BSPD

BSPD: Workforce is critical to tackling the unacceptably high levels of dental decay in children and young people

The current number of specialists in paediatric dentistry is insufficient to meet the oral health needs of children and young people.  More specialists and consultants are required as well as training in enhanced skills in paediatric dentistry for General Dental Practitioners (GDPs).

The British Society of Paediatric Dentistry (BSPD) voices its concern on the shortfall of specialists following on from today’s press release from the Faculty of Dental Surgery at the Royal College of Surgeons of England (FDS RCSEng). Their release highlights the unacceptably high number of dental extractions under general anaesthetic caused by dental decay.  

While supporting the call from FDS for the roll-out of supervised tooth brushing schemes in early years settings and for a renewed commitment to sugar taxes, BSPD spokesperson Claire Stevens highlights the complexity of the current challenges facing the dental profession. 

For too long, she says, the marketing of high sugar foods and drinks aimed at children and young people has accelerated. Every Christmas, for instance, the Coke Tour involves huge trucks going to some of the most deprived parts of the country where drinks are given out for free. 

Dr Stevens said: “Covid-19 has deepened the challenges faced by the dental profession. Post lockdown, dental treatment has been successfully restarted, yet there is an estimated reduction in capacity of 50-65% due to essential measures to minimise the risk of viral transmission and protect staff and patients. Sadly, the number of children requiring hospital-based treatment caused by dental decay is going to remain constant as we have no choice but to anaesthetise very young children who need extensive restorations or extractions.
 
“However, at the same time as ensuring we have the workforce to carry out these treatments, we also need prevention programmes to help families rethink children’s diets and reduce sugar consumption. We would like to ensure that all children are regularly brushing their teeth both at home while the very young should experience supervised toothbrushing programmes in early years settings. The evidence shows that such schemes deliver an excellent return on investment.”
 
Dr Stevens added: “We would like to encourage all local authorities with areas of high dental need to introduce water fluoridation schemes. 45% fewer children aged 1 to 4 in fluoridated areas are admitted to hospital for tooth decay than those in non-fluoridated areas.”
 
“Following on from its excellent green paper on prevention, we would like to see the government delivering on its commitment to extend oral health interventions, supported by all organisations involved in the care and well-being of children and young people. Children’s oral health is everybody’s business.”

References:

https://www.bspd.co.uk/Professionals/Resources/Position-Statements

https://academic.oup.com/ije/article-abstract/49/3/908/5826797

https://www.gov.uk/government/consultations/advancing-our-health-prevention-in-the-2020s/advancing-our-health-prevention-in-the-2020s-consultation-document

BSPD responds to the Local Government Association over the impact of Covid-19 on children’s oral health

The British Society of Paediatric Dentistry (BSPD) has stated that it agrees with The Local Government Association that there should be a resumption in toothbrushing schemes in early years settings as soon as practical and such schemes are essential to counteract the possible increase in dental decay as a result of lockdown.

Dr Claire Stevens, BSPD’s spokesperson, says the LGA is right to highlight the risk of worsening dental decay in children as a result of Covid-19 as well as the guidance that is now available on establishing such toothbrushing schemes. (1)  

BSPD is collecting the data to assess the impact of the pandemic on children’s oral health.  Prior to the pandemic, the figures for children having general anaesthetics for multiple extractions were starting to come down. This was thanks to the concerted efforts of many people, driving up preventive interventions and activities.

The cancellation of general anaesthetics for multiple dental extractions during COVID-19 will inevitably mean that hospitals are working through a backlog of cases once elective (non-emergency) procedures restart. There is also the possibility of increased dental caries in children, the result of being out of education and stuck at home with greater opportunities to snack.

BSPD would like to see children suffering from dental decay to be treated in primary care where possible, to reduce the need for onward referral into hospital. We have been producing resources to support GDPs provide silver diamine fluoride, a technique which arrests the progress of dental decay and may avoid the need for a general anaesthetic entirely. (2)

Dr Stevens commented: “As ever BSPD is keen to work with all stakeholders involved in the care and welfare of children to minimise the impact of Covid-19 on their oral health.”

