CGDent

College of General Dentistry appoints further Ambassadors

The College of General Dentistry has appointed three more Ambassadors: Professor Richard Horton, Dr Govin Murugachandran and Professor Jonathan Cowpe.

College Ambassadors are drawn from different backgrounds and walks of life. They support the engagement of the College in general healthcare and society and promote its influence in the interests of patients and the public, building trust and confidence in the dental profession.

More Ambassadors will be appointed in the coming months as the College works towards its historic, formal launch, now planned for mid-2021.

Chair of the College Board of Trustees, Professor Nairn Wilson, said: “I am delighted that Professors Horton and Cowpe and Dr Murugachandran have joined the College’s exceptional team of Ambassadors. Collectively, they have a huge range of highly relevant expertise and knowledge, with opportunity to greatly increase awareness of the College and its importance. The College looks forward to having the support and encouragement of its new Ambassadors in working towards realising the goals of excellence in oral healthcare provision and new leadership and support for all dental healthcare professionals.”

In commenting on his appointment Richard Horton said: “It is a privilege to join the College as one of its Ambassadors. For too long, medicine has neglected oral health. I want to make it my mission to ensure that oral health receives the priority it deserves within the NHS, medical research, and medical education. The College has a vital part to play in advancing oral health nationally and globally. I look forward to working with the College to deliver these goals.”

Govin Murugachandran commented: “It is a privilege to join the College as Ambassador at a time when the need for a clear and independent voice has shown its importance. I am looking forward to working with the college to bring guidance and innovation to the profession”

Jonathan Cowpe added: “I’m honoured to be an Ambassador for the College of General Dentistry. Dentistry is at the forefront of significant challenges in the delivery of high standards of healthcare to communities, not least during the present pandemic. I look forward to supporting the College spearheading excellence in healthcare delivery and promoting education and training for professionals from across the dental team.”

Richard Horton

Richard Horton is Editor-in-Chief of The Lancet. He qualified in physiology and medicine with honours from the University of Birmingham in 1986. He joined The Lancet in 1990, moving to New York as North American Editor in 1993. In 2016, he chaired the Expert Group for the High Level Commission on Health Employment and Economic Growth, convened by Presidents Hollande of France and Zuma of South Africa. In 2011, he was elected a Foreign Associate of the US Institute of Medicine and, in 2015, he received the Friendship Award from the Government of China. In 2019 he was awarded the WHO Director-General’s Health Leaders Award for outstanding leadership in global health and the Roux Prize in recognition of innovation in the application of global health evidence. He works to develop the idea of planetary health – the health of human civilizations and the ecosystems on which they depend.

Govin Murugachandran

Govin Murugachandran is a dually qualified clinician with a medical degree from University College London and a dental degree from Kings College London. He completed his core surgical training in the London Deanery as part of pursuing a career in Oral and Maxillofacial Surgery.

In 2017, Govin founded Flynotes, a digital health company that uses AI to optimise patient and clinical communications. Flynotes partners with leading organisation and institutions to deliver software solutions to health care professionals. Most recently, Flynotes worked with the FGDP(UK) and CGDent to deliver the Fallow Time Calculator for use by dental teams across the UK.

Jonathan Cowpe

Graduating from the Turner Dental School, Manchester in 1975, Jonathan embarked on a career in Oral Surgery in the NHS and through clinical academia, with senior posts in Dundee, Cardiff, and Bristol. His early research was on the application of quantitative cytopathology in early oral cancer detection. He has been involved in undergraduate and postgraduate education and training developments for 40 years. Elected to the Royal College of Surgeons of Edinburgh Dental Council in 1995, he became Dean of the Faculty of Dental Surgery (2005-08). He was appointed Head of the School of Oral & Dental Sciences, Bristol (2001-04). Returning to Wales in 2009, he was appointed Director of Postgraduate Dental Education in Wales. During that time, he was elected Chair of the Joint Committee for Postgraduate Training in Dentistry (2009-13). These roles facilitate his continuing aspirations to smooth the transition from graduate dental professional into clinical practice, a springboard into a career-long period of CPD and promote an ethos of inter-collegiality and engagement across the profession. Jonathan led on the ‘DentCPD’ project (2010-12) and the recent ADEE reports ‘Review of CPD’ (2019), ‘Preparedness for Practice’ (2020) and ‘Professionalism’ (2020) published by the GDC. He continues to supervise students/trainees in minor oral surgery.

