Members of one of the UK’s leading royal medical colleges have warned of the dangers of a no-deal Brexit in a new survey. The membership of the Royal College of Physicians and Surgeons of Glasgow have sent out the call as Brexit negotiations in Brussels reach a critical stage.

In a membership survey carried out online by the College between the 5th and 11th of October:

· 79 percent of respondents say that a no-deal Brexit will have a negative or strongly negative impact on the NHS

· 44 percent of respondents report that their employer is failing to plan effectively for the potential impact of a no-deal Brexit

· 67 percent of respondents report that the UK Government is failing to plan effectively for the potential impact of a no-deal Brexit on the NHS

The survey was carried out of the College’s UK-based membership, and was prepared as part of the College’s submission to the House of Commons’ Health and Social Care Committee’s current inquiry into the potential impact of a no-deal Brexit on the health sector in the UK.

In the submission, the College’s Honorary Secretary, Dr Richard Hull, stated:

“The Royal College of Physicians and Surgeons of Glasgow is deeply concerned that Brexit may have a seriously negative impact on health and social care across the UK if the UK government is unable to negotiate a comprehensive agreement with the remaining EU member states on our future relationship.

“It is of significant concern to us that our membership clearly lacks confidence in the current contingency planning process for a no-deal Brexit. We believe that both NHS employers and the UK government should reflect on these results, and take immediate action to ensure that everything possible is being done in the coming weeks and months to ensure that the high standards of care currently provided by our health and social care system are able to be maintained when the UK leaves the EU in March 2019.

“This should include:

· Agreeing a cooperative regulatory framework between the Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMA), which would allow the smoothest transition in terms of the authorisation of medicines for use in the UK, safety and pharmacovigilance

· Maintaining close working links with the European Centre for Disease Prevention and Control in order to maintain public health

· Avoiding a situation where there is a need for the imposition of trade barriers, including non-tariff barriers, on medical goods and services

· We also remain particularly concerned about the potential impact of a no-deal Brexit on patient care in Northern Ireland given the current level of cross- border cooperation with the health service in Ireland

“We also remain concerned that there is significant uncertainty within our membership on the future status of EEA nationals who have already chosen to come and work in the health and social care sector across the UK. This has the potential to significantly exacerbate existing workforce issues in the sector, with additional implications for the standards of care our membership is able to provide to our patients.”

“A no-deal Brexit would not deliver these essential actions. We believe that this would have the potential to significantly hamper the work of the NHS and its staff and would present a real and present threat to patient safety.”

BMI Healthcare, the UK’s largest network of private hospitals, is ending the use of plastic and non-recyclable cups in each of its 58 hospitals and clinics across England, Wales and Scotland.

Altogether, the hospital group uses around 4 million single-use disposable coffee/tea cups and a further 1.2 million water cups, each year. By the end of November 2018, patients and visitors will instead be offered recyclable paper water cups and compostable paper coffee cups, which break down within 30 days after use, leaving no adverse effects on the environment.

Jason Hession, Head of Hotel Services for BMI Healthcare, said: “Our previous tea and coffee cups were either Styrofoam or double-walled plastic-lined cups, while our water cups were plastic. None of these break down properly in the environment and we at BMI Healthcare share concerns over the effects of plastic on our wildlife, our oceans and in the food that we eat. By moving to the new recyclable cups, we hope to contribute to the long-term health of our planet and hope we inspire others to do the same. And, of course, we will continue to use, wash and re-use crockery as far as possible.”

The new cups are the latest in a company-wide drive to replace non-essential single-use plastics. BMI Healthcare has already replaced plastic spoons with wooden stirrers, and plastic cutlery with bamboo knives, forks and spoons.

Keep up a strong oral hygiene routine. Brush twice daily for two to three minutes in the morning and evening. Any more and you can wear the teeth away, any less the teeth and gums may suffer

Teeth often become more sensitive in very cold weather. Try switching to a desensitising toothpaste. The active ingredients can block tiny holes in the surface of the teeth and act as a shield by calming any exposed nerves

Your diet plays a big part in oral health, so eat lots of greens like spinach and kale that are high in anti-oxidants as well as Vitamin K, an important nutrient for a healthy mouth

Dry mouth can be common with certain medications including those designed to aid the common cold. This can lead to decline in saliva production so drink plenty of water and use alcohol-free mouthwash

Take Co Enzyme Q10, a vital molecule and dentist favourite for overall gum health. It’s difficult to get enough of this from diet alone, so I recommend taking supplements to boost intake

Hot drinks are a winter favourite, but be careful if you have sensitive teeth as extreme temperatures trigger sensitivity, so stick to room temperature drinks and use lukewarm water when brushing

Do not skip the dentist! Make sure you keep to your six-monthly check-up and ensure they clean with protective fluoride to keep teeth tip-top for the chilly season

Wearing a scarf will help to keep your lower jaw warm and can be used to cover your mouth if you’re experiencing teeth sensitivity in cold air

Canker sores inside the mouth can flare up in winter due to the harsh elements. Swish a teaspoon of salt with warm water round your mouth a few times a day to help heal them

Wear a mouth guard when outside for long periods of time to prevent your teeth from being forced together or chattering which puts extra pressure on them

A recent review has highlighted severe confusion around the best practice for denture care – not only among denture wearers but throughout the dental profession too.