Meanwhile, Dr Saul Konviser from the Dental Wellness Trust, also spoke on the matter: “Everyday we, as dentists, see a large number of children that require not just a simple filling but often multiple fillings or extractions which is often a result of consuming too many sugary foods and drinks. What is worse is that it is almost completely unavoidable. From the work that we do, we know strategies such as oral health prevention and toothbrushing programmes in schools and nurseries is one way of supporting this long overdue ‘prevention better than cure’ ethos. We now urgently call on the Government for more funding – especially as lockdown prevented many children from accessing a clean toothbrush and toothpaste.”

(1) https://www.gov.uk/government/publications/covid-19-supervised-toothbrushing-programmes

(2) https://www.bspd.co.uk/Professionals/Resources

BSPD creates new committee dedicated to research excellence

A new committee has been created by the British Society of Paediatric Dentistry (BSPD) to have scrutiny over all aspects of the Society’s work with academic and clinical governance components. The Quality and Improvement Research Committee (QIRC) will encourage all clinicians in the specialty to produce, disseminate and implement the highest quality evidence. It will co-ordinate national audits, prioiritising ideas, reviewing protocols and allocating leads.

Other functions will include:

  • Providing clinical expertise and guidance to BSPD
  • Reviewing external guidelines and signposting to these
  • Coordinating approaches for representation on external guidelines
  • Advocating for academia, to ensure the best projects are funded
  • Encouraging paediatric dentists to be research active and consider an academic career
  • Having oversight of all requests to BSPD for questionnaires to be disseminated for membership feedback, making sure they are of value and scientifically valid
  • Supporting BSPD’s trainee research collaborative CONNECT
  • Responsibility for the annual Clinical Effectiveness Bulletin

The group has been created at the behest of BSPD’s Executive Committee by Professor Paul Ashley, Senior Clinical Lecturer and Honorary Consultant at UCL, who will be the first Chair, supported by Dr Chris Vernazza, Senior Lecturer and Director of Research at the University of Newcastle’s School for Dental Sciences.

Prof Ashley said: “I am delighted to be asked to Chair this new and important committee for BSPD. It’s our aim to drive the evidence base, support research and encourage more dentists to take a more active interest in research too.”

Dr Vernazza commented: “In the past, it might have been BSPD’s role to write guidelines but bodies like NICE or SDCEP are producing national documents which we can signpost to, leaving QIRC to focus on maintaining the most rigorous and consistent standards in the society’s work.”

As the incoming honorary BSPD Editor for the International Journal of Paediatric Dentistry Dr Vernazza has an automatic place on QIRC.

Other roles to be represented on QIRC are:

  • Consultant group
  • Specialists Group
  • Trainee Group
  • Clinical Effectiveness Bulletin Editor
  • Clinical Effectiveness Bulletin Editor Assistant
  • CONNECT Trainees
  • Teachers group

Claire Stevens, spokesperson for BSPD said: “With the creation of QIRC, BSPD anticipates more national audits in the field of paediatric dentistry as well as more support and encouragement for our members who wish to become or remain research active. These are exciting times.”

BSPD releases resources to support the use of Silver Diamine Fluoride

A comprehensive set of resources to support the use of Silver Diamine Fluoride (SDF) as a treatment to arrest dental caries in the primary dentition is available on the BSPD website. The technique is expected to be more widely used in the coming months as dental teams find ways to minimise aerosol generating procedures. These resources can be found here: https://www.bspd.co.uk/Professionals/Resources.

Included among the resources is a Patient Information Leaflet (PIL) which has been made editable so hospitals and dental practices can add their own logo. A Standard Operating Procedure and a Consent Form have also been developed. A powerpoint explaining the background to the technique as well as a demonstration video to show how SDF is applied has been created and are on our YouTube channel.