Dental Protection and College of General Dentistry announce partnership to offer indemnity protection for less

Dental Protection and the College of General Dentistry have announced the establishment of a partnership which includes a discount on Dental Protection subscription fees for members of the College.  

Under Dental Protection’s new ‘CGDent Scheme’, Members and Associate Fellows of the College will receive a discount of 5% on their Dental Protection subscription, and Fellows will benefit from an 8% discount. Existing Dental Protection members who are also members of the College can contact Dental Protection to get their relevant discount applied.

To take advantage of the reduced fees, College of General Dentistry members should contact Dental Protection. Existing Dental Protection members should call 0800 561 9000 to get their relevant discount applied, and those who are not yet Dental Protection members should visit www.dentalprotection.org/uk to join.

Dental Protection members wishing to join the College should visit https://cgdent.uk/join/ Membership of the College opened earlier this week. Membership is open to all registered dental professionals, and prospective members should at present join the FGDP(UK) to be eligible for admission to CGDent membership. Registered dentists with a postgraduate dental qualification will qualify as full members of CGDent and be eligible for an indemnity fee reduction.

The ethos of Dental Protection is closely allied with that of the College of General Dentistry, with a clear focus on education, quality and standards. This new partnership will allow both organisations to work closer on new initiatives, alongside improving standards of dental care both nationally and internationally.

In light of the challenges currently facing dentists, the two organisations have established a ‘win-win partnership’ that will draw upon their respective areas of expertise in order to meet their members’ needs.

Raj Rattan, Dental Director at Dental Protection said: “I am delighted that we will be partnering with the College of General Dentistry. We both provide high quality support for general dental practitioners and it was an obvious decision for us to work even more closely together.

“This partnership lays on the shared understanding of the needs and challenges that the profession faces. The College seeks to improve the standard of care delivered to patients through standard setting, publications, postgraduate training and assessment, education and research. Something that Dental Protection has also been doing for years.

“I believe this will be the beginning of a long-lasting partnership aimed at improving the standards for the profession and supporting dentists in the UK.”

Nairn Wilson FFGDP(UK), Chair of Board of Trustees, College of General Dentistry, said: “Partnering with Dental Protection is an important step for the College of General Dentistry. I am delighted that Dental Protection are keen to be part of our journey to improve oral health care for all.

“This partnership demonstrates that ambitious and dedicated dental professionals who strive to deliver the best quality of care, through a robust career pathway and professional qualifications such as are being developed by the College, can be rewarded. We look forward to further developing this partnership for the benefit of our members and the profession in the future.”

College of General Dentistry announces membership scheme

The College of General Dentistry (CGDent) has published details of its new membership scheme, enabling all members of the dental team to become part of the UK’s first independent college for primary dental care.

Full Membership of CGDent requires a relevant postgraduate qualification and entitles the holder to use the post-nominal designation ‘MCGDent’. It has now been opened to Full Members of the Faculty of General Dental Practice (FGDP(UK)), who automatically qualify for CGDent membership, but will still need to apply.  Non-members of FGDP who hold the MJDF, MFGDP or MGDS, or a postgraduate diploma-level qualification from one of the four surgical Royal Colleges of the UK and Ireland, can also apply by first joining the Faculty as a Full Member. Those with a dentistry-related PgDip, MSc or PhD from a UK Higher Education institution also qualify if they first apply for ad eundum membership of FGDP.

Fellowship of the new College, described as ‘the hallmark of leadership and commitment to excellence in dentistry’, entitles the holder to use the post-nominal designation ‘FCGDent’. It has now been opened to Fellows of FGDP, who automatically qualify but will still need to apply. Fellows of the other dental faculties of the Royal Colleges of the UK and Ireland, and other recognised institutions worldwide, also qualify by first applying for ad eundum fellowship of the Faculty.

