National dental organisations have come together with a reminder: Antibiotics do not cure toothache

National dental organisations have come together to support the World Health Organisation’s Antibiotic Awareness Week, which runs from 18-24 November.

The Faculty of General Dental Practice UK, Association of Clinical Oral Microbiologists, College of General Dentistry, British Dental Association, British Association of Oral Surgeons, Association of Dental Hospitals and the dental sub-group of the Scottish Antimicrobial Prescribing Group are repeating the message to patients that “antibiotics do not cure toothache”, and reminding dental teams that antibiotics should only be used as an adjunct to definitive clinical management of the cause, and only where indicated.

Since the start of the Covid-19 pandemic, the dental profession has focussed on preventing the transmission of SARS-CoV-2 to their team, patients and the wider population. During the first national lockdown, the provision of general dental services was severely restricted and limited to the referral of urgent and emergency cases and the provision of advice, analgesics and antimicrobials where appropriate.

As a result of these constraints, a marked increase in antibiotics prescribed in NHS general dental practice has been reported. In England the number of prescriptions was up 22% during April to June 2020, and in Scotland there were steady month-on-month increases from April, peaking at a 50% rise in July, when compared with the same periods in 2019.

It is estimated that dentists account for around 10% of all oral antimicrobial agents prescribed in healthcare, and a clear link has been established between the consumption of antimicrobial agents in human medicine, animal healthcare and agriculture and increasing rates of antimicrobial resistance.

While antimicrobial resistance continues to be a long-term problem, a government review reported that 700,000 people worldwide are already dying of antibiotic-resistant infections every year, and estimated that by 2050 the annual global cost could be 10 million lives and £66 trillion.

Prudent prescribing of antimicrobials can slow down the further development of antimicrobial resistance, and all healthcare prescribers play a vital role. The dental profession has shown its clear commitment in addressing antimicrobial resistance by significantly reducing the use of antibiotics in dental practice over the last decade.

Last year alone, dentists in the UK reduced their prescribing of antimicrobials by 9%, and the organisations say it is vital that the profession maintains and builds on this success. They are encouraging all dentists to continue to play their part in reducing the development of antimicrobial resistance by ensuring appropriate prescribing of antibiotics when managing their patients during the Covid-19 pandemic and into the future.

Guidelines for antimicrobial prescribing in dentistry are available at https://www.fgdp.org.uk/guidance-standards/antimicrobial-prescribing-gdps and https://bnf.nice.org.uk.

Posters and leaflets for patients are available at https://www.fgdp.org.uk/antimicrobial-prescribing, and a Dental Antimicrobial Stewardship Toolkit, developed by FGDP(UK), the British Dental Association and Public Health England, is accessible at https://www.gov.uk/guidance/dental-antimicrobial-stewardship-toolkit

NHS England: Contract uplifts confirmed

Following consultation with the BDA, the Department of Health and Social Care has confirmed that contracts will be uplifted by 2.5% in England. The uplift will be paid in November and backdated to 1 April.

The BDA stressed, when the Chancellor announced his deal back in July, that an above inflation award represents a bare minimum any government can offer NHS workers’, adding that the ‘uplift does not begin to cover the huge increases in expenses practices have faced with PPE and meeting new cross-infection guidelines’.

Foundation Dentist salaries will be updated by 2.8%, as will Educational Supervisors’ grants. FD service costs have been frozen, which the BDA has strongly objected to.

This is the second consecutive year of above-inflation pay awards for dentists. The BDA remains clear that this must now be built on, as part of wider plans to maintain the long-term integrity of the service.

The BDA continues to campaign on behalf of NHS dentists.

BDA: Dentists facing uphill struggle, as missed appointments top 14 million

The British Dental Association has warned dentists face an uphill struggle to restore services unless government is willing to support costs for new equipment that could radically expand patient access, as the number of missed appointments hits over 14 million.

Official data on activity seen by the BDA indicates treatments delivered by NHS dental services in England are at a quarter of pre-Covid levels, and have only begun to inch above typical demand for urgent care, which is currently receiving priority. Over 14.5 million fewer treatments have been delivered in 2020 compared to the same period last year.