The resources have been compiled by Laura Timms, an Academic Clinical Fellow at the University of Sheffield Dental School with an interest in SDF. She has just won a prestigious joint grant from RCS and BSPD to make a video to explain the SDF technique to children.

She was motivated to understand more about the technique having been troubled by the extent of decay in some of her young patients; she wanted to find a treatment that would help keep them out of discomfort.

SDF is licensed in the UK for the treatment of sensitivity but Laura was aware of research which shows it has good results when painted onto dental decay in the primary dentition. “Using SDF can buy time for children who cannot manage dental treatment by stopping the decay getting worse until they can have further dental treatment. It’s simple, quick and effective.” 

Without treatment, the children would be at risk of requiring extractions under general anaesthetic and suffering from pain and abscesses while waiting for a hospital appointment. SDF contains both silver and fluoride in a solution of ammonia. It arrests caries until the child is older and more compliant with dental treatment. 

The disadvantage of the technique is that it stains the dental decay black. Some parents find the staining reassuring, however, as it shows that the treatment is working on the decay. If the child is subsequently able to cope with more demanding treatment, fillings or preformed metal crowns may be placed over the SDF. 

There is another option for the biological management of children with dental caries and that is the Hall technique. Preformed crowns are placed over decayed teeth and will also arrest the progress of caries. These are usually well tolerated but may be more challenging to place in very young children.

Laura added: “Ideally, I hope that the new SDF resources will help dental teams treat children in the family dental practice with which they are familiar and either delay or eliminate a referral into hospital.”

Claire Stevens, spokesperson for BSPD and a Consultant in Paediatric Dentistry, said: “All paediatric dental teams working in hospital departments want to keep procedures under general anaesthetic to a minimum currently which makes Laura’s work timely. Ideally, more children will be treated in their family dental practice instead of being referred into secondary care for a general anaesthetic. We are very grateful to Laura for her hard work.“

Laura says she distilled the new guidance from pre-existing resources from Sheffield University and Sheffield Teaching Hospitals, University College London Eastman Dental Hospital, Glasgow Dental Hospital and School and Dundee Dental Hospital teams. She is now working with children on a patient-centred video thanks to the grant awarded by BSPD and RCS.

 Links to resources:

Documents: https://www.bspd.co.uk/Professionals/Resources

Powerpoint: https://www.youtube.com/watch?v=njfhmN55HWs

Video: https://www.youtube.com/watch?v=tELmH9jRvv8

Children call the shots for a new dental video funded by RCS/BSPD

Laura Timms

A team at the University of Sheffield dental school led by Academic Clinical Fellow Laura Timms is preparing to make an information video aimed at children aged 3-10. The topic of the video is Silver Diamine Fluoride (SDF), a technique that helps arrest dental decay.

Laura has just won a grant of £5460 awarded jointly by the RCS (Eng) Faculty of Dental Surgery (FDS) and BSPD for her proposal to make a video to help explain the SDF technique to children and their parents. The video will be made by children who will be recruited to act as filmmakers and presenters and use fun activities to share information on SDF.

The University of Sheffield Dental School began introducing SDF towards the end of 2019. With significant waiting lists for general anaesthetics and very young children needing treatment and suffering toothache, the possibility of applying SDF to arrest caries in primary teeth seemed an attractive option. In some cases, use of SDF avoided the need for a general anaesthetic.

SDF is widely used overseas and at the International Association of Paediatric Dentistry (IAPD) meeting in 2019, Laura attended sessions on the technique. She remembered the simplicity of application from a student elective trip in Cambodia in 2014 and considered how useful it could be for some of her patients. She decided to research SDF and with colleagues in Sheffield and Newcastle wrote a paper published (1) in May this year, examining why SDF is not being used more widely in the UK.

SDF stains teeth black but in her experience, parents often welcome a treatment which stops the decay and may avoid extractions under general anaesthetic. Discussion with the child and parent is vital, she says.

