Month: September 2021

BSPD updates perio screening guidelines for under-18s

The importance of periodontal screening of young people is being reinforced jointly by BSPD and BSP (the British Society of Periodontology and Implant Dentistry) as updated national guidelines for the management of patients aged under 18 in the primary care setting are launched.

The updated guidelines, just published on the websites of both BSP and BSPD, incorporate the new Classification System devised at the 2017 World Workshop. The 2021 guidelines also reflect the new method of staging and grading periodontitis arising from the same landmark meeting, which influences the management of all patients.

At the heart of any screening is the BPE (Basic Periodontal Examination) first developed in 1986. It wasn’t until 2012, however, that BPE screening was produced for the management of young people from the age of seven. A simplified version, the sBPE, examines only six teeth:  the permanent molars and one incisor in the upper arch and one incisor in the lower arch; these reflect teeth susceptible to periodontal disease in this age group.

The two clinicians who developed both the 2012 guidelines and the updated version in 2021 on behalf of BSP and BSPD respectively are: Professor Valerie Clerehugh, Emeritus Professor of Periodontology, Department of Restorative Dentistry, School of Dentistry, University of Leeds, and Dr Susan Kindelan, Consultant in Paediatric Dentistry, Leeds Dental Institute, Leeds Teaching Hospitals Trust.

Professor Clerehugh and Dr Susan Kindelan agree: “Gingival diseases are prevalent in young people, and reversible gingival inflammation can progress to the initial stages of irreversible periodontal destruction in adolescents. While severe forms of periodontal diseases are uncommon in the younger age groups, identification of those affected by gingival and periodontal problems is important and dental practitioners have an important role to play in their early recognition and diagnosis.

“Practitioners should be aware that smoking in children and young people, including the use of e-cigarettes, and higher levels of obesity are factors which might have an impact on the prevalence of gingivitis and periodontitis.”

Dr Susan Kindelan commented: “Prevention of periodontal diseases is hugely important. Patients treated by BSPD members are more likely to have co-morbidities or complex syndromes which impact on gum conditions. For this cohort of patients, early diagnosis and referral is recommended.”

BSPD spokesperson Claire Stevens said: “So much has changed in the field of periodontology over recent years, this update is timely. We very much hope to build awareness of the important of the sBPE so that it is integral to all appointments with young people aged seven and over.”

https://www.bspd.co.uk/Professionals/Resources/BSPD-Guidelines

Henry Schein’s Practice Pink Programme celebrates 15th anniversary supporting the global fight against cancer

Since its inception, Practice Pink has raised more than 1.7 million US Dollar for cancer research, prevention, and awareness efforts

Henry Schein announced the 15th anniversary of its Practice Pink® programme supporting nonprofit organisations dedicated to the fight against cancer. Practice Pink is a global initiative of Henry Schein Cares, the Company’s corporate social responsibility programme.

Through Practice Pink, Henry Schein, together with non-governmental organisations and supplier partners across North America and Europe, is helping dental and medical health care professionals raise awareness and support for a cure for breast cancer and other cancers by offering its customers an array of pink products, including health care consumables, practice supplies, and apparel. To date, Henry Schein has raised more than $1.7 million through Practice Pink.

“We at Henry Schein are committed to aligning our strengths as a business with the needs of society to improve global health, and developing public-private partnerships to help provide care for those in need.” said Stanley M. Bergman, Chairman of the Board and Chief Executive Officer of Henry Schein. “Together with our valued supplier partners and customers, we are collectively helping to support efforts in promoting early cancer detection, improving access to care, and advancing cancer research and prevention.”

As part of the company’s participation in the Practice Pink™ programme, Henry Schein Dental UK donates a percentage of the company’s sales in October and November from selected pink products to Cancer Research UK to support the organisation’s work in research, prevention efforts, early detection of the disease, and improving access to care.

Cancer Research UK wants the survival rate of cancer patients in the UK to be among the best in the world. The organisation focuses their efforts in four key areas – working to help prevent cancer, diagnose it earlier, develop new treatments and optimise current treatments by personalising them and making them even more effective. The organisation’s work is funded solely by donations.

