ELAINE TILLING, Head of Clinical Education at TePe UK talks to Libby Stonell about her life-changing experiences in the Royal Air Force and why they‘ve never left her…

I joined the Royal Air Force when I was 17 and a half. I wanted to get away from home, after failing my O levels spectacularly and my father, who was a naval officer, was so angry with me he sent me to business school for a year.  I achieved my certificate for Business Administration and resat all my O levels and just to really upset my dad, I thought I’d join the ranks! I didn’t have a clue what a dental nurse did really, apart from seeing them in practices. I knew I would probably go for the medical services as I’d been a St John’s cadet since I was 11. Both my father and I were St John’s Officers, so it was inevitable that that’s what I would do.

I joined as a dental nurse originally in 1978 and spent 25 years in the Royal Air Force (RAF). My final post was the Officer’s Commander of Tri Service School of Hygienist and Therapy training. That was my pathway into dentistry.

Elaine in her RAF days (Front, centre)

As a dental nurse, I met the Officers Commander of hygiene training and I thought: “Actually I don’t know what you do, but I want your job” and that is a strong memory that I have. Once I started dental nursing, I worked alongside the hygienists and it made me want to do more. In the military, the dentists were commissioned and it’s scary enough going to the dentist when you’re a junior rank, with poor oral hygiene or a dental problem, but being seen by a dentist and a very senior officer was quite difficult in terms of conversation. I had quite an early interest in putting it in the simplest terms for people because I believe that everyone has autonomy over their health and to have that autonomy, they have to understand. Messages have to be given to people in different ways and hygienists are the people that give those messages, so for me, I knew that’s where I wanted to go. I applied and trained to become a hygienist. I love empowering patients and getting people to understand and buy in to the fact that they can do something about their oral health, big time and very simply, and that was what really pressed all my buttons.

Being a hygienist on the ground for 15 years at home and abroad, and working with people that speak different languages like Chinese and Nepalese was really awesome. It’s so rewarding carrying out dentistry halfway up a mountain, on people that really need to be put out of pain. And equally, encouraging the Gurkha families (who were living abroad for three years while serving), to live healthier lifestyles. They wanted to give their children everything the Europeans had, like Coca Cola, and sweets, as well as tooth decay. The decay rate amongst very young children became frightening, and that’s my bag. So, the job was very rewarding, quite upsetting at times but a great experience. 

I don’t think the experiences I had in the RAF will ever leave me. I carry a ‘get on with it’ attitude and a strong emphasis on teamwork to this day. I was giving a lecture recently and was introduced to someone as the “formidable Elaine Tilling” – I thought: ‘Formidable? I’m five foot.’ I’m not sure if formidable is a good thing, but there you are. n

To find out more about TePe UK’s story and their products, visit www.tepe.com/uk/

Using the most recent figures, released by the NHS this week, the Dental Law Partnership has discovered that just 58.7% of children aged 0-17, living in England, have attended an appointment at an NHS dentist in the 12 months prior to October 2018.

Whilst the attendance rates do vary across the country, with London having the lowest percentage of attenders (49.9%) and Greater Manchester the highest (64.3%), the figures show that millions of children that have not seen an NHS dentist, whether for a check-up or other dental treatment, in the last year.

This is despite dental care being provided free of charge by the NHS to children aged 0-17. The Dental Law Partnership believe that dental anxiety or phobia could be playing a part in the low numbers of child attenders, to the potential detriment of the nation’s oral and wider health.

Dentist Chris Dean, MD of dental negligence claim experts, the Dental Law Partnership, said, “The data highlights that a significant number of children across England are not seeing an NHS dentist regularly. The potential number of people, especially children, not getting regular check-ups, at the very least, is something we find very worrying, because this is the way that dental issues are picked up before they become much worse, causing lots of discomfort, pain and stress. We understand that many people worry when it comes to visiting their dentist, and parents can even pass their own anxiety on to their children. However, we want to encourage people of all ages to make oral health a priority.”

The below table shows the latest attendance data released by the NHS for all regions in England:

The Dental Law Partnership has designed an infographic (attached) that aims to help both adults and children to manage any anxiety they feel about visiting the dentist.

The British Dental Association has received confirmation dentists in England will get a 1.68 per cent uplift in their December pay run which should be seen in early January 2019.