Working with Connect Trainees she led a research project exploring paediatric dentists’ attitudes to SDF and in May she delivered a webinar on the topic to the group. Soon afterwards, she heard that she had been awarded the RCS/BSPD research pump-priming grant for the educational video.

Sheffield has an established reputation for child-centred research and the plan that she evolved with colleagues was to recruit children to help script, film and edit the video. It will be used to explain the treatment to families and also to recruit children to further research to help understand their thoughts and feelings on the technique.

Laura added: “I also want to get the views of dentists and dental therapists on SDF. It’s an easy and simple treatment with the right case selection and if it prevents children suffering with the pain of toothache and needing hospital treatment, it can only be a good thing.”

Professor Helen Rodd is a Sheffield-based Consultant in Paediatric Dentistry and one of Laura’s supervisors along with Profs Paul Hatton, Chris Deery, and Zoe Marshman. She also happens to be a member of the RCS FDS Board and was of course excluded from judging Laura’s grant entry.

She said that the impact of Covid-19 and the move to minimising Aerosol Generating Procedures (AGPs) meant that SDF was more valuable than ever for treating very young children and keeping them out of pain. She welcomed warmly the news of Laura’s grant.

Sarah McKaig, President of BSPD, commented: “We are very proud of Laura. Her work on this technique will help us understand the wants and needs of children and their families as well as the attitudes of dental practices.”

Dr Ranj is ‘Strictly’ Saving Teeth with new online videos for children

NHS doctor, TV presenter, author and celebrity contestant on Strictly Come Dancing, Dr Ranj, is the star of three new mini-videos unveiled today. Actor Gemma Oaten who rose to fame in TV soap Emmerdale supports Dr Ranj as the voice of sidekick Supertooth. 

The videos, which can be found here,  combine live action with computer animation. The aim is to give parents, carers and children the tips they need to keep teeth healthy. During the Covid-19 lockdown, dentists are only providing emergency treatment, which makes preventive advice on avoiding dental decay more important than ever. 

Dr Ranj and Supertooth guide children in different age categories and demonstrate, in just a few minutes, how to brush teeth. The key tips to promote prevention of dental decay are:

  • Brush for two minutes at least twice a day, including last thing before bed
  • Use a fluoride toothpaste
  • Spit, don’t rinse after brushing your teeth

Statistics released by NHS Digital show that nearly 60,000 children go into hospital annually to have teeth extracted under general anaesthetic. The cost for the treatment of this preventable disease is roughly £50 million annually.

The videos were instigated for the British Society of Paediatric Dentistry (BSPD) by real-life Toothfairy Claire Stevens, a Consultant in Paediatric Dentistry and a spokesperson for BSPD. She explained: “Every year, when statistics for dental extractions in children are published, I am interviewed by the media who are horrified that so many children are ending up in hospital having teeth taken out and they want to know why. As a children’s dentist, I know that the main culprit is frequent consumption of sugary foods and drinks, especially between meals. We also know that it can be a challenge to teach children to brush their teeth when they are young and then encourage them to keep brushing as they get older. We had to find a way to reach parents with helpful advice in a fun and non-judgemental way.”

Coincidentally, she was contacted by Ben Underwood, a dentist and the creator of the free Brush DJ app, who was looking for videos that would give parents and carers accurate information in the most accessible format – short, fun and online.

Claire went on a mission to speak to Dr Ranj who had co-created and presented the CBeebies show Get Well Soon. Her daughter loved the programme and would quote Dr Ranj after watching the show.

“As soon as I spoke to him, I knew he was the right person to help make some watchable videos for children. He was immediately on board with the messages and he insisted on giving of his time freely.”

Now in collaboration, Ben and Claire carried out research among high-risk patients supported by BSPD Exec member, Hannah Walsh. They learned that the parents of the target group favoured videos which are short, fun, have star quality and include animation. All aspects of the videos, the length, format, design and distribution, have been tailored in response to the feedback they received. The results are now being written up by Dr Walsh as an academic paper.