Scottish Government Covid-19 inquiry: Dental profession must be better supported in a future pandemic

Dental professionals must receive better support for their physical, emotional and financial wellbeing in a future pandemic situation, to ensure patients continue to get the best possible care and treatment and avoid long-term impacts on the profession.

In its submission to the Scottish Government’s inquiry into the handling of the Covid-19 pandemic, Dental Protection said that during Covid-19 the dental profession desperately needed priority PPE, support measures to mitigate potential financial viability issues due to safety protocols limiting access to dental services, and consistent guidelines.

The organisation said the Scottish Dental Clinical Effectiveness Programme (SDCEP) provided well received clinical guidance at a time when dental professionals around the world sought clarity about operating procedures, and this was a positive learning for the future.

However, Dental Protection said there was an overall sense that dentistry has been “overlooked” throughout the Covid-19 pandemic, and a number of lessons must be learnt should we face a further pandemic.

Helen Kaney, Dental Protection Head of Dental Services, Scotland, said: “Dental professionals have faced significant challenges as a result of the pandemic. The clinical challenges have centred on availability of the required PPE, virus transmission risk and restrictions of the type of clinical interventions that could be undertaken for patients. There have also been and remain, significant financial challenges which may impact on the long-term provision of NHS dentistry in Scotland.

“These challenges were enhanced by a sense that dentistry has been overlooked throughout much of the pandemic. Dental professionals are well used to dealing with and managing risk, but the scale of risk and uncertainty for dentistry throughout this time has been unprecedented.

“Dental Protection has throughout the pandemic been providing dentolegal advice to those dental professionals grappling with these new challenges, to enable them to practise in different ways, comply with guidelines and to help them protect their wellbeing.

“But the profession as a whole needs greater support from the outset should we face a pandemic situation in the future – this includes swift publication of clear, consistent guidelines, appropriate PPE as a priority, and effective financial support measures to protect the financial stability of practices and ensure that patients can continue to receive optimal care within the safety protocols.

“Addressing the shortfalls from this crisis will be vital in ensuring patients continue to get the best possible care in any future pandemic, and in safeguarding our profession. We hope the challenges we have raised will be considered as part of the inquiry.”

Dental Protection’s full recommendations to inform the inquiry:

  1. Professional bodies, associations and Dental Defence Organisations should work together to ensure there is consistency in the guidelines that are issued in exceptional times, and that the focus remains on patient care. The specific areas of concern should be documented for future reference to ensure that timely advice is issued from the outset should there be another pandemic in the future. The resources published by the SDCEP, and the speed of their production, were valued by the profession and are positive learning.
  2. The inquiry should consider what further action should be taken to monitor the number and type of complaints being made to the GDC about dental professionals during this pandemic, and seek ongoing reassurance from the GDC that the extremely challenging context in which dental professionals have been practising continues to be taken into account.
  3. Dental professionals should be recognised at the start of any future pandemic as a group at particular risk, and be given priority PPE so they can continue to treat patients safely, protect themselves and their teams.
  4. Dental professionals should be rewarded and incentivised to treat patients in the way that is most effective and safe during a pandemic, so that the safety protocols which make more normal levels of activity impossible, do not threaten the financial viability of practices in the long term.
  5. Policies and guidelines should offer broader guidance on coping with the psychological aspects of managing workload and the clinical challenges and limitations for dentists and their teams during a pandemic situation – such support would help to safeguard the wellbeing of the profession.

3M shines at the BOC

For many years, 3M Oral Care has been synonymous with exceptional orthodontic appliances and products. At this year’s British Orthodontic Conference, 3M showcased some of its most innovative solutions yet.

Delegates were able to see solutions such as 3M APC Flash-Free Adhesive Coated Brackets first-hand. These time-saving brackets are not only designed for ultimate comfort but also have the exact amount of adhesive necessary for a firm bond – eliminating the need for flash and preventing any problems such as the formation of adhesive clumps during placement.*

The team from 3M also showed Clarity Advanced Ceramic Brackets – discreet, beautiful brackets that help improve patient confidence and have anti-staining properties to ensure that they remain aesthetic throughout the whole course of treatment.*

To find out more, please contact 3M today.

