Dear Editor,

For the time that you have allowed the Ex-Chief Dental Officer the column space in your magazine to rewrite history, in an attempt to create a legacy of his period in office, I have resisted the urge to reply to the thoughts of Mr Cockcroft.
But his column in November’s edition I am afraid prompted me from my efforts to ignore what he writes, to respond to the fantasy opinion pieces as I believe it’s time to respond to his sniping comments every month about the BDA.
It is quite remarkable that the CQC continue to find such high levels of compliance within our profession suffering from the effects of his bestowal, which year on year gets harder and harder for my colleagues to survive within the ever squeezed NHS and the failed contract of 2006. This contract is indeed the legacy of the CDO.
He complains about the negative when indeed it’s very hard to see many positives. I gave an interview on Radio Cumbria recently, speaking about a contract owned by the very Corporate he is now a Director of, which could not survive in Appleby-in-Westmorland and closed down with three months’ notice. Maybe Barry thinks this is good news? Perhaps his Board Meetings are joyous occasions where mydentist report a £3.6 million drop in NHS revenue for the last quarter?
The prospect of NHS England raising an extra £200 million from patients within this Parliament is obviously more good news and will encourage those just above the exemption category to attend a dentist with a 10% rise in the last two years on what they pay for NHS Dentistry. Also, the good news is that patients who fail to understand the exemption categories will be fined £100, 40,000 reasons to celebrate for the treasury, but sadly not for those harshly fined.
Perhaps we should rejoice in the clawback figures exceeding £80 million for NHS England, the recruitment crisis in dental practices, the legal disputes between the BDA and NHS England over Orthodontic Procurement and Patient Charge removal without UDA credits on late submitted or overproduced UDAs. Perhaps Barry can point me towards some more positive stories.
With surveys showing the morale of the profession is at an all-time low and younger dentists seeing their future away from the NHS, we are surrounded by positivity only in the world that exists for the Ex CDO.
No matter how many column inches Barry is allowed by you in the months to come, the profession will know the effects of his time and his legacy, which I am afraid is not at all positive. Perhaps that’s the negativity he really fears. I can only be thankful he is trying to influence the past and has no further influence on the future.

Eddie Crouch
Vice Chair BDA PECA

A leading doctor has issued a warning to Asians living in the UK that they could be putting themselves at a significant risk of mouth cancer as a result of traditional high-risk habits.
Dr Chet Trivedy, who is an A&E consultant at Kingston Hospital in London, believes common cultural habits in many British-Asian communities, such as tobacco and betel (areca) nut chewing, is placing thousands at severe risk of developing mouth cancer.
Dr Trivedy, who is also a dentist and trustee of the Oral Health Foundation, says chewing tobacco and betel nut increases a person’s risk of developing mouth cancer by up to seven times.
Highlighting the significance of the issue, Dr Trivedy, wants more British Asians to be aware of the dangers of chewing products containing betel nut and tobacco, also referred to as ‘paan’ or ‘paan masala’, and emphasises the need for greater education about its links to mouth cancer.
Dr Trivedy says: “I grew up in the Gujarati (Indian) community in Britain and have seen first-hand the devastating effect that mouth cancer can have on our community, not only through my work but also on a personal level. I am therefore incredibly keen to draw attention to this major problem.”
A report from the National Institute of Health and Family Welfare (NIHFW), has revealed that mouth cancer is among the top three cancers in India and accounts for 30% of the country’s cancer burden.
Mouth cancer also has incredibly high rates in other Asian nations such as Pakistan, Bangladesh and Sri Lanka and Taiwan.
“Without a doubt, one of the biggest reasons for this is the traditional cultural behaviour of paan masala chewing,” Dr Trivedy adds.