Recommendations from professional bodies online and the literature illustrated a lack of awareness around – how to clean dentures, what to clean them with, and how often they should be soaked. These examples, alongside numerous others, have raised concerns about how patients have been taking care of their dentures.

This lack of clarity has also led to another of our findings – that the standard of cleanliness amongst denture wearers is poor. Given that the oral health and general health risks associated with poor denture cleaning and maintenance can be extremely serious, we have sought to address the issue of the correct way to clean dentures. As a result, the Oral Health Foundation has published new guidelines on the best care and maintenance of full dentures. These guidelines were developed by an independent global taskforce and with an educational grant from GSK.

By working together, the dental profession will play a leading role in helping patients get this information.

Daily cleaning and soaking

Dentures can get built-up with deposits such as microbial plaque, calculus and food debris. Denture wearers often complain of oral issues such as denture stomatitis, bad breath and staining.

An unfortunate but common misconception among denture wearers is that since they have lost all their teeth, there is no need to take care of them. Of course, this could not be further from the truth. Patients must understand that dentures require the same level of care and attention as natural teeth.

For example, denture stomatitis is a chronic condition that can compromise a patient’s quality of life, not just that of their oral health. Dental professionals have the responsibility to make patients aware of the risks of failing to look after their dentures and giving them the correct advice on how to care for them.

Patients need to clean their dentures daily by both brushing and soaking them. Brushing can be done with either a toothbrush or a denture brush along with an effective, non-abrasive denture cleanser. Toothpaste should not be used and has been shown to damage the denture, often causing scratches and surface material loss and increasing the build-up of plaque.

Night-time respite

There also has been a lack of clarity in advice on whether dentures should be left in at night. Recommendations had ranged from removal for several hours to no removal necessary at all. Understandably, this created confusion, not only for patients but us as dental professionals too. The variety of messaging out there is disturbing and has quite often been personal opinion, not based on scientific evidence.

There is evidence to show that wearing dentures for longer time periods or overnight, may lead to an increased risk of aspiration pneumonia. We should be advising denture wearers to take them out overnight unless they have specific reasons for leaving them in.

Keeping in touch with patients

Maintaining an on-going dialogue and regular contact with denture wearers is just as important as it is with patients who still have all their own natural teeth. Denture wearers must feel they can talk to their dentist about any problems they may be having, as well as for general advice about looking after their oral health.

This is why regular recall and maintenance programmes should be recommended to all patients with dentures.

The amount of inconsistent and often unproven advice about cleaning and maintaining dentures is confusing for the denture patient and we need the help of the dental profession to fix this issue.

These new recommendations can help health professionals give patients clear and trustworthy advice about the best way to look after their dentures. n

www.dentalhealth.org/denturecareguidelines

Our sister publication, Smile (Oral Health Matters) magazine, have set up a twitter account for dental hygienists and therapists to enjoy. You’ll receive the latest updates of news, views and opinions from experts within the profession. Be sure to give them a follow.

twitter.com/smileohmmag

The BDA has slammed plans for inflation-busting fee rises for dentists from the Care Quality Commission (CQC), questioning the rationale for a hike targeting the UK’s lowest risk healthcare sector.

Plans would see GDPs face a 13% increase in fees – over £100 for the average provider – from April 2019, while GPs will see their fees unchanged. The BDA says this represents a wholly disproportionate burden, particularly on smaller practices.

The CQC has been collecting data on primary healthcare services since 2011, and has consistently reported that dental practices, when compared with all other sectors, present the lowest risk to patient safety. The CQC currently inspect 10% of dental practices year, and have found enforcement issues in only 2% of that group – just 0.2% of whole population.

The BDA is demanding an urgent meeting with the CQC and will be calling on GDPs in England to respond to the consultation.

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

“When time and again CQC reports show this profession is delivering the very best for our patients, it is baffling they’re asking us to pay through the nose for them. There is frankly no justification why low risk, high quality care comes with such a high regulatory price tag.

“Our compliance costs have surged by over 1000% in the last decade, and the sustainability of services has already been pushed to breaking point. Many practices will struggle to understand why they face inflation-busting fee increases for doing right by their patients.

“We urge colleagues take this opportunity and spell out to the CQC what these extra burdens will mean for their practices.”

The Oral Health Foundation was joined by a room full of campaigners and supporters earlier this week, as the charity launched this year’s Mouth Cancer Action Month at the House of Commons.

More than 75 people from across 40 organisations were in attendance and heard from a range of speakers reemphasising the need for greater nationwide support for mouth cancer awareness.