For more information, call 0845 873 4066 or visit www.3M.co.uk/Ortho

Diabetes Mellitus and Dentistry

It is predicted one in seven Britons are suffering from diabetes mellitus and one in three have incipient and undiagnosed pre-diabetes. This will be a major problem for our medical colleagues and us. We should be very involved with these patients.

There are two main groups of diabetics:

Type I:  There is an absolute deficiency of insulin.  Patients are usually in a younger age group.

Type II: Is characterised with both insulin resistance and a deficiency.  It is usually found in older age groups and is associated with obesity.

As well as Gestational Diabetes, during pregnancy and other, associated with other diseases, drug use or genetics for Indian and African peoples.

Traditionally diabetes has been diagnosed following a fasting blood glucose or a glucose tolerance test. A simpler test measures  HbA1C,  counting the number of glucose molecules attached to red blood cells. If this is above 6.5 mmol/L, it is officially diabetes.  The target of treatment is to maintain this glycolysated haemoglobin at below 6.5 per cent as this has been shown to lead to fewer diabetic complications (1).

Diabetics have serious complications including:

  • Retinopathy leading to blindness
  • Cardiopathy
  • Nephropathy
  • Neuropathy
  • Micro and macro arterial disease 
  • The sixth, dental complications, have received much less publicity (2). They are periodontopathy , and xerostomia. Other dental symptoms, caused by neurological changes, include burning mouth and tongue and altered taste sensations

It is not just the diagnosis of hyperglycaemia that is important but its severity that affects the periodontium most (3,4). Diabetics have a 3 – 4 times greater risk of developing periodontal disease than non-diabetics (5); for diabetic smokers the risk significantly greater (6).

We define periodontal disease as the loss of bony support to the teeth, increased pocket depth and inflammation of the surrounding tissues caused by the body’s reaction to plaque (7), whilst xerostomia is reduced salivary output with its risk of developing caries (4).  High blood glucose levels are also associated with an increased incidence of oral thrush.

Periodontal disease is a reaction to toxins produced by dental plaque and an abnormal immune response with reduced levels of tissue healing, the severity and progression of which depend on the host response to biofilm, although the causative organisms are still under debate (8). 

Diabetic periodontopathy was first recognised by Williams in 1928 (9). Recent research has shown as close inter-relation between diabetes and periodontitis, the one affecting the other and vice versa, a two-way street between these diseases (10,11). Diabetes and periodontal disease are biologically linked (12,13).

  • This interrelationship between diabetes and periodontal disease provides an example of systemic diseases predisposing to oral ‘infection’, and once that ‘infection’ is established there is an exacerbation of systemic disease (17)
  • Diabetics and non-diabetics have a similar oral flora (14)
  • Diabetics have an increased susceptibility to infection and delayed wound healing (15)
  • There is a common pathogenesis between diabetes and periodontal disease involving an enhanced inflammatory response at both local and systemic level. This is caused by the chronic effects of hyperglycaemia and formation of advanced glycation end-products and lipids that promote the inflammatory response (15,16)
  • Diabetics have significantly higher levels of local inflammatory mediators, especially cytokines and tissue necrosis factor when compared with systemically healthy people with periodontal disease (15,18). Interleukin 8 is also raised and give a potential contribution to cross-susceptibility (19)
  • Diabetes enhances periodontal bone loss through enhanced resorption and diminished bone formation(20)
  • The severity of periodontal disease in diabetics may not correspond to levels of bacterial plaque observed clinically. More aggressive treatments may be required (21)
  • C-reactive protein levels are raised in both diabetes and periodontal disease (14)
  • Antibiotics prescribed for periodontal disease may reduce insulin requirements (21). However,there is no consistent evidence that the addition of antimicrobials to scaling and root planning is of benefit (22)
  • Periodontitis progression is associated with an increase in HbA1c levels in type 2 diabetes (23)
  • Periodontitis may play a role in increasing the incidence of new cases of type 2 diabetes and possibly gestational diabetes (24)
  • There is a significant association of periodontal disease with gestational diabetes mellitus and pre-eclampsia (25)

Various mechanisms for this altered immune response in the periodontal tissues of diabetics have been suggested, but none are proven. However, polysaccharides in Gram negative bacteria stimulate the production of cytokines and oxidative stress is critical in the development of diabetic complications (8).

