This week has seen the latest statistics from the NASDAL (The National Association of Specialist Dental Accountants and Lawyers) Practice Goodwill Survey released. The survey for the quarter ending 30^th April 2018 shows a mixed picture across the country and a number of practices seeming to benefit from large corporate buyer competition.

The headline figure for deals has dropped slightly – an average goodwill value of 132 per cent of gross fees – 5 per cent down from the previous quarter. Average valuations are reasonably steady at 140 per cent of gross fees which is an increase of 4 per cent on the quarter ending 31^st January 2018. NHS practices in particular still appear to be in huge demand with a significant number of sales in the quarter at considerably over 200 per cent of gross fees.

Alan Suggett, specialist dental accountant and partner in UNW LLP who compiles the goodwill survey, said, “A particular area of note in this survey is that certain practices that are larger and located in the ‘right place’ are gaining from competition between the larger corporate groups such as BUPA, Portman and Genesis as they compete for the sale. Small comfort if you are looking to sell in the ‘wrong place’!

As we have noted previously, geographical factors seem to be becoming increasingly important, and this links with a similar pattern in associate availability. Bank appetite to lend is still very strong although RBS are now effectively out of the market due to lack of appetite leading to very high interest rate pricing.”

The goodwill figures are collated from accountant and lawyer members of NASDAL on a quarterly basis in order to give a useful guide to the practice sales market. These figures relate to the quarter ending 30^th April 2018.

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

The British Dental Association (BDA) has responded to the Government’s delayed decision on pay uplifts for dentists working in the NHS in England by saying that much more now needs to be done to address serious recruitment and retention difficulties across the service.

The Government has broken from its previous austerity policy and accepted a recommendation by the Review Body on Doctors’ and Dentists’ Remuneration (DDRB) that dentists’ pay should be increased by 2%. However, it is not proposing to backdate that uplift to the usual April date, instead delaying implementation until October to cut costs.

The Government is also proposing an uplift for expenses for general dental practice of 3% (except for staffing costs, which will be limited to 2%). Using the DDRB formula these figures would have been 4.1% and 3.2% respectively.

Survey evidence suggests over two thirds (68%) of NHS practices in England attempting to recruit in the last year struggled to fill vacancies. This had increased from half (50%) of NHS practices who attempted recruitment in the previous year reporting issues.

Levels of NHS commitment are now a leading driver of low morale and motivation. The BDA has previously reported that 58% of NHS dentists say they are actively planning to leave the service in the next 5 years.

Devolved administrations are yet to confirm their response to the DDRB report. 

Henrik Overgaard-Nielsen, the BDA’s Chair of General Dental Practice said:

“An end at last to public sector austerity is welcomed.

“However, this award will not begin to address the decade-long real-terms pay cut suffered across general dental practice. Real incomes for GDPs have fallen by 35% in that time. Indeed the overall impact will be a further pay cut this year; a 2% pay increase remains well below any measure of inflation.

“The Government’s proposal to recognise the cost of running a dental practice fails to match inflation or take into account what we actually pay our staff. It is also galling that the Government has compounded matters by delaying the implementation of the recommendations of its own independent pay review body.

“We are seeing the result of ten years of cuts without precedent in the UK public sector: practices across England unable to fill vacancies, and patients are travelling further or waiting longer to access care. The Government needs to do more than pay lip service to address what is fast becoming a dental crisis.” 

Charlotte Waite, the Chair of the BDA’s England Community Dental Services Committee, said:

“This below-inflation and delayed uplift for NHS employed dentists will do little to address mounting problems of recruitment and retention. There is also some uncertainty about how all the NHS pay uplifts will be funded, the BDA will pursue this as a matter of urgency. I would not want to see a lack of Government funding have a detrimental impact on services which provide care for the most vulnerable patients in the community.”

The British Dental Association (BDA) has warmly welcomed the Government’s announcement that all 12 and 13-year-olds in England will be vaccinated against the human papillomavirus (HPV).

Devolved administrations in Wales and Scotland were quick to commit to expansion of their vaccination programmes, which currently just cover 12-13 year old girls, to boys following last Wednesday’s recommendations from the Joint Committee on Vaccination and Immunisation (JCVI). 

The BDA has been a leading voice in the call for a gender-neutral approach to the vaccinations, which was acknowledged by Health Minister, Steve Brine MP, in Parliament today as he made the announcement.

Currently vaccinations are provided to school age girls as protection from cervical cancer. HPV has emerged as the leading cause of throat cancers, especially among young people, and rates are rising steeply overall.

