It has become recognised that periodontal disease is closely connected to several systemic diseases, including osteoporosis, cardiovascular disease, diabetes and the risk of premature birth.[i] Dr Francesco Martelli has made the study of the effects of periodontal disease on general health his life work, and he now leads a network of clinics conducting customised, non-surgical periodontal treatment.

Dr Martelli originally trained as a general practitioner in the 1980s before re-qualifying as a periodontologist and implantologist. In Florence, Italy, he became an expert at treating aggressive periodontitis with surgical procedures. However, after around 15 years of performing first-class treatment, Dr Martelli found himself intrigued by patients who did not respond or became worse after surgery. He recognised that he was able to stabilise the teeth of many patients but despite his best efforts, for others there was only little or no improvement in their periodontal situation. In order to understand the challenge of periodontal disease more comprehensively, Dr Martelli decided to return to education and enhance his knowledge of microbiology, molecular cell biology, biochemistry, genetics and immunology.

“At the end of this updating process I had more knowledge in terms of microbiology, immunology and genetics and could now understand the reasons why some patients did not get any benefit from surgical periodontal treatment,” Dr Martelli said from his IMI Clinic in Leeds.

Around the year 2000, new chair side microbiological testing became available on the market, making it possible for Dr Martelli to both identify and quantify periodontal pathogens. This type of testing provided him with clear information about the oral environment, the composition of the microbes that colonise in periodontal pockets and a better understanding of the molecular biology and ecological system of each individual patient. Dr Martelli was able to precisely customise treatment according to the patient’s genetic and microbiological predisposition.

This new insight allowed Dr Martelli and his team to develop ground breaking strategies to manage and challenge periodontal disease. Gradually, he and his clinical teams were able to significantly reduce the number of surgical procedures they performed. By carefully tailoring treatment according to the patient’s microbiological, genetic and enzymatic assessments a customised treatment plan, adapted according to the diagnostics of each individual patient, can be delivered to a large number of patients, both consistently and effectively.

In order to have his treatment methods recognised, Dr Martelli and his associates conducted double-blinded randomised studies on 2,683 dental patients at a number of different dental centres. This allowed them to evaluate the efficacy of the new protocol and revealed that periodontal treatment using laser irradiation, guided by accurate microbiological patient characterisation, and was consistently effective in modifying oral microbiome and eradicating periodontal pathogens, thereby restoring long-term periodontal health.[ii]

Describing the bio laser assisted therapy, Dr Martelli stated: “Operating microscopes are used to guide the laser light. This allows us to penetrate periodontal tissue and deliver selective and precise action to break down cell membranes and destroy periodontal pathogens. By using laser treatment, we do not damage any healthy tissue and we are able to root plane the teeth, eradicate pathogens and bio-modulate inflammation without detaching the gum or causing bleeding. Through this approach, we have achieved an up to 100% success rate and patients receive a solution that is non-invasive so there is less pain, sensitivity and swelling.

“Even the assessments that we carry out are painless. The microbiological test for example, is carried out by inserting a small cone of absorbent paper into the periodontal pocket. The periodontal disease risk or genetic test is simple; a swab taken from the mucosa inside the cheek.”

The process is carefully monitored, he added.

“After each session we check the status of the microflora ecosystem once again to ensure that we have either reached our final goal or if we need to supplement the treatment. This does not mean that we never do periodontal surgery but we have been able to reduce it right down to around 2-5% of patients, and only after we have tried the personalised, laser assisted PerioBlast^™ protocol first.”

Dr Martelli’s passion for this revolutionary treatment is fuelled by the fact that as well as killing off periodontal pathogens, the PerioBlast^™ protocol also triggers the immune system into action and bio-stimulates the bone marrow stem cells surrounding the teeth. Apart from genetic, microbiological and biomechanical assessments, Dr Martelli and his clinicians also make bone metabolism assessments to measure bone density. This gives them insight into the health of the maxilla and mandible, indicates where the patient presents in terms of osteopenia or osteoporosis and monitors osseous-regeneration of the periodontal bone and, ultimately, the stability of the teeth.