Practitioners have been waiting 4 months since the Government made their announcement on what uplift they could expect. Only now do dentists finally know the extent of the uplift on contract values for 2018/19 – a mere 8 months since the award should have been in place in April 2018.

Contractors will see a 1.68 per cent uplift backdated to April 2018 – but also because 1.68 per cent is not the full 2 per cent uplift promised in pay, an additional 0.65 per cent award will be made on 01 April 2019 to realise the full 2 per cent promised back in July. This does not affect the nature of any future award being made from April 2019 but it does mean that any subsequent awards are based on a 2 per cent 2018 award.

On 15 November, the Statement of Financial Entitlements were finally signed to allow contract uplifts to be paid in January and contractors will not see any increases in their uplift until 2 January 2019. 

The BDA has seen delays represent a new low for pay reviews. At this stage – in late November – the BDA has usually submitted the evidence for the next year of pay awards and has a date in the diary to give oral evidence. Dentist leaders have expressed their profound concerns that the DDRB process is only just commencing.

The delays to the process in England seem to be set now on a delayed course meaning late award implementation. Combined with the exit of the UK from the EU in March 2019, any process is unlikely to be high on the government agenda for April 2019 implementation.

BDA Vice Chair Eddie Crouch said:

“Dentists are usually bitterly resigned to the late application of the contract in addition to the paltry amount being offered. However this year’s delays represent a new low.

“Pushing the uplift back to a January 2019 receipt date cannot be justified given the challenges many practices are facing to simply maintain viability. For reasons of affordability, the recommended uplift was announced as a staged award back in July. We know the profession has suffered under austerity and pay restraint, and even though pay ceilings have been lifted we are still adversely affected.

“While the Government is tied up by Brexit negotiations and political wrangling, hardworking NHS dental colleagues are seeing ever eroding income and decline in earnings. A once stable profession is struggling to stay afloat and maintain the high quality care that our patients deserve.

“The anger and frustration across the profession is palpable. These delays have been unacceptable, the failure to implement the award in full in 2018 is inexcusable. Continued unwillingness to recognise a profession at the very limits of its patience will leave NHS services in a perilous position.”

There seems to be a surfeit of “surveys” around at the moment, the least important of which seem to always grab the headlines.

I recently saw a survey published in a dental magazine about a looming mass exodus from the NHS in the next five years. This survey reminded me of the survey published by the BDA in the run up to the introduction of local commissioning in 2006. I remember having to do multiple media interviews after this particular BDA survey suggested that 96 per cent of dentists would leave the NHS if the new arrangements were introduced, plainly rubbish but it got the headlines which is what it was intended to do. The actual loss of service around the introduction was around 3 per cent, mainly practices with a very small NHS commitment and where the dentists were inexplicably walking away from life time indexation of their pensions.

The results of this recent survey were remarkably similar and although if you looked closely in the margins of the magazine you could see the words “advertorial” ,this obviously did not have the same prominence as the attention seeking headline.

If you looked closer at the origins of the survey then it became clearer that the survey was carried out by the provider of a private patient payment plan which has a direct financial interest in people moving away from the NHS.

The relationship between NHS and private provision in dentistry is clearly changing, indeed it has been for many years, the NHS is there, funded by taxpayers (through taxation or patient charges) to provide treatment or advice that is deemed clinically necessary and which the patient is wiling to undergo. The private sector is there to provide care that the patient wants, whether clinically necessary or not, without the constraint of NHS rules and regulations.

What is clear from every source of information is that the quality of care provided by dentists and their teams is high, whatever the method of funding. I think it is a pity that organisations trying to promote a non NHS model do so, so often, by criticising the standard of care in the NHS.

I practiced clinically for many years and found that the most rewarding thing was the ability to make a deference to peoples’ lives, whether it be providing eight veneers to improve the appearance of a young lady with pitting hypoplasia in her incisors or managing to motivate and support somebody from a homeless shelter who had never really had somebody take an interest in them before. This is what professionalism is all about, doing what is best for every patient and putting your personal interests second. We are lucky, as dentists, that, at the end of the year, the financial reward is at a level that most in society can only dream about no matter how hard they work.

The reality is that the impact of these surveys has always, ultimately, been small. In a profession where the significant majority of graduates are now female who would walk away from a system where you can keep the benefits of self employed status and still have generous maternity pay arrangements and a pension to which the NHS also makes a contribution.

We live in a world where it is no longer a case of “NHS or private”, the dental world is a mixed economy within which dentists can reap the benefits of both systems and offer genuine choice to patients.

Financially, the recent significant increases in patient charges in the NHS have made it a reality that a significant number of people may find it more economical to have relatively minor work carried out in the private sector, but this needs careful messaging to the patient.

The real pity is that is that when genuine survey data are available which demonstrate that the negativity which seems to surround dentistry in the media is misplaced it generates little media interest. Public Health England has published data, which shows that dentists are playing a vital role in supporting the improvement in oral health that has been a feature of our society for years.

The challenge now is to ensure that those who have not benefited so much from the overall improvement, such as the homeless and those from the more deprived groups are not excluded.

The Oral Health Foundation is calling for free dental care for mouth cancer patients to combat the discriminatory costs of ongoing healthcare that survivors are often burdened with.

Following treatment for mouth cancer, patients are faced with a series of long-term oral health issues, that often result in complex and expensive dental work.

The charity estimates that mouth cancer sufferers could face dental costs of up to £1,500.00 over five years – around five times higher than that of the national average.

The Oral Health Foundation has labelled it a ‘tax on cancer’ and believes government should be supporting cancer patients financially in their aftercare.

Dr Chet Trivedy, trustee of the Oral Health Foundation and consultant at Kingston Hospital says: “In addition to the overwhelming emotional and psychological impact that mouth cancer can have, survivors can also be challenged with several oral health issues. Chronic toothache, tooth loss and dry mouth are just some of the common problems that require long-term dental care.

“Frequent dental treatment is often a necessity for mouth cancer victims.  With NHS dental charges ranging from £21.60 to £256.60 in England, the recurring costs over the course of a year can be staggering.

“The financial impact of mouth cancer is often overlooked. As it stands, there is a tax on mouth cancer. This is highly discriminatory and extremely unfair. We are urging health ministers to address this inequality. Free dental care will go a long way to support mouth cancer patients in their aftercare.”  

Annual cases of mouth cancer have reached 8,300 in the United Kingdom.

It is one of the fastest-increasing cancers, with cases growing by 49% in the last decade and 135% in the last generation.

New research, conducted as part of November’s Mouth Cancer Action Month finds that four in five (81%) Brits believe that mouth cancer sufferers should be financially supported for their ongoing dental treatment.¹

More than half (57%) believe those diagnosed with mouth cancer should not have to pay anything to address their complicated oral health needs.

The findings were published in the State of Mouth Cancer UK Report 2018. The report raised the on-going costs associated with mouth cancer as one of the major challenges sufferers are facing.

In addition to more oral health problems, mouth cancer sufferers face the chance that their cancer can return.

Paul Roebuck (56) from Stratford-Upon Avon, completed his treatment for mouth cancer exactly one year ago. Paul now requires a dental check-up every two-months and is left footing the bill.

Paul says: “I visit the dentist in between my two-monthly hospital appointments because I never know if, or when my, cancer may come back. It cannot be identified by a blood test and it is unreasonable and impractical to have CT or MRI scans so often.

“Visiting the dentist is my insurance policy. Hoping that if something does appear, they can catch it early.”  

Chief Executive of the Oral Health Foundation, Dr Nigel Carter OBE, adds: “There are significant ethical and moral issues around paying for the privilege to be examined for cancer.

“Cost remains a significant barrier for why people continue to avoid regular dental visits. These are crucial for frequent mouth cancer examination and for diagnosing cancer as early as possible.”      

Taking place throughout November, Mouth Cancer Action Month is supported by Simplyhealth Professionals and aims to raise awareness of mouth cancer and save lives by promoting the values of prevention and early detection. 

In addition to regular dental visits, the Oral Health Foundation recommend self-checks at home. The symptoms of mouth cancer include mouth ulcers that do not heal within three weeks, read or white patches and unusual lumps and swelling. These symptoms can be found in the mouth, on your or in the head and neck areas.

This can be done by looking in the mouth, lips, head and neck.

You can read the full State of Mouth Cancer UK Report 2018/19 by clicking here: www.dentalhealth.org/stateofmouthcancer.