The condition is linked to 5% of all cancers worldwide, including some that affect only men ((cervical, vaginal, vulvar, penile, anal, and oral (mouth and throat), as well as genital warts)).

Over 30 people in Britain are diagnosed with oral (including mouth and throat) cancers every day. Over the last decade, oral cancer incidence rates have increased by almost a quarter (23%) in the UK, making it one of the fastest rising types of cancer, and it has a higher incidence among men. Around nine out of 10 oral cancer cases are linked to preventable causes like smoking, alcohol and contracting HPV.

Dentist leaders have expressed their hope this move will mark a sea change on public policy on prevention. The BDA has been a vocal critic of sweeping cuts to local public health budgets, and government’s unwillingness to commit any new investment to tackle tooth decay – currently the number one reason for hospital admissions among young children. 

The decision leaves Northern Ireland – currently operating without a government – as the only major UK jurisdiction yet to commit to extending their programme.  

BDA Chair Mick Armstrong said: 

“This decision will save lives. When our NHS faces such sustained pressure from so many preventable conditions, from cancers, to tooth decay and obesity, this sort of cost-effective intervention must not be a one off.  

“Health professionals need this breakthrough on HPV to mark the beginning, and not the end, of this government’s willingness to invest in prevention.” 

Hormonal changes during pregnancy can have a huge impact on expectant women in a number of ways. Higher levels of oestrogen and progesterone increase the blood supply to certain parts of the female body and the latter also combines with relaxin to help the muscles of the uterus relax and allow space for the foetus to grow. The side effects of this can cause aches in the joints and back, while relaxed muscles in the digestive system can lead to heartburn and nausea.1 The alteration in hormones can also cause some women to feel low or more tearful than they otherwise would. As the pregnancy progresses, most women experience a lessening of these negative side effects and they develop that famous ‘glow’.

Lose a tooth for every child?

You will more than likely have come across the phrase ‘gain a child and lose a tooth’ – the implication being that women lose a tooth for each child they carry. Heralded as just an old wives tale, a study published this spring actually suggests otherwise. Gabel et al (2018)2 provided evidence for causal links between the number of children a woman had and the number of missing teeth. In particular, they found a strong causal relationship between number of children and number of teeth for women who had a third child after having two children of the same gender. Women who had a third child after the first two were different genders had an average 4.27 fewer teeth than those without a third child.

So why the tooth loss? Contrary to other traditional beliefs, it is thankfully not because women’s teeth become ‘soft’ during pregnancy. There are various possible reasons for increased tooth loss among women who have had children and pregnancy gingivitis (or periodontitis) seems to be a major contributor.

Several studies since the early 1960s have linked pregnancy with an increased prevalence of periodontal disease, with a review paper finding that 30 per cent to 100 per cent of pregnant women were affected.3 It also found the risk of disease to increase as the pregnancy progressed, with women’s gingival index and periodontal pocket depth increasing until at least the third trimester and remaining higher than those of non-pregnant women. The same study concluded by suggesting a correlation between increased plasma levels of pregnancy hormones and a decline in periodontal health.

The risk of periodontal disease among pregnant women has also been associated with similar factors to those affecting the non-pregnant population, such as low income, obesity (prior to pregnancy), smoking and poor oral hygiene.4

There is evidence to suggest a link between periodontal disease and an increased risk of preterm birth and low birth weight, which is once again higher among women from economically disadvantaged backgrounds.5 However, the research does highlight the potential for bias in some of the studies available, so more papers are needed to confirm a causal relationship between oral health status and adverse pregnancy outcomes such as these.

Avoiding the risks

For the dental team, our role is to ensure our pregnant patients have the knowledge and support they need to stay as healthy as possible throughout what should be a magical time in their lives. As some dental treatment is contraindicated, or simply just not backed by enough evidence to confirm its safety during pregnancy, prevention is our best friend. Preparing patients for what might be ahead and encouraging a good oral hygiene routine from an early stage (even from before the pregnancy if possible) is essential.

Communicating this information in a friendly but clear way is also important – some expectant mothers could already be slightly apprehensive about the changes they are going through and we don’t want to make this worse. Using simple language they can easily understand and offering resources they can browse in their own time when they leave the surgery is most helpful, particularly as they can share and discuss the information with partners who may not have been present at the dental appointment. The British Society of Periodontology (BSP) offers a range of free downloads focusing on ‘Oral Health During Pregnancy’ on its website that might be useful here (www.bsperio.org.uk). 

The British Society of Dental Hygiene and Therapy (BSDHT) happily welcomes the decision reached by the Department of Health concerning the extension of the HPV vaccine to boys under the national programme. As one of the 47 patient and professional organisations participating in HPV Action, this is a cause that is truly close to our hearts so we are thrilled that the desired conclusion has been reached.

This decision has taken many years to come to fruition, and finally boys will be able to benefit from the same protection that girls have had access to since 2008. This means that the 400,000 boys who have previously gone unvaccinated each year will now have extra protection against some of the malicious effects of HPV, including oral, penile and anal cancers alongside genital warts.

HPV is the most common sexually transmitted disease, so extending the vaccine to boys is likely to make a huge difference. High street pharmacies have already started to offer the vaccine to those who are unable to receive the vaccine as part of the national programme, and these measures will ensure that those who need the protection most are able to receive it.

Professionals must remain vigilant for the signs of oral cancer despite these recent measures, as many people will remain unvaccinated. However, this is a fantastic step forward in the fight against HPV and one that should be widely applauded

The British Dental Association has welcomed official confirmation that UK government advisors have finally recommended funding human papillomavirus (HPV) vaccinations for boys – with almost 400,000 across UK set to benefit each year.

Subject to ministers negotiating an effective rate on bulk purchase of the vaccine, advisors have backed extending immunisation to adolescent boys at the same age as adolescent girls (12-13 years).

The BDA has been a leading voice in the call for a gender-neutral approach to the vaccinations, which are currently provided to school age girls as protection from cervical cancer. HPV has emerged as the leading cause of throat cancers, especially among young people, and rates are rising steeply overall. The condition is linked to 5% of all cancers worldwide, including some that affect only men. 

Over 30 people in Britain are diagnosed with oral (including mouth and throat) cancers every day. Over the last decade, oral cancer incidence rates have increased by almost a quarter (23%) in the UK, making it one of the fastest rising types of cancer, and has higher incidence among men. Around nine out of 10 oral cancer cases are linked to preventable causes like smoking, alcohol and contracting HPV.

Government advisors at the Joint Committee on Vaccination and Immunisation (JCVI) have delayed recommendations to expand the programme in recent years, and have received widespread criticism for questioning the cost effectiveness of vaccinating boys, based on unpublished, flawed and out of date modelling.

The BDA has urged UK and all devolved governments to press ahead on implementation. 15 countries are already vaccinating boys or plan to do so. These include Australia, Austria, Barbados, Bermuda, Brazil, Canada, Croatia, Czech Republic, Italy, Liechtenstein, New Zealand, Norway, Serbia, Switzerland and the United States of America.

BDA Chair Mick Armstrong said:

“Every year 400,000 boys have been left unprotected from the life-threatening conditions fuelled by HPV. Finally, all our children can benefit from a universal vaccination programme. 

“Oral cancer claims more lives than car accidents, and men are twice as likely as women to develop it. Dentists are often the first to see the tell-tale signs, and have fought to see prevention put into practice.

“Too many children have missed out as government advisors have dragged their feet on extending the programme. Further delay will only cost lives. Health professionals expect swift rollout of a national programme.”

HPV Action welcomes today’s JCVI statement on HPV vaccination for boys and calls on the Department of Health and Social Care to accept the JCVI’s advice and without further delay announce that boys will be included in the national HPV vaccination programme.
 
This decision is long overdue. The vaccination programme for girls began in 2008 and the government’s vaccination advisory committee (JCVI) began its assessment of whether boys should also be vaccinated in 2013. Decisions were promised for 2015 and then 2017 but postponed until now. In the meantime, about 400,000 more boys each year have been left unprotected against HPV infection and the diseases it can cause.
 
HPV vaccination for boys is not only supported by the 51 member organisations of HPV Action but also by the BMA, Cancer Research UK and many individual clinicians. Both boys and girls are now vaccinated, or soon will be, in about 20 other countries. The clinical, ethical and equity arguments for gender-neutral vaccination are overwhelming.
 
HPV Action is now seeking:

•        An immediate announcement by the Department of Health and Social Care that 12/13 year old boys will be included in the HPV vaccination programme. The same decision must also be made at the same time by the governments in Scotland and Wales.

•        The early publication of an implementation plan for a national rollout throughout the UK at the earliest possible opportunity (September 2019 at the latest).

•        A catch-up programme for boys which parallels that available for girls. This would mean that any boy in school years 8, 9, 10 and 11 can be vaccinated.

•        The production of information materials targeted at boys, their parents and teachers.

•        A national campaign aimed to maximise vaccine uptake in both sexes with the aim of eliminating current variations in uptake between local authority areas.

•        An early agreement on the procurement issues between the Department of Health and Social Care and the vaccine manufacturers.