As periodontal disease and diabetes mellitus affect each other, there is some early evidence to suggest that individuals with periodontal disease may be at higher risk of developing Type II diabetes (16) and pre-eclampsia (25).  Periodontal infection has an adverse, yet modifiable  effect on glycaemic control (26). When periodontal disease is brought under control and pathogens removed, the HbA1C level falls (16), there is improved glycaemic control (23) and there can be a reduced requirement for insulin dosage. The overall management of diabetes may improve (27) because. periodontal therapy improves metabolic control (23).

The emphasis must be for individuals to improve their personal plaque control, to reduce the numbers of bacteria and biofilm both supra- and sub-gingivally using toothbrushes and interspace brushes.

These patients will also require frequent professional interactions, in depth oral health teaching, and consistent educational reinforcement.

This means that all diabetic patients should be advised that they are at increased risk of developing periodontal disease and need regular dental care because of the positive bidirectional association between periodontal disease and diabetes mellitus and underlines the need for screening of patients with periodontal disease for diabetes mellitus and vice versa (28). However, this is not happening because this recommendation does not appear on the annual NICE check list for General Medical Practitioners and very few doctors have been taught about this inter-relation.

The evidence is overwhelming that the alveolar bone loss associated with periodontal disease is the result of a complex inflammatory response to plaque antigens.  It follows that, if individual patients can be educated and persuaded to fully control their plaque on a daily basis, then the inflammatory reaction will subside. This requires dental appointments and skilled teaching in toothbrushing techniques, interdental plaque control, the relationship of the Stephan pH curve to the development of caries, and follow-up.

Diabetics have to learn to manage their blood sugar levels following suitable education and guidance.  Therefore, the vast majority are capable of managing and controlling their plaque. However, doctors are not checking that diabetic patients are receiving dental care.

There is an unmet need for in-depth guidance from Public and Professional Bodies.  This is made more complicated because health care in the UK is devolved to the Welsh and Northern Irish Assemblies, the Scottish Parliament as well as the Westminster Government for England. The main general educational focus is theirs.   Each may develop its own system but all need to take action. They could begin with a simple poster campaign placed in every hospital diabetic clinic, GP practice and pharmacy to advise diabetics to seek regular dental care because the evidence is unequivocal, diabetes and periodontal disease are interrelated. 

For example, the charity Diabetes Now website does mention periodontal disease as a complication of diabetes without explaining in detail what it is or what the consequences can be (29).

Two years ago I asked NICE to add dental care to the General Medical Practitioners check list. Despite providing evidence they refused. I shall try again.

There is an absence of inter-professional collaboration between doctors and dentists while managing patients with diabetes mellitus (30). However, there is action we as dentists could take now to educate our medical colleagues:               

Notify the GP of each diabetic patient you are caring for and ask for the HbA1C blood test results. Provide details of your ongoing BPE scores with an explanation of the numbers in return and show how periodontal disease is progressing or regressing.

If you have a patient with developing periodontal disease that has an atypical pattern or does not resolve, or xerostomia, burning mouth or sensory loss you must consider diabetes or prediabetes as a contributing factor and refer your patient to his/her GP for blood sugar investigations, especially Hba1C levels.

Share you BPE scores with your patients and explain what the numbers mean. If you need full 6 point pocket depth measurements with a bleeding index, record of gingival recession or an interproximal brush use chart share them too.

 Consider the timing of repeat radiographs to avoid unnecessary radiation.  This will have to be determined by clinical presentation and the rapidity or otherwise of periodontal deterioration.  For apparently well controlled cases, perhaps further radiographs at 3 yearly intervals are indicated (7).

If doctors refer new diabetic patients, stage one of treatment is to remove supra and subgingival calculus and biofilm, the latter of which can only be removed by ultrasonic scaling, teaching OHI and interproximal plaque control.