Dr Ben Atkins, trustee of the Oral Health Foundation brought the room to order and introduced Sir Paul Beresford MP, the event’s parliamentary sponsor.

Sir Paul spoke about the importance of campaigns such as Mouth Cancer Action Month, before highlighting the landmark decision made by English, Welsh and Scottish governments to introduce gender-neutral HPV vaccinations.

The Oral Health Foundation’s Chief Executive Dr Nigel Carter OBE, was next to welcome everybody to the event, speaking about the continued importance of mouth cancer awareness.

Dr Carter said: “It is a great pleasure to be able to bring so many ardent campaigners against mouth cancer in one place, to help drive home the importance of the continued need for action.

“We owe our thanks to Sir Paul Beresford, who makes it possible for the campaign launch to be held at the House of Commons, showing just how important this campaign is.

“Thankfully, since we started Mouth Cancer Action Month, awareness of this deadly disease has grown from a very low level to a point where most people have at least heard about the disease, but it is not enough yet.

“During November, thousands of grassroots activities and events will make a positive impact to mouth cancer awareness across the country. We will continue to do this until we put a stop to mouth cancer in the UK.”

The room then heard from the campaign’s two main sponsors, Simplyhealth Professionals and Dentists’ Provident.

Dr Henry Clover, Chief Dental Officer at Simplyhealth Professionals, added: “We continue to show our support to this campaign because we understand just how much it has done already, and also, how much work is still to be done to save lives.

“Mouth cancer cases continue to increase in the UK. Even after the many years of successful campaigning, research still shows that 73% of UK adults are not fully aware of the main symptoms of mouth cancer.”

Dr Clover also highlighted research from Simplyhealth Professionals which found that 83% of people in the UK do not check for signs of mouth cancer regularly. When put together with the number of people still failing to visit the dentist regularly, shows why many cases of mouth cancer are found late.

“I believe dental professionals should be at the forefront of changing the public perception of mouth cancer. We have produced a step-by-step guide for dental professionals to help do this and support through social media will be essential in bringing life saving messages to more and more people.”

Researchers at Queen Mary University of London have produced a new orthodontic bracket bonding adhesive that protects the tooth surfaces around the brackets from decay. This decay is often referred to as white spot lesions which affects, according to a 2015 meta-analysis, nearly 70 per cent of people fitted with orthodontic braces*.

The problem areas are around the edges of the retaining brackets where plaque accumulates. Because of the wires and brackets it is difficult to keep the teeth clean. This results in many patients ending up with straight teeth after orthodontics but with blotchy marks that can affect their willingness to smile and reduce their self-confidence. This discolouration takes many months or even years to disappear.

The new bioactive bonding adhesive differs from the currently used materials by continuously releasing fluoride, calcium and phosphate to form fluorapatite. Fluorapatite will remineralise adjacent tooth surfaces and also reduce plaque formation around the orthodontic bracket, reducing the risk of initial decay seen as a chalky surface on the tooth enamel.

Professor Robert Hill at Queen Mary University of London said: “This is a significant breakthrough which will benefit all those wearing orthodontic braces” explained. The research we undertook is an extension of the technology we developed with BioMin Technologies when developing BioMin F toothpaste and this adhesive prevents the development of unsightly white spot lesions around the brackets.”

Braces are very popular, with more than 200,000 children and adults in England and Wales starting orthodontic treatment last year. They allow the wearer to have an attractive, confident smile, bite correctly, eat more comfortably, and to care for their teeth and gums more effectively. In the USA, over four million people are wearing braces, of which 25 percent are adults.

Professor Robert Hill added: “This new special adhesive includes a much lower sodium content than that used in BioMin F toothpastes so it reacts, rather than dissolves. Our latest research shows the adhesive forms protective fluorapatite – the fluoride analog of tooth mineral – around the brackets. We hope to see the first commercially available product within two years.”

If you, or anyone you know within dentistry, are dealing with financial difficulties, please do not hesitate to contact the BDA Benevolent Fund. 

The BDA Benevolent Fund was established in 1883 and provides financial aid to dental students, dentists and their families in need, irrespective of whether they are in training, in practice, have left the profession or are retired. You do not have to be a BDA member to request support from the Fund.

The types of financial assistance the charity can offer varies, but the Fund has recently supported people with the following:

• Regular monthly grants towards day-to-day living 

• One-off assistance to meet a specific need

• Funding for those returning to work following a period of illness or because of Fitness to Practice proceedings; this may include help with retraining costs and professional fees.

All contact is confidential and if the charity can help, it will.  Each case is dealt with on an individual basis and the assistance provided is tailored to each person. The dedicated team will also try to point you in the right direction to access other support services where appropriate.

If you would to talk to someone from the Benevolent Fund to see how you might be helped, please do not delay in getting in contact – simply call 020 7486 4994 or visit www.bdabenevolentfund.org.uk.