Dr Martelli believes that this customised approach to treatment has the potential to restore the long-term periodontal health and prevent relapse. In just three words, he summed up the key points of the PerioBlast^™protocol: “Decontamination, bio-modulation and bio-stimulation.” This method modifies the bacterial communities of periodontal pockets, restores the oral ecosystem to health and offers enduring stability. He also claims that it has the potential to keep the teeth in function for the rest of a patient’s life, providing they are fully compliant following the procedure.

When asked about healing time, Dr Martelli explained that there are two facets to healing: “In terms of the infection and the microbiology of the situation, I can usually reach a solution within a few weeks. By eradicating the infection we can then help the periodontal tissues to heal, stimulate bone growth and improve bone density that will have benefits for many for years to come.

Dr Martelli concluded that periodontal therapy guided by the microbiological characteristics of the patient not only prevents pathogenic bacteria from thriving and destroying periodontal tissues, but also has the potential to prevent those pathogens from entering the bloodstream and causing or exacerbating other systemic diseases.

For further information about the PerioBlast™ protocol and IMI Clinics visit www.perioblast.com

[i] Kim J & Amar S. Periodontal disease and systemic conditions: a bidirectional relationship. Odontology. 2006 Sep; 94(1): 10–21. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2443711/ [Accessed 18^th July 2017]

[ii] Martelli FS et al. Long-term efficacy of microbiology-driven periodontal laser-assisted therapy. European Journal of Clinical Microbiology & Infectious Diseases March 2016. Vol. 35(3)423-431. https://link.springer.com/article/10.1007/s10096-015-2555-y [Accessed 18th July 2017].

FTA Law have been awarded Lexcel accreditation by the Law Society of England and Wales for the second year running. Lexcel accreditation is recognised in the legal profession as the quality mark for excellence in legal practice management and client care with only the top 18% of Law firms in England and Wales being recognised with accreditation.

FTA Law Managing Director Thomas Coates commented, “When we launched FTA Law in 2016, one of our primary objectives was to build a specialist dental law firm providing top client care in a working environment that would attract and retain the highest quality of staff. Remarkably we did this after just one year of trading, so to have sustained the standard for a second, consecutive year is phenomenal. We know our clients have exacting standards, which we aim to exceed. To have this formally recognised by the Law Society is wonderful.”  

FTA Law are a full service independent law firm providing bespoke legal solutions to the healthcare sector. Founded by experienced dental solicitors Thomas Coates (Managing Director) and Sarah Buxton (Head of Dental Employment Law and HR), the firm demonstrates many years’ experience in advising dentists, practice owners and other industry professionals. Services include practice sales and purchases, business advice, employment/HR law and dispute resolution.

FTA Law specialist teams embrace new and dynamic ways of offering legal services focusing on absolute transparency of fees and a high level of prompt and efficient service tailor made to clients. More details about FTA Law are available at www.fta-law.com

THE Advertising Standards Authority (ASA) has just upheld a complaint1 against a manufacturer of orthodontic appliances for making misleading claims about one of its products. Ruling that the advert must not appear again in its current form, the ASA ordered the company not to make claims that its device could move teeth faster and reduce pain for brace wearers unless they held adequate evidence.

The British Orthodontic Society has pointed out that this is the third time in the last few years that the ASA has upheld a claim of misleading advertising in relation to an orthodontic product. This is not altogether surprising given the fierce competition for patients in a growing market.

However, the lessons from these rulings go beyond orthodontics. Everyone in the dental sector should be concerned about misleading advertising claims, given the risk to patients and the potential damage to public trust. Failure to adhere to regulatory and ethical standards can also have dento-legal repercussions for dental professionals.

Both the ASA and the GDC may take action in response to inaccurate or misleading claims and the ASA can refer offenders to the Office of Fair Trading. In addition, an adverse finding by the ASA could easily lead to a GDC investigation if it raises questions about a registrant’s professionalism.

The good news is that there is plenty of guidance and support available to help dental professionals avoid the pitfalls. Only recently, the Committee on Advertising Practice (CAP) which produces the CAP advertising code (administered by the ASA) published ‘dental ads wisdom’2, while the GDC’s guidance on advertising can be found on its website3. And of course, dental professionals can get specific advice from their dental defence organisation if they are unsure.