Dentists have been required to maintain 60-minute windows between patients after an Aerosol Generating Procedure (AGP) to minimise risks of viral transmission, contributing to this dramatic fall in patient volumes.  Recent recommendations by the Scottish Dental Clinical Effectiveness Programme (SDCEP) – which are widely anticipated to inform official guidance across the UK – could reduce this ‘fallow period’ to as little as 10 minutes where dentists can demonstrate a sufficient number of air changes per hour (ACH) in their surgeries.

The BDA has stressed that if practices – both NHS and private – are required to make changes to adhere to new official advice, then government will need to provide financial support.

Progress will require many of the UK’s 12,000 practices to undergo an on-site survey by ventilation engineers. With practices already struggling to remain financially sustainable the BDA has stressed the government must show willingness underwrite this work and offer commitments for capital funding for necessary equipment.

Practices will likely require mechanical ventilation, fitted internally or externally, with ducting as required, with those with surgeries without natural ventilation like windows facing significant challenges. It has been over a decade since dental services In England received any form of direct capital investment. Corporate provider MyDentist recently announced a £1.25m fund to reduce fallow time to 20 minutes in the 600 practices in their group.

The BDA anticipate many patients with untreated decay will end up requiring more extensive and costly interventions as result of limited access to dental services. Oral cancers – which kill more Britons every year than car accidents – are also going undetected in the absence of routine check-ups.

BDA Chair Eddie Crouch said: “Dentist are facing an uphill struggle to restore services and get on top of an ever-growing backlog. New rules could offer some hope, but only if government is willing to show leadership. If practices are going to get more patients back through their doors, it will hinge on support to invest in new kit.

“Until we see commitments, dentists will be fighting a losing battle, as early signs of decay are missed, and oral cancers go undetected.”

British Dental Association members launch legal action over data breach concerns

Members of the British Dental Association (BDA) who may have had their personal details leaked online are preparing to take legal action against the organisation amidst concerns that more should have been done to protect their data.

Sort codes and account numbers, as well as private e-mails and correspondence are thought to have been stolen by hackers in a digital attack which took place on July 30th.

An investigation is currently underway to determine the full extent of the breach, with the BDA – a trade body representing dentists and dental students across the UK – now reaching out to members that may have been affected.

Hundreds of site users have since expressed their concern over the breach, and several members have now instructed law firm Simpson Millar to begin investigations and to start legal proceedings.   

Robert Godfrey, Head of Professional Negligence at Simpson Millar solicitors – who is also handling hundreds of data breach claims for hacked easyJet customers – said the data breach was ‘deeply concerning’.

He has been approached by site users and believes anyone affected by the breach could have a valid claim for damages against the BDA for the distress caused by the ordeal.

He said: “We have had members of the BDA site contact us who are quite rightly very concerned. We are actively investigating potential claims on behalf of people directly affected by this serious breach. This is a clear violation of GDPR and data protection rules.

“I am confident any person whose details have been accessed could have a valid claim. It is clear there has been of breach of the residents’ right to privacy and the BDA is ultimately responsible. There is a clear entitlement to compensation for any upset, injury and cost of support and disruption to their lives.

“Many will be anxious and fear they will be targeted at home or work in the future.

“There is no doubt that the affected people are going to need support in this difficult time both from their family and friends. There are around 35,000 dentists in the UK, so this breach can be expected to have had a significant impact on a large number of people.

“The BDA are a professional body who have a very clear duty of care to ensure that the members of their site, who hand over their confidential information to them have their data secure and protected, are not exposed such as has happened in this breach.”

Mr Godfrey added: “We would strongly suggest that those who are contacted by the BDA should seek legal advice about their options as a result of this breach.” 

 

Those seeking advice are urged to contact Mr Godfrey of Simpson Millar on 0800 260 5010.

Russ Ladwa inaugurated as BDA’s 134th President

Russ Ladwa, who has held many of the leading roles in UK dentistry, has today taken office as the 134th President of the British Dental Association.

A former Dean of the Faculty of General Dental Practitioners, he has chaired both the Federation of London Local Dental Committees and the Dental Vocational Training Authority, and was a board member of the odontology section of the Royal Society of Medicine before being made its President. In 2012, having been a life-long member of the BDA, Russ was elected to its board, serving until 2019.