Associate Membership of CGDent is now available to all dental professionals who are registered with the General Dental Council or an overseas equivalent, including dental care professionals and newly qualified dentists. Applicants do not need to be members of FGDP(UK), though Associate and Affiliate Members of the Faculty are encouraged to join CGDent in this category. To join, visit https://cgdent.uk/join/.

From 1 July 2021, applications for Full Membership or Fellowship of CGDent will also be open to all members of the dental team with appropriate qualifications, without the requirement of FGDP membership. Associate Fellowship, with the post-nominal ‘AssocFCGDent’, will also then be introduced to mark out those who have developed their practice to a high level, and as a stepping stone to Fellowship. CGDent has also committed to enable membership for retired practitioners.

Prior to 1 July 2021, CGDent is only charging members at all grades an initial administration fee of £20, and details of annual fees thereafter will be announced in due course.

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. 

FGDP(UK) & CGDent COVID guidance update reduces fallow times

The Faculty of General Dental Practice UK and College of General Dentistry have updated their guidance on the implications of Covid-19 for the safe management of general dental practice, incorporating the reduced ‘fallow’ times recommended by the Scottish Dental Clinical Effectiveness Programme.

The guidance, first published on 1 June, supports dental professionals to take a risk-based approach to providing safe care, whatever the national Covid-19 threat level, at each step of the patient journey.

Among the distinguishing features of the document was its consideration of the risk of exposure to potentially-infectious aerosols arising from dental procedures as being on a continuum, rather than defining some procedures as ‘non-AGPs’ and treating all ‘AGPs’ as if they carry equal risk.

Members of the guidance task group felt compelled at the time to accept the 60-minute fallow period recommended by Public Health England following higher risk procedures. However, they also felt it would be more appropriate to adopt a more nuanced approach which also considered the length of procedure, as well as the potential to employ procedural and environmental risk mitigations, and suggested that reduced fallow times based on such factors might be justified.

The SDCEP review of aerosol-generating procedures in dentistry, published last week, takes just such factors into account in recommending context-specific fallow periods of between 10 and 30 minutes. While the FGDP-CGDent guidance has been thoroughly reviewed in light of the latest evidence and the experience of dental practices over the last four months, the most significant change is therefore the adoption of SDCEP’s fallow time recommendations, which have also been incorporated in an accompanying Fallow Time Calculator, which will be launched soon.

SDCEP’s review also divides dental procedures into groups according to their potential to generate aerosols, and to avoid any confusion over which procedures require fallow time, the FGDP and CGDent have ensured that those they classify in their guidance as posing a ‘higher exposure risk’ correspond to SDCEP’s highest-risk ‘Group A’ categorisation.

Available free of charge at https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide and https://cgdent.uk/standards-guidance, the revised document also provides additional detail and updated guidance on:

  • air ventilation and air cleaners
  • the use of the 3 in 1 syringe
  • the risk of aerosolisation from dental handpieces
  • decontamination of the surgery
  • the relevance of the R number and prevalence rate
  • the protection of vulnerable staff

Dental professionals are invited to learn more by joining two related webinars, which will be free to view live through Prodental. On Monday 5 October at 7pm, representatives of FGDP, SDCEP, the BDA and the Office of the CDO for England will discuss The Mitigation of Aerosol Generating Procedures in Dentistry, and on Monday 19 October, Mythbusters 2 will look at the latest changes and challenges of COVID-19 in light of the recommendations of SDCEP, FGDP and CGDent.

Onkar Dhanoya FFGDP(UK), Vice Dean of FGDP(UK) and Chair of the task group which developed and revised the guidance, said: “Our revised guidance, incorporating the fallow time recommendations arising from SDCEP’s thorough review of evidence on the generation and mitigation of aerosols in dentistry, will enable general dental practices to increase delivery of patient care while maintaining the safety of both patients and members of the dental team. This in turn should help improve access to dentistry, addressing some of the unmet oral health need which has built up in recent months, and support the viability of dental practices as the pandemic continues. Thanks are due to all the members of the task group, which represents a huge range of organisations and professional disciplines, for once again pulling together for the benefit of our profession at this critical time.”