“This highly carcinogenic substance is commonly used in Asian communities as a powerful stimulant and is widely available in most South Asian grocery stores. It’s used commonly in religious ceremonies and to aid digestion, you can often spot a betel nut user as it stains their mouths a bright red colour.
“How it is consumed differs between communities, but it is most commonly consumed as a substance called ‘quid’ involving a mixture of slaked lime, betel leaf and flavourings such as cardamom and tobacco.
“By including slaked lime, the ‘quid’ causes hundreds of tiny abrasions in the mouth which the cancer-causing carcinogens in the betel nut can enter the cells of the mouth.
“Chewing is incredibly unsafe as it allows prolonged exposure to these carcinogens and, dangerously, far too many people are unaware of the severe damage it can cause.”
A recent study led by the University of York revealed as many as a quarter of a million deaths worldwide are caused by smokeless tobacco products every year.
The study found a ‘hotspot’ of use in South and South-East Asia, in particular India, which accounts for almost three quarters (74 per cent) of the total global disease burden.
Dr Trivedy has issued the warning as part of Mouth Cancer Action Month, a campaign which aims to raise awareness of mouth cancer, promote the value of self-examination and encourage regular trips to the dentist, as they perform a visual mouth cancer check during every dental check-up.
The charity campaign is organised by the Oral Health Foundation, sponsored by Simplyhealth Professionals and has further support from Dentists’ Provident.
“Mouth cancer awareness in Asian communities is vital as it has a very high mortality rate,” Dr Trivedy says.
“Survival chances are closely linked to late diagnosis but far too many cases are being caught too late for effective intervention, particularly with Asian communities who may be less active in accessing healthcare.
“I encourage British Asian communities to spot the warning signs, ulcers which do not heal within two weeks, red or white patches in the mouth and any unusual lumps in the head or neck area. Visit a dentist or doctor if they notice anything unusual.
“Betel nut chewing is particularly associated with a condition called oral submucous fibrosis (OSF), which causes severe scarring in the mouth resulting in affected patients only being able to open their mouth by a few milometers’. About seven per cent of those affected will go on to develop mouth cancer.
“I want the British Asian community to become more involved in mouth cancer awareness and help make a difference by spreading lifesaving messages throughout their communities and beyond.”
As Mouth Cancer Action Month draws to a close today, the Oral Health Foundation is keen to stress that mouth cancer can affect anyone, so everybody needs to be able to recognise and act on the early warning signs all year around in order to improve early diagnosis and help save lives which otherwise could be lost to this terrible disease.
Find out more information about the signs, symptoms and causes of mouth cancer at www.mouthcancer.org.

A man has won £15,000 after botched dental surgery left him missing five teeth – and a broken jaw.
According to the Daily Mail, Clive Horsey, 58, was left in agony when the planned surgery to remove four teeth under general anaesthetic went wrong.
The dentist fractured his jaw trying to pull out a healthy, fifth tooth.
Mr Horsey from Radlett, Hertfordshire, has been left with permanent numbness and still struggles to eat certain foods after the shambolic procedure.
Mr Horsey arrived at Barnet Hospital, north London, for the procedure when doctors told him they would be taking the fifth tooth out, which concerned him.
He said: ‘My dentist said I needed to have my four teeth out.
‘I was apprehensive about the procedure but followed the dentist’s advice.
‘I presumed it would be a relatively routine procedure for the surgeon.
‘I’d been under the impression that I was just having four teeth out.
‘So I was slightly concerned to suddenly be told another tooth needed to be extracted, but trusted the surgeons knew what they were doing.’
He went through with the surgery, but when he woke up, he was told there had been ‘complications’ during the fifth tooth removal and his jaw had been fractured.
Mr Horsey added: ‘I woke up from surgery and was told I had a broken jaw.
‘I remember my heart just sank.
‘I didn’t know then what effect it was going to have on my life.’
After his x-rays were analysed, Mr Horsey discovered there had been no reason to have the fifth removed at all, and its ‘awkward’ position made the extraction procedure more complicated.
Since the fracture, Mr Horsey says he struggles to move his mouth properly and the numbness makes it difficult to eat certain foods.
He said: ‘I now suffer from numbness inside my left cheek, and my jaw constantly clicks.
‘I can’t open my mouth like I used to, which coupled with the clicking and numbness makes it difficult to eat certain foods.
‘It’s horrible, I am so angry.
‘If the surgeon hadn’t extracted this tooth he never would have fractured my jaw.
‘To think the tooth never even needed to be removed in the first place is soul destroying.
‘For months after the incident, I could barely open my mouth and was on a liquid diet.
‘I lost about two stone and I’ve been left with permanent numbness.’
Mr Horsey complained to the then Barnet and Chase Farm Hospitals NHS Trust, now the Royal Free, but found them ‘unresponsive’.
The Dental Law Partnership took on his case in 2014, and it was successfully settled in September this year when the trust paid £15,000 in an out of court settlement.
The NHS Trust denied liability.
Daniel Kinnear of The Dental Law Partnership said: ‘The distress and injuries our client has experienced were completely unnecessary.
‘The surgeon should never have extracted this particular tooth, and had it been left alone Mr Horsey’s dental problems could have been avoided.’