I also recommend that dental practices regularly review their advertising and promotional material to ensure it meets current standards. Based on the common errors seen by the DDU’s advisers, practices should be on the alert for the following:

• Superlatives – The GDC generally disapproves of ‘grandiose’ statements to describe the services offered such as ‘the best’. More generally, steer clear of making any claim which might raise unrealistic expectations, such as ‘perfect smile’ or ‘pain-free’, particularly with aesthetic treatments.

• Specialist titles – Dentists shouldn’t use the words ‘specialist’, ‘specialises’ or ‘specialising’ when referring to themselves or their practice unless they, and all other dentists in the practice, are on a GDC specialist list, and then only in relation to the particular specialist list(s) upon which their name(s) are entered.

• Identifiable patient images – Patients must give their informed consent before identifiable information can be used in advertising material, such as testimonials or photos. Consider whether it is necessary for the patient to be identifiable, even with consent, and the patient should be able to withdraw their permission at any time.

• Promotional offers – The GDC permits dental professionals to offer practice promotions, but you must ensure the conditions are clear, not potentially misleading, and any offer made is honoured in full.

• Fees – Many complaints about dental charges stem from a breakdown in communication. Be clear about whether treatments are available on the NHS and provide details of payment arrangements, such as whether patients are expected to pay for their treatment in advance or on completion. If you stop providing NHS treatment, ensure all NHS branding is removed from your website and promotional material immediately. n

The British Dental Association has warned that low income patients are turning away from NHS dentistry in droves, thanks to a hostile environment cultivated to keep costs down, as official figures show a fall of two million treatments delivered to patients exempt from NHS charges since 2013/14 – a fall of 23% in 4 years.

8,818,170 free courses of treatment were provided in 2013/14 compared to 6,819,158 in 2017/18.

Dentist leaders have expressed grave concerns that patients are being put off from seeking treatment by the government’s aggressive approach to fines for ‘misclaiming’ free care. Over 400,000 high needs patients a year – many on very low incomes, the elderly, and those with learning difficulties – have received £100 fines simply for ticking the wrong box on forms.

The number of fines issued went up 10-fold in the last 4 years, from 33,887 in 2012/13 to 365,181 in 2016/17, yet 90% of appeals are won. NHS England has circulated a “Don’t Assume You’re Entitled” campaign to NHS practices, and an official NHS Health Costs twitter feed – meant to provide advice on claiming – is routinely discouraging claims, and utilising the hashtag #DontRuntheRisk.

Dentists have accused ministers of unwillingness to engage with hard to reach families, while pursuing low impact, unfunded initiatives preaching to regular attenders, as data also reveals over 4.9 million children (41.4%) failed to see an NHS dentist in the last 12 months. The NHS has spent £165 million on child tooth extractions in hospitals since 2012.

The Government spend per head on NHS dentistry has fallen £4.95, from £40.95 to £36, in the last five years, while patient charges have increased by over 23%. Nearly 1 in 5 patients have delayed treatment for reasons of cost according to official statistics.

The British Dental Association’s Chair of General Dental Practice Henrik Overgaard-Nielsen said: 

“This huge fall in NHS attendance amongst patients exempt from NHS charges is the logical outcome of failed government policy. 

“Ministers have created a hostile environment for vulnerable groups and those on low incomes who have a right to free dentistry. These patients, often with complex needs, require early intervention not the ever-present threat of fines.  

“Sadly the government has shown no interest in getting hard to reach families to attend, when prevention could save our NHS millions.”

More than two in five children (41.4%), aged 0 to17, did not see an NHS dentist in the 12 months to 30 June 2018, according to figures published by NHS Digital today. This is a very small decrease compared to the same period in the previous year, when 41.8% of children did not visit a dentist.

The Faculty of Dental Surgery at the Royal College of Surgeons advises that parents and carers take children to see the dentist as soon as their first teeth appear, and certainly, by the time they turn one. Children should then see a dentist at least once every 12 months so that problems like tooth decay can be picked up early.

Responding to today’s figures, Professor Michael Escudier, Dean of the Faculty of Dental Surgery, said:

“Frankly, it is unacceptable that more than two in five children did not see an NHS dentist in the last year. Today’s figures serve as a reminder that there is still a long way to go in improving children’s oral health in the England. Despite free dental care for under 18s and a number of campaigns to educate families about the importance of seeing a dentist at least once a year, progress has been slow.”