FGDP(UK) & CGDent to update Covid-19 guidance following SDCEP AGP review

The Faculty of General Dental Practice UK and College of General Dentistry have welcomed the Scottish Dental Clinical Effectiveness Programme’s review of the mitigation of aerosol-generating procedures, and will be issuing updated COVID-19 guidance shortly in view of its recommendations.

The SDCEP document, published today, represents the agreed positions of a working group comprising dental professionals from across primary care, secondary care, academia and public health, in addition to expert opinion from subject specialists in particle physics, aerobiology and clinical virology. The consensus report was compiled following a review of the currently-available evidence on the generation and mitigation of aerosols in dental practice, and the associated risk of coronavirus transmission.

Among the key positions, and in contrast to those adopted to date in official protocols, the report divides dental procedures into three categories of aerosol generation potential according to the instruments used, with fallow periods recommended only for the highest risk procedures, and suggests the determination of fallow time using a multifactorial approach with a ‘benchmark’ of 15-30 minutes.

The FGDP-CGDent guidance, published in June, also set out a more nuanced approach to considering the generation of aerosols in dental practice, and while allowing for potential adjustment of fallow time, accepted a 60 minute period following procedures carrying a higher risk of exposure to potentially-infective aerosols.

Ian Mills, Dean of FGDP(UK), Trustee of CGDent and a member of the SDCEP’s review group, said: “SDCEP’s review of dental AGPs has been extremely thorough, and followed a rigorous and methodical approach. Its publication is potentially a very significant moment in the recovery of dental practices in the midst of the coronavirus pandemic and I commend the SDCEP Team for the hard work and dedication they have shown in producing this report.

“We welcome in particular the more refined stratification of the transmission risk inherent in types of dental procedure; the allowance for fallow time to be calculated from the cessation of the procedure; and the sophisticated approach to calculating fallow time, which considers both procedural and environmental mitigation factors such as high-volume suction, the use of rubber dam and provision of adequate air ventilation.

“These approaches align exceptionally well with our own guidance and we feel it is important that current standard operating procedures are reviewed in light of SDCEP’s recommendations. Adoption of these measures will enable the increased delivery of patient care to tackle the backlog of unmet need, and avoid further deterioration in dental access and oral health inequality. A reduction in fallow time will also support the viability of practices, while the maintenance of universal precautions will continue to keep both patients and members of the dental team safe.

“We aim to update our guidance as soon as possible, and are currently working with partners to develop an online Fallow Time Calculation Tool to support its implementation.”

SDCEP’s Mitigation of Aerosol Generating Procedures in Dentistry – A Rapid Review is available at https://www.sdcep.org.uk/published-guidance/covid-19-practice-recovery/rapid-review-of-agps.

The current FGDP-CGDent guidance, Implications of COVID-19 for the safe management of general dental practice – a practical guide, is available at https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide and https://cgdent.uk/standards-guidance.

College of General Dentistry recruits for an Advisory Strategy Group to guide its development

The College of General Dentistry is recruiting an Advisory Strategy Group, seeking contributions from across the dental team. This is an important opportunity for people across the Registrant community to make an active contribution, guiding the future direction of the College. 

The Group will play a crucial role in advising the Board of Trustees as they make plans to launch the College. The Group’s 15 members, who will have first-hand experience working across the dental team, will provide much-needed insight into the ideas, perspectives and priorities of people working in dentistry. 

Chair of Trustees, Prof Nairn Wilson, said:  “This is an exciting moment for the College, a step closer to its formal launch, and a mark of our commitment to embrace the interests and contributions of the whole dental team. We believe that a lack of diversity in leadership and influence in dentistry is a barrier to effectiveness – and we want our Advisory Strategy Group to draw upon strengths across the many communities that have such an important role to play for the future.”

Applications close on August 21st, with interviews planned in early September. Details can be found at https://wp.me/P8ZZcL-tx

Why Colour is the Elephant in the Room – Webinar to explore experiences from the dental profession

On Tuesday 21st July at 7pm, FGDP(UK), in collaboration with ProDental CPD and the College of General Dentistry, is hosting a webinar titled Why Colour is the Elephant in the Room, which will take a look at real life experiences of and what we can do about racism in dentistry.