In the first instance recalls are likely to be at three monthly intervals. Depending on patient response, this interval may be increased.  The classic signs of periodontal improvement are:

  • Reduction in the number of bleeding points
  • Reduction in pocket depth
  • Reduction in plaque score
  • No further bone loss radiographically

Another sign of periodontal improvement is:

  • Increase in interspace brush diameter in some interproximal spaces with time (30)

The bottom line is clear; patients need to control their plaque effectively and efficiently to control periodontal disease, caries and reduce the effects of systemic diseases.  Whilst daily plaque control must remain their responsibility as dentists our responsibility is to show patients how to control their plaque effectively and to monitor and record progress (or regress) at regular intervals.

In summary there is a need for:

  • Doctors and dentists to work together and share test results
  • An education campaign to encourage diabetics to attend for dental care
  • Better dental record keeping and sharing this information with patients
  • Develop better ways to help patients control their plaque on a daily basis
  • Publicity at national and local level about the two-way relationship between diabetes and dental disease

About the Author

Dr Turner was a Specialist in Restorative Dentistry before his retirement from clinical practice. His achievements include inventing colour coded pocket probes, setting up the Dental Practice Unit at Sheffield Dental School in 1080 and its first Head, moving to Salisbury as Director of Dental Services and Postgraduate Tutor then specialist referral practice from 199.

He developed the Spacemark Dental interdental brushing chart to assist patients in achieving ideal daily plaque and periodontal disease control.

References:

  1. National Diabetic Information Clearinghouse (NDIC) website (US).
  2. Löe H.
    Periodontal disease. The sixth complication of diabetes mellitus.
    Diabetes Care 16: 329, 1999.
  3. Genko RJ, Borgnakke WS
    Risk factors for periodontal disease
    Periodontol 2000 62: 59, 2013.
  4. Kocher T et al
    Periodontal complications of hyperglycaemia/diabetes: Epidemiological complexity and clinical challenge.
    Periodontol 2000 78: 59, 2018.
  5. Preshaw PM, Bissett SM.
    Periodontitis: oral complications of diabetes.
    Endocrinol Metab Clin North Amer 42: 849, 2013.
  6. Battancs E etal
    Periodontal Disease in Diabetes Mellitus: A Case-Control study in Smokers and Non-Smokers.
    Diabetes Ther 11: 2715, 2020.
  7. American Academy of Periodontology website.
  8. Wu YY, Xioa E, Graves T.
    Diabetes Mellitus related bone metabolism and periodontal disease.
    Int J Oral Sci 7: 63, 2015.
  9. Williams J.
    Diabetic periodontoclasia.
    J Amer Dent Assoc 15: 523, 1928.
  10. Preshaw B et al.
    Periodontitis and diabetes – a two way relationship
    Diabetologia 55: 21, 2012.
  11. Mealy BL.
    Periodontal disease and diabetes – a two way street.
    J Amer Dent Assoc 137: 265,2006.
  12. Bullon P, Newman HN, Battino M.
    Obesity, atherosclerosis and chronic periodontitis: a shared pathway via oxidative stress and mitochondrial dysfunction?
    Periodont 2000 64: 139, 2014.
  13. Tsaic C, Hayes C, Taylow GW.
    Glycaemic control of type II diabetes and severe periodontal disease in the US adult population.
    Community Dent Oral Epidemiol 30: 182, 2002.
  14. Moore PA et al.
    Type I diabetes mellitus and oral health.
    J Periodont 70: 409, 1999.
  15. Liu R et al.
    Tumor necrosis factor-alpha mediates diabetes-enhanced apoptosis of matrix-producing cells and impairs diabetic healing.
    Am J Pathol 175: 1574, 2009.
  16. Wang TF et al.
    Effects of periodontal therapy on the metabolic control in patients with type 2 diabetes and periodontal disease: a meta-analysis.
    Medicine (Baltimore) 28: 292, 2014.
  17. Southerland JH et al.
    Diabetes and periodontal infection – making he connection.
    Clinical Diabetes 23: 171, 2009.
  18. Johnson DR et al.
    Cytokines in type II diabetes.
    Vitam Horm 74: 405, 2006.
  19. Lappin DF et al
    The influence of glycated haemoglobin on the cross-susceptibility between type 1 diabetes and periodontal disease.
    Periodont 86: 1249, 2015.
  20. Pucher J, Stewart J.
    Periodontal disease and diabetes mellitus.
    Curr Diab Rep 4: 46, 2004.
  21. Grossi SG, Genco RJ.
    Periodontal disease and diabetes mellitus; a two way relationship.
    Ann Periodontal 3: 51, 1998.
  22. Simpson TC et al.
    Cochrane Database Syst rev, CD004714, 2015.
  23. Costa Kl et al.
    Influence of periodontal disease on changes of glycated haemoglobin levels in pateints with type 2 diabetes mellitus: a retrospective cohort study.
    J Periodontol 88: 17, 2017.
  24. Genco RJ, Graziani F, Hasturk H.
    Effects of periodontal disease on glycaemic control, complications and incidence of diabetes mellitus.
    Periodont 2000 83: 59, 2020.
  25. Kumar A et al.
    Association between periodontal disease and gestational diabetes mellitus: A prospective cohort study.
    J Clin Periodont 45: 920, 2018.
  26. Taylor GW.
    Bidirectional inter-relationship between diabetes and periodontal disease: an epidemiological perspective.
    Ann Periodontol 1: 99, 2001.
  27. Mealy BL, Rethman MP.
    Periodontal disease and diabetes mellitus. Bidirectional relationship.
    Dent Today 22: 107, 2003.
  28. Diabetes Now website.
  29. Stöhr J.
    Biderectional association between periodontal disease and diabetes mellitus: a systematic review and meta-analysis of cohort studies.
    Sci Rep 11: 136, 2021.
  30. Siddiqi J et al.
    Diabetes mellitus and periodontal disease: The call for interprofessional education and inter-professional collaborative care.
    J Interprof care 10: 1, 2020.
  31. Turner CH.
    Implant maintenance
    The Dentist pp62, 2011.