NHS Digital data shows children aged 0-4 were the least likely to attend the dentist in the last year. Nearly two thirds (65.9%) of 0-4 year olds did not attend the dentist in the 12 months up to June 2018.

Breakdown of non-attendance by age group:

Professor Escudier added:

“It’s so important that we get children along to the dentist from a young age. Dental check-ups in early years are as much about getting children comfortable in a dental environment as they are about checking teeth. Many adults are reluctant to visit the dentist because as children they first visited the dentist after, rather than before, problems emerged. 

“Tooth decay is 90% preventable. If we make sure our children visit the dentist regularly, eat less sugar and brush twice a day with a fluoride toothpaste, we can spare them the trauma of cavities or even worse, tooth extractions.

“There have been some significant steps forward in the last year which we hope will result in more children attending the dentist over the next 12 months. NHS England’s Starting Well programme, which was launched in 13 high needs areas, is a very welcome initiative, which we’d like to see expanded so more children can benefit. We would also urge Government to use some of the money raised by the Soft Drinks Industry Levy to improve oral health education, so that no child is left behind.”

Northern Ireland Department of Health waiting time statistics published today (Thursday 30 August) show there are now more than 18,000 patients waiting more than a year for inpatient treatment and almost 88,600 waiting more than a year for an outpatient appointment. The Royal College of Surgeons has said that this number is a symptom of long-standing problems with the Northern Ireland health service and not helped by the current political impasse in Northern Ireland. By contrast, in England around 3,500 patients were waiting more than a year for treatment – approximately 0.1% of the entire waiting list.

Data for the quarter from April to the end of June 2018 show 21.6% of patients waited more than 52 weeks to be admitted for inpatient or day case treatment. An additional 6,819 patients are now waiting over a year for surgery compared with the same period in 2017, a rise of 60.6%.

Northern Ireland surpassed Belgium’s record on Tuesday (28 August) for the longest peacetime period without a properly functioning government, with 591 days having now passed since the power-sharing executive collapsed.

Government targets require that no patients should be waiting longer than 52 weeks for treatment. Northern Ireland’s waiting times targets have changed often over the years. Using the targets in force at each quarter in recent years, the 52 weeks target has not been completely achieved in over 11 years. 

The latest performance data shows more than 5,771 (31.9%) trauma & orthopaedics patients and 3,356 (18.6%) general surgery patients were waiting over a year for treatment.

Unlike the rest of the UK, Northern Ireland measures its waiting times in two stages: referral to first outpatient appointment, and then outpatient to inpatient. Therefore, the real wait of many patients will be even longer than the statistics indicate.

Responding to these figures, Mr Mark Taylor, Director for Northern Ireland at the Royal College of Surgeons, said:

“Waiting times in Northern Ireland for inpatient and day case treatment are the worst in the UK. Tens of thousands of patients are waiting more than a year for treatment compared to around 3,500 in England.

“The health service in Northern Ireland is facing significant challenges exacerbated by capacity issues, workforce shortages, uncertainty over long-term budgets and the political stalemate at Stormont. All this comes at a time when health services across the UK are having to adjust to rising demand from an ageing population. People are living for longer with multiple chronic health problems. 

“A number of reviews have set a clear path for reforming the health service in Northern Ireland however the absence of a political administration hampers implementation. This is incredibly frustrating for Health and Social Care staff who remain committed to delivering a high standard of care, despite very difficult circumstances.

“It is very clear that in order to progress with pace and scale, we need the urgent return of the Northern Ireland Executive. Significant decisions and legalisation are needed to bring about the changes required to address waiting lists and make the NHS sustainable for the future. It is unacceptable for patients to continue to spend many months on waiting lists.

“The release of £30 million in transformation funds targeting waiting lists earlier this year is welcome but this is only a stop gap. We need to increase capacity within the system to meet the increased demand as well as the backlog of patients. Surgeons in all specialties are ready to embrace elective care centres and other aspects of the transformation agenda but time is now critical.

“The political deadlock that has paralysed public services in Northern Ireland has gone on too long now and is hurting the health of the nation. The RCS recognises there is the will from all involved in the delivery of care to bring about change however such a reconfiguration requires political leadership and a sustainable budget.  Without this, we fear waiting times in Northern Ireland will continue to spiral out of control, putting patients at very real risk.”