The British Dental Association (BDA) has responded to an investigation by the Times that shows that in 24 local authorities in England dentists can only take on private patients.

According to the BDA, of those surgeries with information on NHS Choices, the study found 49 per cent currently cannot take on new adult NHS patients, while some 42 per cent are unable to see new children entirely.

The investigation suggests areas including West Devon, North Lincolnshire, Gosport, Barrow-in-Furness and Stafford are unable to take on any adult NHS patients at all.

The BDA has long criticised the cost limited funding system for dentistry that can provide care for little over half the population. Targets for activity are set in contracts – dentists are penalised if they fail to meet targets but are not paid if they exceed them, even if they have the capacity to meet patient demand.

The BDA has expressed concern that the government is failing to honour two successive manifesto pledges to make a decisive break from the target driven contract system introduced in 2006. It has questioned responses from NHS England, suggesting that new initiatives such as ‘Starting Well’, targeting high needs children in just 13 local authorities will meaningfully expand access.

This unfunded programme has no new resource to provide additional access in any high needs areas, and in the capital is believed to be operating in just three wards in the London Borough of Ealing. The BDA has said vital work encouraging childhood attendance and improving access cannot rely on recycling existing limited budgets.

The BDA’s chair of General Dental Practice Henrik Overgaard-Nielsen said: “When dental care is being commissioned for just half the population it’s not surprising that millions of patients risk missing out.

“Access problems are now hitting patients across England, but officials would rather brush them off than fix the rotten system at their heart.

“Work on expanding access and encouraging child attendance is vital, but it is disingenuous to suggest that government plans can achieve this. Without new resources, NHS dentists are being asked to swap one group of patients for another.
“This isn’t about dentists turning their back on NHS dentistry. For over a decade this failed system has turned its back on them.”

The GDC if offering online information for registrants and CPD providers in preparation for Enhanced Continuing Professional Development, which comes into force for dentists on 1 January 2018 and dental care professionals later in the year on the 1 August. All General Dental Council (GDC) registrants will be expected to maintain a Professional Development Plan (PDP), which keeps a record of their personal development and training.
The PDP will gradually include a log of completed activities, including date, number of hours and the learning outcomes covered. It will store the CPD certificate for each activity. During the five-year cycle, dentists will need to complete 100 hours of verifiable CPD, with 75 hours for hygienists, dental therapists, clinical dental technicians and orthodontic therapists and 50 hours for dental nurses and dental technicians. Non verifiable CPD will no longer need to be declared. In future, when paying the annual retention fee (ARF), dentists and dental care professionals must make a declaration of the CPD hours they have completed in that year.
Says the GDC, “We have produced guidance for CPD providers and registrants, outlining the new requirements. You can also take a look at our videos, which also offer a summary. If you dental professionals have any queries pertaining to ECPD please get in contact by email communications@gdc.org“