Russ qualified as a dentist from the London Hospital Medical College in 1975. He returned from a short spell as a civilian dentist in the US Army to work as an associate in an NHS practice in West London in 1977, buying the practice shortly thereafter.

In the 1980s Russ was involved in establishing the Asian Odontology Group and was a founding member of the Association of Dental Implantology. In 1990, he was one of the first London GDPs appointed as a Postgraduate Dental Tutor, a position he held for 23 years.

Russ Ladwa said: “Clearly the coronavirus pandemic will inevitably loom large over my presidency. So, I am heartened the BDA has stepped up and shown real leadership when it hasn’t always been forthcoming from the authorities. This challenge, huge as it is, will dominate, but not define my term of office.

“Yes, we have a responsibility to meet this threat head on, but we cannot shirk the other challenges we face. My predecessor, Roz McMullan, put mental health and wellbeing at the forefront of our agenda. She has my heartfelt thanks. In these uncertain times, the foundations she has laid are needed more than ever and will be built upon.

“And there is the task ahead to help this Association look more like the profession it serves. I have always believed in the mantra that any post should be won on merit alone, with equal opportunities afforded to all.  I am equally clear that every dentist requires strong role models to aspire to. They should be able to see themselves in the BDA, if they are to take part, to grow and even lead a strong membership organisation, such as ours.

“So, the underrepresentation of women across the BDA seriously concerns me just as much as the profession-wide under-representation of Black, Asian and other minority dentists. Democracy sometimes has to be helped along. As half the profession and half of our membership, the case for women to be better represented is undeniable. I am glad that this is being currently addressed positively and I promise to do all I can, during my term, to support their cause.

“I know many colleagues now face an uncertain future. Oral health inequalities we’ve struggled with for so long look set to widen. Prevention looks less attainable than ever. But a pandemic isn’t the time to step away from these challenges. It’s the moment to confront them head on.

“I pledge to be a listening President for all our members, regardless of their background, specialty, or discipline. In these trying times we are stronger together.”

BDA: Data misses dramatic fall in access during Covid

The British Dental Association has warned the latest NHS Dental Statistics do not fully show the unprecedented fall in access driven by the Covid-19 pandemic.

While limited figures have been offered for the period up to 30 June 2020, data focuses on treatment delivered by high street NHS dentists in England in between 31 March 2019 and 31 March 2020. In this period only 58% of children had attended an NHS dentist in the previous 12 months, and 49.6% of adults in the last two years. 

Freedom of information requests by the BDA indicate access to the Urgent Dental Care Network – set up to treat emergencies during lockdown when face-to-face care was suspended in practice – amounted to little over 2% of normal levels of activity. Paperwork lodged by dentists with the NHS Business Services Authority indicate just 83,300 courses of treatment were delivered in May 2020, compared to an average of around 3.5 million per month in January to March. 

The BDA has warned that England has not yet turned the page on low levels of access. Recent BDA surveys indicate the overwhelming majority of practices are now operating at less than a quarter of their former capacity following the resumption of face-to-face care on 8 June. 

According to NHS data 38.4 million courses of treatment were delivered last year, an average of around 9.6 million per quarter. Low levels of capacity mean it will be a major challenge to deliver anything assembling those levels going forward. 

Practices are facing significant barriers to expanding capacity, including the need to leave surgeries fallow for 60 minutes after an aerosol generating procedure. Unless regulations evolve, the BDA has warned tens of millions of patients in England will effectively lose access to dental services.   

Dave Cottam, Chair of the British Dental Association’s General Dental Practice Committee, said: “This is data is from another era. Since March patient access has fallen off a cliff, and there is no certainty when or if it can be restored. Access was in bad place pre-pandemic. We should lament how few children and adults made it to an NHS dentist last year, but the real question now is how we can even bring the service back to these levels. We have practices struggling, and tens of millions of patients need somewhere to go. We need government to work with us to rebuild capacity.”

Double down on prevention: BDA issues open letter to Matt Hancock on the future of public health

The British Dental Association (BDA) has sought urgent clarity on the government’s future plans for public health provision following its pledge to scrap Public Health England.

