When writing about ‘the future’, the tendency is to look at what might happen next year but one of the benefits of being involved with dental students is that even somebody of my age has to recognise that the really important changes, although predictable, may take decades to impact.

The students I meet on the Birmingham University Alumni Leadership Mentoring Programme may well still be practising in 2060 –so what will have changed by then?

Dentistry has changed massively since I graduated in 1973. At that time, dentistry was focused on meeting the overwhelming need for treatment, largely driven by the high levels of caries and the changing societal attitude to poor oral health.

Services have diversified and we are now dealing with a combination of different needs and growing ‘wants’, with people with good oral health but ‘imperfect’ appearance wanting to do something about it.

This aspect of ‘want’-driven care is certain to continue but may change; already we have seen a shift from highly invasive cosmetic interventions to a greater focus on minimally invasive work. My view is that this is a really good change, as the massive tooth loss that occurred when cosmetic work was based on crowns and bridges almost always caused problems down the line, even if the patient was not told of the potential issues!

The attitude to appearance will also depend on how the social media world – with its  obsession with perceived perfection – evolves and whether there is a backlash against ‘appearance bullying’.

There is a lot of robust data that tells us that caries will be massively less prevalent in just a couple of decades – the most recent Chid Dental Health Survey (CDHS), for instance, revealed a significant reduction in overall caries rates. Given the better knowledge around evidence-based prevention and the pressure on food manufacturers to reduce the sugar content in foods, particularly those aimed at children, this is bound to accelerate.

At the other end of the spectrum, the rapidly increasing older dentate population will present a growing challenge, as it will within other areas of healthcare. There is no doubt that our current political leaders are repeatedly being told by leading clinicians that this section of society presents the biggest issue. At the moment, their response seems to mirror that of an ostrich to sand, yet how governments of the day face up to the obvious financial implications will determine, largely, the quality of care the older dentate population receives.

Working with young undergraduates has shown me that they have a great diversity of interests, are keen to understand public health issues, keen to use the latest technologies and, above all, keen to make a difference. I think dental professional lives will become more diverse and working in communities will become more of a norm for the whole dental team. I suspect that balance of education provision between dentist and DCP will change and the regulators and representatives of the professions will have to change to reflect that.

There are fleeting glimpses that community water fluoridation might finally be getting more widespread support and the recent statement by The Royal Society of Chemistry that it is safe and effective is a huge help, given that they are neither pro nor anti water fluoridation but definitely pro the accurate interpretation of scientific research.

In the shorter term, contract reform seems to be heading into the longer grass. Perhaps this is not such a bad thing as it may encourage Local Dental Professional Networks to look at what they can do to improve services and outcomes using the flexibilities that are there within the current legislation, rather than just waiting for something to happen centrally.

Public Health England has already had success in reducing sugar consumption and encouraging dental engagement in the Change for Life programme, a a major achievement that should have a long term impact.

Access to services plays a vital role in improving oral health and, when you combine NHS and private services, there has been a significant growth over the last ten years (around 35 million people now seeing a dentist regularly compared with around 31 million in 2006). There is, though, a worrying correlation between those who do not seek care and those with the highest levels of disease. The CDHS showed that caries prevalence is highest in deprived and ethnic minority populations and we need to find ways to better engage and motivate those groups.

The recent Care Quality Commission report showed that our dental services are effective and of a high quality but we need to better message their availability and to press commissioners where availability is insufficient. The 2006 legislation imposed a statutory duty on the NHS to provide or commission services to meet the local need and in some areas where there is limited availability and demonstrable unmet need they need reminding of this.

We, as a profession, always seek perfection – not a bad aspiration but is it realistic? As with other areas of health, individual behaviours determine our own oral health.

We all know that obesity and smoking are principle determinants of poor general health but even intelligent people are sometimes obese and smoke, we cannot remove this cognitive dissonance from our society, just as we cannot mandate dental attendance, but we have to explain the benefits in clearly understandable and consistent messages.

Working with young dentists and students has shown me that they do not fear change, view it as inevitable and see it as an opportunity rather than a threat and that the best thing is to be influential as the world, and the dental world, continues to change.

An Amur tiger visited a house in the remote village of Solontsovy, north of far-east Russia, and lay quietly waiting on the porch.

The big cat, which appeared to have a severe tooth and gum problem, seemed exhausted and in need of urgent assistance.

Galina Tsimano, who lives next door, spoke of her neighbour’s surprise at finding the tiger on his doorstep in the morning: “Alexey Khaideyev came across a tiger on his porch. He and his wife and grandmother live on the outskirts of the village, near the river and forest.”

As Alexey realised what had happened, he rushed inside to call the emergency services. Tiger experts are sure that the animal was seeking human help for her tooth pain and hunger.