The final crucial pieces in the jigsaw, said Claire, were production and sponsorship. They were fortunate to have Joff Powell and his team at Pedwar Productions make the videos and he invited actor Gemma Oaten to be the voice of the animated character Supertooth.

She said: “Health care solutions provider Henry Schein and dental suppliers Dentisan generously came on board as sponsors and I have been supported by BSPD Executive throughout. Now we all hope to see positive results – fewer children in our clinics with decay.”

Dr Ranj commented: “Every child deserves to grow up happy and healthy, and that absolutely includes having healthy teeth. I’ve seen so many instances where dental health is forgotten, or people just don’t realise its importance, until it’s too late. The statistics around how many children have to have teeth removed because of decay are shocking. All it takes to prevent this situation is some simple advice and practice, which is why I’m so keen to be part of this campaign.” 

Patrick Allen, Managing Director of Henry Schein UK and Ireland, commented: “We at Henry Schein are very happy to partner with the BSPD and Brush DJ to help promote the importance of children’s oral health to their overall wellbeing. The videos with Dr Ranj are an excellent and innovative way to help engage with families so they understand the importance of their children brushing their teeth, which can support reducing the risk of getting tooth decay.”

Bob Newsome, Managing Director at infection control manufacturing specialists Dentisan said, “We are delighted to have been able to help spread the word about the importance of daily tooth brushing for children. These videos are a perfect blend of a serious message given in a fun and age-appropriate way.”

View the videos on YouTube here.

British Society of Paediatric Dentistry celebrates National Nurses Day

It’s National Nurses Day today and the British Society of Paediatric Dentistry is taking the opportunity to celebrate this important group of dental care professionals. In ordinary circumstances, dental nurses are essential to patient care and to the organised running of clinics. During the Covid-19 pandemic, many dental nurses around the country have been redeployed, showcasing their transferable skills.

Claire Stevens, BSPD’s spokesperson, said that she is extremely proud of dental nurse colleagues who have been redeployed. One of them is her colleague Jo Wrigley who works in the Paediatric Department at Manchester Dental Hospital. In March, Jo was told that she would be transferred to work with the Family Liaison Team at the Royal Manchester Infirmary.

With colleagues from the Manchester Dental Hospital, she has been an essential interface between terminally ill patients and their families. Donned up in protective wear and armed with an iPad, she has enabled sick patients to communicate with relatives, sometimes supporting them to say their farewells.

Empathy, calmness, and a commitment to making a difference are essential qualities for dental nurses being redeployed. Another dental nurse who has excelled is Amanda Hunter who is usually based in the Paediatric Dental Department at King’s College Hospital. She and colleague Paige Holdaway, are now working in the hospital’s Intensive Care Unit, also helping with some of the sickest patients with Covid-19.

One of her roles is to turn patients who are on ventilators who must not lie in the same position for more than four hours. She is also taking bloods, running monitoring for blood pressure, oxygen saturation and carbon dioxide output, fetching drugs, washing patients and making beds.

Liz Roebuck is a Consultant in Paediatric Dentistry at Edinburgh Dental Institute (and a member of BSPD’s Executive Committee) and has seen the difference some of her team members have been making to medical services in Scotland.

Lesley Allan and Nicola Vale have both been redeployed to work at a Covid Assessment Centre based at St John’s Hospital in Livingston. All the patients who come into the hospital have been told they should see a doctor and Lesley and Nicola both help with giving patients safe access, and monitoring vital signs.

Dr Roebuck said:  “Within dentistry, we know the crucial role of dental nurses in delivering effective patient care. A small, but important, benefit of the last two months has been the growing appreciation of their skills, expertise and professionalism across healthcare as a whole. Nurses Day 2020 has special meaning for all of us who are missing our dental nurse colleagues. There will be many emotional reunions as our teams regroup.