In an open letter to Secretary of State for Health and Social Care Matt Hancock, the BDA has stressed that oral health inequalities will likely widen as a result of the Covid-19 pandemic. It has outlined its concerns over the potential loss or disruption to priority work areas in dental public health, including the generation of tools and guidance for local authorities, commissioners and practitioners, epidemiology, and providing leadership and co-ordination covering key groups from young children to vulnerable older people and policy areas including sugar reduction.

BDA Chair Mick Armstrong said: “Any loss or disruption to dental public health work will have a material impact on communities across this country. We now risk leaving policy makers without evidence to base plans, practitioners without guidance to operate in unprecedented times, while losing vital expertise from a committed and highly skilled workforce. Effective management of the pandemic response is a clear a national priority. But meaningfully protecting the public long term hinges on an effective approach to public health, in which oral health is not an optional extra.
 
“We have greeted signals from the Department of Health and Social Care on prevention. As Matt Hancock has noted scaling up these approaches has the power both to transform lives and save money. A pandemic is not the time to cast aside that logic, but to double down. This vital agenda demands both proper resourcing and organisational commitment.”

Dental practices in Wales reportedly ‘operating at less than a quarter of capacity’

ITV News is reporting that dental practices are ‘operating at less than a quarter of capacity’ in Wales and that they will not be operating fully until ‘at least October’ according to some claims.

The report states that while services at dental surgeries across Wales are able to resume, as lockdown restrictions have been eased, stringent guidelines have made it difficult for them to operate fully. The Welsh Government allowed dental practices to resume from 1 July, however, a “phased approach” was taken due to the fact that, in some procedures, the risk of cross-infection is high due to the transfer of saliva.

Professor Mike Lewis told ITV News that this is why dentistry was going to be one of the areas of medicine that is going to “find it very difficult to return to normal because of the aerosol generation.”

Dental practices in England could fully resume on 8 June, while practices in Wales are currently operating under an ‘amber light’ in which some, but not all, procedures can resume.

A spokesperson for the British Dental Association said: ” The green status, where routine care returns, is unlikely to be reached till October at the earliest. Both nations are operating fallow time and maintaining 60 minute gaps between patients to reduce risk of viral transmission. This is a major barrier to access for all. It is not a return to business as usual in either nation. Most practices are operating at less than a quarter of their pre-pandemic capacity.”

BDA servers illegally hacked

The British Dental Association (BDA) has alerted its members to a cyber security breach, which took place last week, as its IT systems were hacked last week. The association has warned that hackers may have gained access to members’ user names, contact information, transaction history, bank details (including account numbers and sort codes), correspondence history, and case notes.

The BDA website, telephone line, and network all remain down for the time being, while investigations and restoration efforts are carried out. Members thought to be affected are being contacted.

The BDA is warning its members to remain alert and to be wary of any contact from parties claiming to be from a bank, utilities provider or the BDA itself. The association reminds its members that genuine callers will never request card or bank details.

For the time being, the BDA can still be contacted via the following email addresses:

The library’s online catalogue and ebooks also remain available: https://bda.247lib.com/bdalib/

 

Above inflation increase of 2.8% offers some comfort for service in crisis

The British Dental Association has said confirmation of second consecutive year of above-inflation pay awards for dentists must now be built on, as part of wider plan to maintain the long term integrity of the service.

The announcement will see 2.8% uplift on pay backdated to April, with no staging. This will apply to hospital and community dentists, with a final uplift to contract values for general dental practitioners to be confirmed following a consultation on expenses. 

In evidence submitted to the DDRB before the onset of the Covid 19 crisis the BDA made the case that the sustainability of NHS dentistry was already on a knife-edge. With a deal on abatement secured, it has stressed that the viability of the service can only be maintained with parallel action on support for private practice, future NHS contract arrangements and long-term consistency on pay.

BDA Vice Chair Eddie Crouch said: “These are difficult times for colleagues, and that NHS dentists aren’t being handed another pay cut will offer some comfort. Before Covid-19 hit years of pay restraint had already taken their toll. Above inflation increases are starting to repair that damage, and now must be pursued in tandem with other needed action to keep this service afloat.

“We’ve secured needed progress on abatement and pay. We now need to see a concerted strategy to ensure the nation’s dental services – both NHS and private – have a future.”