Despite the tiger suffering an acute problem in her jaw, Sergey Aramilev, director of the Amur Tiger Centre, said the cat behaved “absolutely peacefully”, as if she was grateful for their help.

News from the Ministry of Natural Resources reveals that the tiger had no upper teeth and had left her unable to eat which caused her to be malnourished.

The emergency team that dealt with the tiger sedated her and moved her to a rehabilitation centre where she is on a diet of antibiotic-laced meat.

The Amur tiger is endangered, with only 500 remaining in their natural habitat in Eastern Russia.

The latest Practice Goodwill survey from the National Association of Specialist Dental Accountants and Lawyers (NASDAL) has revealed that practice valuations have continued to rise while actual deals have started to fall. It also shows that valuations of NHS practices are commanding higher values than those that are private and mixed.

Ajay Patel, partner at Elan & Co LLP in London, said: “Dental practice acquisition and disposal remains buoyant in London and south east, despite the gloom and doom predictions for the new contract, increase in borrowing costs and capping of NHS pay.”

He added: “With high values I see high gearing and an over optimistic view by acquirers in their own ability to develop and grow the practice.”

“Many acquirers do insufficient financial due diligence work only to find out that they are burdened with a practice in which most of their income goes towards servicing loans and reinvestment.”

“High acquisition costs demand that any potential acquirer should consider carefully all financial aspects, not only for the acquisition but also some years after acquisition.”

NASDAL has reminded all that as with any averages, these statistics should be treated as guideline only.

Ceire Smith, a 25 year old from Ireland, swallowed a sharp dental instrument during root canal treatment. She has now sued the dentist and Health Service Executive (HSE) in the Irish High Court after claiming it’s damaged her boxing career, as it prevented her from qualifying for Rio Olympics 2016.

The incident happened in 2013 after her dentist dropped the barbed instrument down her throat. Ms Smith was subsequently told that it would “pass through her system.” However, her counsel told the court that it travelled inside her body, lodging near her hip, centimetres from her femoral artery, before being removed in surgery in 2014.

Ms Smith, who is a Cavan Boxing Club flyweight, claims that the HSE failed to refer her onto a gastroenterologist who could have monitored the positioning of the instrument in order to cause minimal damage to her boxing career.

After the incident, Ms Smith struggled to perform well in her sport as she was experiencing weakness and severe abdominal pain. After visiting hospital, she was assured she was still fit to compete and was instead diagnosed with irritable bowel syndrome.

She was unable to take part in the world championships in South Korea in November 2014 and has said that was hugely upsetting for her.

For the full story: https://www.breakingnews.ie/ireland/irish-olympic-boxing-hopeful-who-swallowed-barbed-dental-instrument-sues-dentist-and-hse-825590.html

The Guardian  reports that intimate body piercings for children have been banned in Wales after it has emerged it can lead to health issues and make young people vulnerable to abuse.

The new law means that practitioners are not allowed to carry out or arrange intimate piercings including to the tongue, breasts and genitals on anyone under 18. Those living in Wales are the first UK country to encounter the ban and face prosecution or a fine if they were to break it.

The Welsh government said because children aren’t fully grown when getting a piercing, that it could ultimately result in complication as they continue to develop. Also, their age may mean that they have little experience or knowledge of how to clean their piercing properly, which could pose the risk of infection.

The chief dental officer for Wales, Dr Colette Bridgman, spoke to the Guardian regarding tongue piercings: “It can lead to lasting damage to teeth and gums, and can cause serious swelling in the mouth that can effect breathing. Many dentists in Wales have seen patients who have permanent harm following piercing, and dental teams in Wales really welcome this new law.”

A study was conducted on body piercings that revealed the intimate kind more often resulted in complications. It revealed that half of incidents reported were due to tongue piercings.

If you wish to read the full story, click here: https://www.theguardian.com/uk-news/2018/feb/01/wales-bans-intimate-piercings-under-18s-health-fears

The British Society of Dental Hygiene & Therapy (BSDHT) and British Association of Dental Therapists (BADT) are working with NHS England who is leading a programme to extend supply and administration responsibilities to a number of professional groups. This includes the use of exemptions by dental therapists and dental hygienists.

If dental hygienists and dental therapists were able to supply and administer some medicines in their practice, this would bring about many positive benefits, especially for patients. Treatment could be performed even if the dentist was not available, so the patient would not be asked to return at another time. Compliance would be encouraged, ultimately improving the standard of their oral health.

The delegation of responsibility will also improve patient access and choice, too. Also, the dental team as a whole will benefit from a practice that uses its time more effectively, with the dentist freed up to focus on treating people in the chair.

Find out how you can support the work of the BSDHT and get behind the case for exemptions.

For more information about the BSDHT, please visit www.bsdht.uk,
call 01788 575050 or email enquiries@bsdht.org.uk

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