NASDAL Goodwill Survey – a return to normality?

This week saw the latest results published from the NASDAL (National Association of Specialist Dental Accountants and Lawyers) Goodwill Survey statistics. This survey covers the quarter ending 31st July 2021 and includes data on valuations as well as deals completed (i.e., practices bought or sold by NASDAL members’ clients in the period).

As the graph illustrates, the quarter saw big jumps both in those deals completed and valuations. In terms of deals done, goodwill as a percentage of fee income in the quarter across all types of practice averaged 144% of gross fees – that was a significant leap from 128% in the quarter to 31st April 2021. NHS practice goodwill bounced back with practice goodwill at 161% of gross fees – up from 146% in the previous period.

Private practices goodwill values saw a big increase – up to 133% of gross fees from 110% of gross fees in the previous quarter. Mixed practices reduced slightly with values of 145% of gross fees from 156% of gross fees last time.

Normal service resumed?

Alan Suggett, specialist dental accountant and partner in UNW LLP who compiles the goodwill survey, commented, “In my commentary on the last results, I did say that I was surprised to see big drops in goodwill values and that it had not been my subjective experience. As with all statistics, there can be anomalies.

“It seems that the figures from this latest quarter have borne that out. Why did last quarter’s figures occur? I would be speculating but it could be that there was a backlog of discounted deals that were delayed due to Covid and they all went through in the one quarter.

“Certainly as we move forward, NASDAL members are reporting that the market is robust and that sale prices are not being reduced and are reaching their full potential.”

The goodwill figures are collated from accountant and lawyer members of NASDAL in order to give a useful guide to the practice sales market. These figures relate to the quarter ending 31st July 2021.

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

Christie & Co sells two Glasgow dental businesses, demonstrating huge buyer demand

Specialist business property adviser, Christie & Co, has announced the sale of two Glasgow dental practices; Patrick G Neilan B D S to a first-time buyer, and Scotstoun Dental Practice to a large dental group.

Patrick G Neilan B D S is a well-established, two-surgery NHS dental practice, with a dedicated patient base of over 2,800 patients. It offers significant scope for further potential including longer opening hours and the introduction of specialist treatments. The business is located on Kilmarnock Road in Shawlands – a popular residential suburb in the south side of Glasgow, approximately four miles from the city centre.

The practice was previously owned by Mr Patrick Neilan who has been operating as a dentist since 1975, firstly as an Associate and then, in 1992, as the sole Principal of the practice at its current site. Patrick G Neilan B D S has been sold to first-time buyer, Mrs Jennifer Logan, who was an Associate at another practice in the area.

Mrs Logan comments, “As a former patient at the practice, I had some knowledge of the patient base and the loyalty that they felt for the previous owner. Since taking over, the patients have been very understanding and obviously sad to see Mr Neilan go. However, they have welcomed new techniques and embraced different approaches, more specialist treatment and most recently facial aesthetics.”

The second practice sold is Scotstoun Dental Practice, formerly TKB & LD WRIGHT Dental Surgeons, a two-surgery practice based on Dumbarton Road in Glasgow. Established over 90 years ago, the practice has been owned by Mr Kerr and Mrs Lesley Wright since 1981 and was brought to market to allow the pair to pursue a well-earned retirement. The business has been purchased by a large Scottish dental group after a short marketing period.

Joel Mannix, Senior Business Agent at Christie & Co, who handled the sales, comments, “These are two very different dental practices – one is fully Associate-led that attracted attention from group operators looking to add to their portfolios, and the other being of interest to independent first-time buyers. Both sales attracted a great deal of interest which is commonplace in the Scottish dental market.

“So far in 2021, Christie & Co has sold a record number of dental practices in Scotland – this activity level doesn’t show signs of slowing down and is likely to continue for the foreseeable.”

Patrick G Neilan B D S and Scotstoun Dental Practice were sold for undisclosed sums.

BOS supports GIRFT report into Hospital Dentistry

The Consultant Orthodontist Group (COG) of the British Orthodontic Society are delighted to support the publication of the GIRFT report into Hospital Dentistry.  Recommendations in this new report aim to improve access and standards of care for patients, and knowledge of activity to the secondary care trusts and wider NHS.

Liz Jones, National Lead for the report, engaged with specialties as data collection revealed variations, coding of activity being a standout issue especially in Orthodontics.

The COG working group, chaired by Helen Travess, developed two booklets to clarify the guidance on coding for hospital dentistry, published by BOS, RCS and GIRFT.  Developed for clinicians, clinical coders and other health professionals within secondary care trusts, it aims to improve the quality of data and reduce unwarranted variation. It has been widely published through the society, with open access to clinicians. Orthodontics has been an exemplar to the field, with other specialties also now developing guidance to coding.

Jonathan Sandler, President of BOS, said: “We welcome this new report into hospital dentistry.  It couldn’t be more timely in this post pandemic phase of healthcare delivery.  Interdisciplinary working is key to hospital dentistry.  This report supports these aims with recommendations on workforce and access to such care. It also highlights the role of oral heath advice and multi government agency action.” 

Dental Protection reveals key advice trends during Covid-19

Handling patient complaints about delays in treatment due to backlogs, and situations where staff refuse a Covid-19 vaccination, are the key areas dental professionals have sought advice and support from Dental Protection in 2021, according to the leading dental indemnifier.

Dental Protection has revealed some of the most common advice themes from March 2020 when the pandemic hit, right through to the present. Throughout the past 18 months, dental professionals have sought advice and support from Dental Protection on a range of evolving challenges, from providing emergency care during lockdown, through to managing with limited PPE, interpreting guidance and returning to work safely.

Dental Protection’s Director Raj Rattan, said dental professionals should take some comfort in the fact that they are all seeking advice from their dental defence organisation on similar challenges, and be reassured that the team at Dental Protection remains responsive and agile to the changing dental landscape.

Some of the most common advice themes

March 2020 at the beginning of the pandemic:

  • Provisions for emergency care during lockdown following the closure of dental practices
  • The practicalities and indemnity for running/working within Urgent Dental Care Centres and redeployment to other services
  • Shortages of PPE
  • Teledentistry/remote consultations and triage

Summer 2020:

  • Queries about reopening of surgeries and returning to work
  • Interpretation of the Public Health England/Chief Dental Officer (CDO) guidance in the different UK jurisdictions about the return to work and provision of modified services e.g. AGPs and fallow time
  • Queries in relation to the reopening of private practices
  • Fit testing of FFP3 facemasks, ranging from who can do this, where they do it and who for, and appropriate indemnity arrangements
  • Individual staff difficulties with wearing FFP3 facemasks and returning to work.
  • Issues relating to lone working

Autumn 2020:

  • Return to the more usual (non Covid-19) queries about clinical care and patient complaints in relation to their treatment
  • Assisting with the flu vaccination roll-out

January 2021 onwards:

  • Covid-19 vaccination queries – administering the vaccine and appropriate indemnity arrangements
  • Advice about when a member of staff refuses the vaccine
  • Assisting members in managing complaints from patients because treatment has been delayed due to Covid-19 restrictions
  • Advice in relation to challenging interactions with patients because of continued Covid-19 restrictions in healthcare environments and difficulties in accessing treatment due to accumulated demand
  • Healthcare worker self-isolation queries

Raj Rattan, Dental Director at Dental Protection, said: “Due to the rapidly changing dental landscape over the last 18 months, dental professionals have sought advice and support from Dental Protection on a plethora of often complex issues, including deciphering and adhering to evolving guidance, while doing their best to provide necessary care and treatment to their patients.

“We know it has been a challenging time for members, both from a professional and personal perspective and that the cumulative effects of stress have affected many dentists’ sense of mental wellbeing. The social isolation over a prolonged period has also taken its toll in many cases.

“During recent months, requests for advice and support have centred around handling complaints from patients because treatment has been delayed or because they can’t access their dentist quickly because of backlogs of work. Alongside this, many dental teams are experiencing abusive behaviour, as patients have become increasingly frustrated.

“We want to reassure all members that Dental Protection is here to offer support. Throughout the pandemic, members have and can continue to rely on us for advice and assistance. Our teams remain responsive to the evolving challenges, demonstrating thought leadership and agility to ensure that we are doing our very best to help and support.

“Please remember that Dental Protection also offers confidential counselling services as a membership benefit.  This is delivered by ICAS’ independent, qualified counsellors who are available 24/7. A range of wellbeing resources are also available including apps, podcasts and webinars at www.dentalprotection.org/uk/wellbeing.”

Dental incorporation 15 years on – an erosion of the benefits?

Fifteen years have passed since the law was changed allowing dentists to incorporate.  At the time, there were plenty of dentists who embraced incorporation in order to reduce their tax liability. Today the benefits are less clear-cut and the Ross Brooke Dental team urge caution.

Specialist dental accountant Nathan Poole commented: “Our view has always been that incorporating can be beneficial but will depend on individual circumstances. The dentist needs to know how they will manage a range of factors, outstandingly the limits placed on withdrawals from the business.”

He explained that when a dental practice is incorporated, the cost of the goodwill has to be amortised, or off-set over a period of roughly five years. If the value of the practice was £500k, then a notional charge of £100k has to remain in the business until the good will is written off. This reporting requirement is a bitter pill to swallow for the sole trader who has always had full access to all their earnings.

Ross Brooke Dental provides a feasibility to any client considering incorporation so they can weigh up all the aspects which might affect them, such as:

  • How to extract income from their company
  • Amortisation of goodwill
  • Moving the balance sheet of the practice into the limited company
  • The Director’s loan account
  • Shareholders
  • Staff contracts – employees must be employed by the company

Nathan continued: “Whether to incorporate may not seem like one of life’s big decisions, but as a dentist, it could be among the most critical choices you will make, and that includes career, marriage and where you live!”

Ross Brooke Dental founder Linda Giles agreed. She said any dentist who wanted to incorporate should be given the option of a detailed feasibility study by their accountant. Anything else would be a dereliction of duty.