and the GDC’s findings that a third of EU graduates may leave the UK in the next five years. A significant number of currently registered dentists are also thought to be considering retirement in the next few year – for ‘considering retirement,’ read ‘running for the exit like their backsides are on fire.’ One suggestion to alleviate the operator shortage problem – get a UK trained dental therapist before everyone catches on.
Thankfully, I never came close, but it was always something else to worry about. July saw NHS England and NHS Improvement (nope, I’d never heard of it either, I’ll need to Google it later) agreed to remove wrong-site blocks as a ‘never event.’ The British Dental Association had long argued that administration of wrong site blocks didn’t meet the threshold of a never-event. Although inconvenient to the patient and incredibly embarrassing for the dentist or student, giving a patient a dribble on the wrong side, is hardly likely to kill.
Removing the wrong teeth is considered a never-event and I would suggest that allowing your dog to bite a practice inspector really ought to be on the list. Dentist Aileen Hopkins was erased by the GDC after one of the three dogs she kept at the surgery bit an inspector. The dentist had 57 complaints about safety and hygiene also considered, but the dentist apparently thought the GDC was being a bit “nit-picky.”
Journalists know August as ‘the silly season,’ the time of year when people are on holiday and Parliament and public bodies uproot and go to the Algarve. Hence, not a lot happens during August, which meant the The London Evening Standard reported on the UK’s first ‘healthy’ supermarket which was launched in Central London. In essence, the store was giving greater visibility to healthy foods such as fruit and vegetables and less shelf space to foods like chocolate, crisps and sugary drinks. And that was it really. Laudable though it is, it didn’t really press any journalistic buttons. Nobody was bitten by a dog and no one was brought in front of a disciplinary body for stacking M&M’s in front of the Monster Munch.
The British Orthodontic Society and Oral Health Foundation announced plans for a national campaign to warn patients about the risks of internet-based/DIY orthodontics. GDPUK had warned earlier in the year that patients are being prescribed courses of adult orthodontics without seeing a qualified dentist face-to-face or having a full clinical examination. Although one of the companies involved in providing internet-based ortho offers ‘scanning’ in various centres throughout the UK, you CAN have a traditional impression taken – providing you take it yourself. Curious, I approached an online advisor at Smile Direct Club for further information. Just don’t try the following if you are keen on hanging on to your registration.
Bad news for parents of teething children, hoping for restful nights. The British Dental Association revealed that 9 of the 14 teeth products licenced for use in the UK could have potentially harmful side effects. The nine products contained either sucrose, alcohol and or/lidocaine and there is apparently little evidence that the products are effective in reducing teething pain. Where does that leave dentists when confronted with a red-eyed, half-lidded mum begging for advice on how to relieve teething pain? My guidance for the desperate parents would still be alcohol. Forget the child, just drink the alcohol.
But great news for dentists. Early in October, the GDC announced the new levels of ARF fees set for the next three years, ‘barring any unforeseen exceptional circumstances.’ The new level for dentists is £680 and £114 for dental care professionals. Two thoughts: a) why did they bring reduced fees in after I retired? b) what does the GDC define as ‘unforeseen and exceptional circumstances?” There’s still three months to go. Don’t bank on it yet!
Also in October, Medical News Today reported on a study linking periodontal disease with hypertension. This didn’t surprise me. Patients with perio often caused my blood pressure to rise.
More concerning was the revelation that overseas dentists are being allowed to register as dental therapists by the General Dental Council, without any practical examination of their clinical skills. Normally, dentists qualifying outside the EU have to take the Overseas Registration Examination (ORE) or the Licentiate In Dental Surgery. An investigation by GDPUK.com revealed that there is a high failure rate in the practical element of the ORE and yet overseas dentists are being allowed to register and carry out operative restorative procedures on patients, with no further checks on their skills. The GDC is apparently convinced that its checking of the dental syllabus of these dentists is ‘robust’ and yet apparently NOT robust enough if they want to work as dentists.
At the end of October, the GDC was again in the headlines, when it was revealed that the regulatory body withheld evidence from its own Professional Conduct Committee (PCC) which resulted in the erroneous reinstatement of a fraudulent dentist to the dental register. Justice Julian Knowles criticised the GDC in a High Court hearing brought against the GDC and the dentist, by the Professional Standards Authority. He said the GDC had committed a ‘serious procedural irregularity’ in withholding evidence from the PCC. The evidence was withheld following its late submission to the dentist’s legal counsel because it had been mislaid by a GDC solicitor.
The GDC was probably feeling hunted by now, much like their registrants. It was early in the month that the Daily Telegraph revealed that the GDC had spent over £17,000 on hiring private investigators to ‘investigate’ registrants. BDA chair Mick Armstrong described the GDC’s investigatory method as ‘entrapment.’ One case involved private eyes attempting to induce a clinical dental technician to provide treatment without a dental examination by a dentist, by claiming she was too unwell to go to see a dentist for an examination. This revelation just made me feel slightly grubby. I mean, the GDC is supposed to be setting the profession’s standards and all they are interested in is in putting on a heavily stained Columbo mac.
It appears that the GDC only scares legitimate dental professionals. GDPUK.com ran a story that a Derby man who was fined for illegal teeth whitening in 2017 has been caught doing it again. A Derbyshire Live reporter set up a sting operation to catch Colin Vernall attempting to sell his whitening wares again. He told the reporter although he wasn’t registered with the ‘dental council,’ he did do a course. Mr Vernall, who prefers to be called ‘Vern’ Collins (sounds legit) is still taking money for his whitening service despite the £7,000 fine he received as a result of a court case brought by Derby City Council Trading Standards officers. When the reporter revealed his identity, Vern said: “Teeth whitening has changed and it’s self-administered, I simply supply the equipment and you place the tray and products in your mouth yourself.” Thus abrogating all responsibility presumably. He added “I'm simply renting you the light to accelerate the procedure.” When it was obvious the reporter wasn’t going to use his services, Vern said: “I just got a taxi up here, it has cost me a tenner to get here as well.” Vern has gone ‘mobile’ since his £7,000 run in with Trading Standards.
As I write during the hiatus between Christmas and New Year’s Eve, the GDC hasn’t yet found any ‘unforeseen exceptional circumstances’ which will destroy our dream of having to pay a mere £680 quid a year to have our names placed on an internet list.
But there’s still two working days, so don’t spend the savings yet.