The British Dental Association has expressed concern about the long-term sustainability of the service, as new data from NHS Digital has shown that NHS dentists in England and Wales have experienced a 35% pay squeeze over the last decade.

This unprecedented drop has seen real incomes for practice-owning dentists fall by as much as £47,000, and their associates by over £23,000 over the last decade. Costs facing individual practitioners for regulatory compliance and registration have gone up by 1000% in the same period.

NHS dentists are expected to receive a below inflation pay uplift of less than 2% for 2018/19.

Official data also published today shows morale and motivation among NHS dentists is now at an all-time low in all UK nations, with lower levels of morale linked to higher NHS commitments. The data shows a continued fall in the NHS workforce in England and Wales, with numbers at their lowest levels since 2010.

Research for the BBC has revealed that just 52% of NHS dental practices in England are accepting new adult patients, and just 60% accepting new child NHS patients. The Westminster Government’s spend per head on NHS dentistry has fallen £4.95, from £40.95 to £36, in the last five years.

The British Dental Association’s Chair of General Dental Practice Henrik Overgaard-Nielsen said: 

“Austerity is meant to be over, but across the UK NHS dentistry is running on fumes. We’ve seen a drop in real incomes without precedent in the public sector. The results are predictable, morale at an all-time low, recruitment and retention problems mounting, as patients wait longer or travel further for care.

“Underfunding and failure to deliver meaningful reform has left the sustainability of this service in doubt. Matt Hancock pledged to put prevention at the heart of his approach to the health service. In the service’s 70^th year he must recognise that we can’t have NHS dentistry without NHS dentists.”

1. The best care is prevention. So, the most important advice I can give is to maintain a good oral health routine throughout your life

1.  As we age, our gums shrink and start to recede so it’s crucial to look after them and avoid the risk of gum disease. Flossing regularly to remove debris trapped between the teeth is vital for this

1. If regular flossing becomes difficult or painful, try using a water flosser. They are much easier to handle and use water to gently push particles away from the teeth

1. All teeth contain dentin, which yellows over time and can show through the enamel coating as it wears away. To help keep the enamel strong, limit your sugar intake and avoid brushing too harshly

1. As we get older, so do our teeth and they will naturally become discoloured. Avoid consuming highly pigmented food and drink such as blueberries and red wine to reduce a build-up of stains

1. Keep clear of quick-fixes when it comes to whitening older teeth. Always consult with a reputable dentist who will recommend the best course of action for your teeth based on their condition

1. Don’t panic if you start to lose teeth. Advancements in dentistry such as implants can help rebuild your smile. Implants are permanent and fitted to match your natural teeth

1. The look and feel of false teeth have also improved massively. Full and partial dentures are custom made and can replicate your original teeth, just be sure to care for them as though they were your real teeth!

1. Dry mouth can become more common as we age as a result of certain medications and a decline in saliva production. Drink plenty of water and use an alcohol-free mouthwash to help prevent this

1. Reduce your risk of gum disease and more serious conditions including oral cancer, by maintaining a healthy diet, limiting alcohol consumption and not smoking

Decline in Scottish students at Glasgow Dental School – as overseas intake rises five-fold since 2012

The share of dental school places given to international students has increased nearly five-fold in seven years in Glasgow. This comes amidst warnings that a lack of Scottish students being trained could trigger a recruitment crisis in the future.

Scotland’s Herald reveal figures showing the increase in overseas students, yet document a decline in Scottish students being given study places.

Of the 78 students set to study dentistry this year, 52-67 per cent are Scottish, down from 85 per cent in 2012.

A spokesperson for the BDA said: “The Glasgow University figures show a worrying steady decline in the proportion of Scottish dental students in the past five years.

“Scottish students are more likely to remain in Scotland and work in the NHS, therefore the University and the ScottishGovernment must ensure that Scottish applicants are not being disadvantaged compared with applicants from elsewhere in gaining a place to study dentistry at Glasgow.”

For the full story: http://www.heraldscotland.com/news/16603405.worrying-decline-in-scottish-students-as-glasgow-dental-school-as-overseas-intake-rises-five-fold-since-2012/