Looking at the response of the dental profession to the Black Lives Matter movement, the webinar aims to provide an honest exploration of racial inequality and prejudice with real life experiences from colleagues working in all areas of dentistry.

Chaired by FGDP(UK) dean Ian Mills, the panel will comprise:

CPD will be available. GDC outcomes: A,B,C,D

To register for the event, follow this link.

BSP, FGDP, CGDent issue joint statement on the provision of a dental prophylaxis under Level 4/3 Covid-19 alert status

The British Society of Periodontology and Implant Dentistry (BSP), Faculty of General Dental Practice UK (FGDP) and College of General Dentistry (CGDent), working with the Office of the Chief Dental Officer for England, have issued a joint statement to clarify and contextualise the differences in guidance issued relating to the provision of a dental prophylaxis under Level 4/3 Covid-19 alert status:

The BSP guidance relates to prophylaxis as part of professional mechanical plaque removal (PMPR) in  people with periodontitis. The FGDP guidance relates to the more general term of ‘tooth polishing’,  which may not necessarily be undertaken for therapeutic reasons.  

The international evidence‐based S3‐level treatment guidelines in periodontology strongly recommend PMPR (highest evidence level: 100% consensus) in managing periodontitis. Clinical  harms may result in periodontitis patients if this is withheld.  

A prophylaxis undertaken with a slow speed handpiece, with no water, reduced prophy paste and due diligence, is considered a Non‐Aerosol Generating Procedure (non‐AGP) as defined by emergent particle sizes (WHO 2007) and can be safely undertaken with level 2 PPE (R11 mask, gloves,  goggles/visor, plastic apron over scrubs). However, non‐AGP procedures are not without some risk and polishing teeth for cosmetic reasons is not recommended until Level 2 alert status is reached.  Prophylaxis does cause splatter which can travel in a ballistic manner between 15‐120cm from  patients’ mouths and which may contact the eyes, mouth and skin of the operator/assistant; hence the need for level 2 PPE. Teeth should be dried with gauze and high volume aspiration is recommended.  

The BSP guidance provides a risk categorisation based on procedure. The FGDP-CGDent guidance adopts a similar approach but uses the terms low and high‐risk Aerosol Generated Exposure (AGE), to ensure additional factors are taken into consideration when considering exposure to risk. These include length of procedural exposure to splatter, risk of exposure to naturally-generated aerosol (coughing, sneezing or breathing), and the potential to apply mitigation measures. These are different approaches and both have value and require professional judgement by clinicians on a case-by‐case basis, whilst accounting for the Covid‐19 risk of the operator and assistant.

Professor Nicola X West, Honorary Secretary, British Society of Periodontology and Implant Dentistry

Ian Mills, Dean, Faculty of General Dental Practice UK, and Trustee, College of General Dentistry

Sara J Hurley, Chief Dental Officer for England

CGDent & FGDP(UK) publish Covid-19 guidance synopsis

The College of General Dentistry and FGDP(UK) have published a synopsis of their guidance on the implications of Covid-19 for the safe management of general dental practice. Production of the synopsis has been supported by Sensodyne.

The new synopsis highlights key recommendations at each step of the patient journey, and is designed to be used in conjunction with the guidance document, which supports dental professionals to take a risk-based approach to providing safe care, whatever the national Covid-19 threat level.

The guidance has also now been updated with some minor amendments. Among these, prophylactic polishing of teeth has been added to the risk stratification matrix, use of face coverings by all patients and carers in non-clinical areas is now recommended (in line with government advice on preventing transmission in enclosed public spaces), and the use of shoe and head coverings is only now advised when indicated by a risk assessment. There are also some clarifications, such as around selection of PPE based on a risk assessment, and on the mopping of floors between patients following treatment carrying a high risk of exposure to aerosol.

Both the synopsis and guidance are available at https://cgdent.uk/standards-guidance and https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide.