Dental Sky

‘Action not words’

Jill Harding talks to Dental Sky about the UK’s oral health crisis

A healthy smile is fast becoming an indicator of our socioeconomic status. With a wealth of studies to evidence the correlation between oral health and income, occupation and social background, the current shortage of NHS appointments has further deepened health inequalities in the UK.

Issues of access are widespread. Amid the crisis, patients who can afford private dental care have migrated away from the long NHS waiting lists, whilst those who cannot are missing out on regular check-ups, risking their health and quality of life.

With NHS dentists beset by what was considered by many an unworkable contract, the pandemic exacerbated the problems of access. Appointment delays created a backlog and the steep rise in living costs are now adding to the problem.

NHS Digital reveals that the number of adults seen by NHS dentists within recommended timeframes decreased by 9.5% in 2021-22 against the previous year. [1]

Two years ago, a report by Public Health England outlined the influences on public dental health, stating that ‘there is clear and consistent evidence for social gradients in the prevalence of dental conditions, the impact of poor oral health and service use’ [2].

It recognised that oral health inequalities ‘remain a significant public health problem’ and that reducing them ‘is a matter of social justice, an ethical imperative and, for public bodies across the health sector, a legal duty’.

This year, National Smile Month (16 May-16 June 2023) is shining a light on the importance of toothbrushing. Every year the campaign champions the benefits of having good oral health and promotes the value of a healthy smile.

The 2023 campaign is ‘Brush for better health’ – clarification of the systemic links between oral health and overall well-being vital to public health messaging. But with the pandemic’s impact still reverberating and the financial crisis forcing people to carefully consider their outgoings, the nation’s oral health is paying a heavy price.

There are health implications for people in vulnerable groups or those with lower socioeconomic status and failure to access dental care is among the challenges. These populations often have considerably poorer oral health across all assessed outcomes. For some, this may even involve limited access to toothbrushes and toothpaste or limited places to clean their teeth.

The Wrigley Oral Healthcare Programme’s Oral Health Index recently revealed that more than half (54%) of its 6,000 respondents believed there is a postcode lottery accessing dental services. With 68% agreeing there is a crisis in the provision of dentistry, three-quarters (77%) felt the government could do more to promote oral health. [3]

With fewer NHS appointments available and many areas with long waiting lists to register, it can impact the quality of life for those people for whom private dental care is unaffordable. Sometimes, they take matters into their own hands with media stories of DIY dentistry highlighting deeper problems.

Dentaid The Dental Charity has been operating mobile dental units across the UK for many years. The charity’s volunteers visit homeless shelters, soup kitchens and community buildings to provide free dental screening, advice and treatment for underserved-communities who are unable to access NHS dental care.

The charity’s efforts to break down barriers and help people who most need dental care access essential dental treatment are a vital lifeline for many. But it has cast its net beyond the people experiencing homelessness and other vulnerable groups of late to include public-access clinics. This focus had to change when the pandemic limited opportunities to help populations overseas. But their work has highlighted needs here in the UK, and demand has skyrocketed in the last 2 years.

Jill Harding is the communications director at Dentaid The Dental Charity.

Back in 2008, Dentaid The Dental Charity was refurbishing and delivering dental equipment to countries in need. It then developed its work to care for those in pain by funding outreach clinics and sending teams of volunteers to support local dental professionals.  Now, although its overseas work continues, it is very much focused on helping the UK population.

Jill says: ‘The pandemic was not solely the catalyst for the charity’s work on home soil. It had already started working in the UK when, in 2015, it responded to a cry for help from people in Kirklees in West Yorkshire who were using a soup kitchen but unable to eat the food due to toothache.

‘It was a slow evolution for the first couple of years but, since lockdown, demand skyrocketed partly due to the backlog created by the pandemic. This also led to heightened awareness about the groups of people who have always faced challenges in accessing dentistry.’

Earlier in the year, the charity updated its branding, too, to better reflect its work.

‘The old logo had an image of the globe within it, but times and our charity have moved on’, Jill says.

The new Dentaid logo

So, whilst it was always the charity’s intention to develop its UK work, the growth in demand has been ‘almost exponential,’ Jill says. ‘Dentaid The Dental Charity has always been fleet of foot. When opportunities to help more people present themselves, we make the most of them. There is now a vast geographical spread, and we are looking to work in new areas all the time. The team has expanded rapidly – we now have 28 members of staff and are currently planning to expand our regional hubs, too. We already have one operating near Halifax and are about to open one in Kent and base a mobile dental unit in Northern Ireland. We are mindful of environmental impact, so this helps reduce the need to travel.’

The charity will run at least 500 clinics in the UK this year. After its unveiling at the BDIA a new unit will be based at Maidstone, Kent run by a clinical supervisor and mobile unit officer from a hub that will serve the southeast.

Disengagement with traditional services can include logistical challenges, too. Often, vulnerable groups haven’t the contact details necessary for registration, or they may not have anywhere to store their belongings while they are treated. 

‘Our outreach work in mobile dental units takes our services to places where vulnerable groups feel safe and comfortable – hostels, day centres and night shelters. We are breaking down the practical, emotional and mental barriers to them accessing dental care.’

But sustainability is key here. As Jill says: ‘Our work needs to be sustainable, which is why we offer oral health education alongside all of our clinics that return to locations regularly. We must start conversations with patients about their teeth to ensure long-term health. Many of the people we treat haven’t attended for so long that they are disconnected from dentistry, which is why we return regularly. During sessions at our mobile units, volunteer clinicians offer oral health advice and hand out toothbrushes and toothpaste. Volunteers on our BrightBites programme, an oral health education scheme that visits schools, also hand out these resources.’

The government’s failure to address political and public health failures is difficult to ignore. Considering the litany of challenges dentistry faces, it must impact the team hugely. But Jill is keen to stress the importance of action rather than words.

‘As a charity, it isn’t for us to say why these services are not available to everyone or comment on funding in dentistry. What we do focus on, however, is being out there and doing something – running our clinics for the communities that need us most. We now have seven mobile units and one trailer servicing the UK. We have a fundraising events programme and encourage practices to hold events. We are always looking for volunteers and welcome input from across the profession.

She adds: ‘Dentaid The Dental Charity has always stepped in where there is a gap in care. Our services are delivered by much-valued volunteers who have often identified a need within their communities. Quite simply, we are committed to helping those who are the hardest to reach – wherever they might be.’

For more information, visit https://www.dentaid.org/

References

  1. https://digital.nhs.uk/news/2022/9.5-decrease-in-adults-seen-by-dentists-in-past-two-years
  2. https://www.gov.uk/government/publications/inequalities-in-oral-health-in-england/inequalities-in-oral-health-in-england-summary
  3. https://smile-ohm.co.uk/2023/03/14/more-than-a-third-of-11-16-year-olds-would-resort-to-diy-dentistry-measures/

 

 

‘We all need to be beating that drum together’

Claire Berry argues the case for a business-focused approach to  dental hygiene

It is almost 10 years since regulatory barriers were removed to give some dental care professionals (DCPs) direct access to patients – a move hailed at the time as a key policy change.

The change followed much petitioning from professional organisations at a time when there were also moves by the Department of Health to make greater use of the skill set of the dental team.

Dental hygiene and therapy may have come a long way since then, but some attitudes have failed to keep pace.

Many in the profession have yet to fully acknowledge the autonomy of dental hygienists and therapists – and it is a bit of a bugbear for Claire Berry, an award-winning dental hygienist.

Claire has made it her mission to remind the profession (dental hygienists and therapists included) of the value of the roles.

She is passionate about the importance of utilising their full scope of practice and the powerful dynamic of patient education and positive behavioural change they bring to the profession.

With fellow award-winning hygienist Faye Donald, Claire runs The Contemporary Hygienist, a movement designed to empower and support DH&Ts, providing quality training, and discussion groups and networking opportunities.

She wants to raise the bar for her profession and give colleagues the confidence to strike out for a more independent and business-focused way of working that, she argues, benefits everyone.

Claire explains: ‘The majority of us are self-employed, often travelling from clinic to clinic to care for patients. Ultimately, we are a business, but when we work across practices it is often wrongly assumed we are “someone’s” hygienist. It can create confusion – from who sets the boundaries to appointment times, from what equipment we use to product recommendations.’

This scenario is neither conducive to high-quality oral health care nor business success.

‘For as long as people continue to “shoehorn” everything into a 20-minute hygiene appointment, the profession suffers, the patients suffer, and the clinician ultimately suffers. We all need to be beating that drum together.’

She adds: ‘We must work together to change the mindset towards a more “associate hygienist” concept. We sometimes fall back on the thinking that “this is how it has always worked”, but times are changing.’

Independent thinking is only part of the solution. Using the best equipment to help meet the needs of patients and having the freedom to choose the best products are also vital components of a successful business.

Claire says: ‘As a self-employed DH&T, you need to think as a business. I buy my equipment because I want to invest in my business, and I choose how I practise, giving my patients the best care. I want a long career, so I will work to the best of my abilities using the equipment and treatment modalities I choose. This mindset also allowed me to take control of my career pathway. By investing in my business, I became an asset to any practice. It is a nice position to be in.’

Claire takes her physical health seriously, too, so the equipment she invests in supports her and allows her to work without risk to her neck, joint or back.

‘Only you will care enough about that, so ensure you use the right tools to support health and career longevity. Choosing my products and equipment has given me the freedom and autonomy to be the clinician I want. There is fulfilment in that.’

Longer appointment time is, she adds, vital for DH&Ts to carry out their duties successfully and particularly important to deliver pain-free treatments to patients who might be nervous or need anaesthesia.

Whilst communication is the cornerstone of patient relationship-building, Claire believes developing technologies can help the profession earn patient trust – especially if it means faster, more effective and pain-free procedures.

‘I’m all about pain-free care, especially as a hygienist. We see periodontal patients far more over a lifetime than other dental team members. Minimally invasive and pain-free procedures empower patients, and we should use the most effective methods.

‘It can help to earn trust if a patient recognises we have invested in equipment that makes their treatment more enjoyable, comfortable, effective and efficient. They are far more likely to choose that clinician over someone who fails to prioritise this.’

So when she discovers game-changing technology that offers this, Claire believes it is worth the investment.

She has been using The Wand for a couple of years now. A computer-assisted system that administers anaesthesia via a pen-like device, The Wand helps calm even the most needle-phobic patients.

It allows the delivery of LA to target a single tooth without affecting the structures around it.

Claire says: ‘I use it to treat localised sites that require deeper access. I can target specific teeth painlessly so that the patient leaves looking normal and feeling great. It is ideal for patients who are needle phobic or who dislike the after-effects of local anaesthetic.

‘The Wand goes hand in hand with guided biofilm therapy (GBT), which is designed as a protocol to be minimally invasive and pain-free. It’s a no-brainer that I continue that experience even when they require a local anaesthetic.’

More recently, she has started using the new Wand Travel Kit, which means she can easily transport the equipment between surgeries.

Compact and easy to carry, it is ideal for DH&Ts working at multiple sites. For Claire, it’s another investment that increases the value of her care delivery to patients.

‘The experience I offer has perceived value to the patient, so any cost is immaterial. They expect pain-free treatment wherever they attend an appointment with me using equipment that enhances my ability to screen for and treat disease. Plus, they get treated by a clinician who enjoys every minute of what she does!’

Claire’s mindset shift about her work, the investment in her business and her autonomy as a clinician have alleviated much stress in her day-to-day dentistry.

She adds: ‘The Wand has further enhanced this for me, with the travel kit ensuring the optimum pain-free care wherever I practise. Now is the best time to invest in yourself. Set your business apart and feel empowered.’

A helping hand

The hands of dental professionals undergo daily wear and tear and this comes with occupation-related risk to skin health as well physical fatigue. But, much like the gold standard in dental care, prevention is better than cure.

Sound protective measures are a long-term investment in any career in dentistry – after all, hands are the most invaluable tools.

Hand health

Hand hygiene is an integral part of preventing infection in clinical dental practice, but it can be detrimental – the resulting skin damage well documented.

With repeated exposure to abrasive chemicals and irritants, as well as saliva and blood, the need for frequent hand washing can lead to dryness and even contact dermatitis, with the need to wear gloves sometimes leading to Latex allergy. All of which are a concern for those working within the profession.

Indeed, work-related contact dermatitis is the most common form of skin disease in the dental team, reports the Health and Safety Executive (https://www.hse.gov.uk/skin/employ/highrisk/dental.htm).

According to HTM 01-05 Decontamination in primary care dental practices: ‘Hand hygiene is crucial in preventing the spread of infection and the recontamination of surgical instruments and devices. Clean hands are an essential counterpart to the use of gloves. Neither measure is a substitute for the other.’ (https://www.england.nhs.uk/publication/decontamination-in-primary-care-dental-practices-htm-01-05/)

Gloves then help to protect against these threats as they act as a physical barrier. 

However, whilst the wearing of gloves might mitigate against the risks of exposure to pathogens and the spread of disease, they do come with their own challenges.

Hand fatigue

Hand fatigue is also a common problem in dentistry. Whilst the tasks of clinical practice demand hand precision and finite repetitive movements, gloves can often restrict movement of the hand, requiring extra muscle effort to perform tasks. This can result in carpal tunnel syndrome.

Therefore, anything ergonomically designed to support musculoskeletal health has huge appeal. To help reduce risks, practitioners should:

  • Ensure that the instruments they use reduce stress
  • Take regular breaks
  • Undertake regular hand-stretching exercises between appointments
  • Utilise hand-stabilising techniques
  • Invest in their own health and wellbeing with protective products that reduce fatigue.

Glove options

When it comes to glove purchasing, practices very often buy in bulk and opt for any that meet infection control requirements.

But choosing what gloves to wear for the individual tasks in practice isn’t always straightforward. Many people form allergies to glove materials, especially if these are worn on a regular basis. Latex allergies are particularly common among healthcare workers.

Other types of gloves can also cause allergies, and those who suffer from asthma may have adverse reactions.

London Hygienist

Anna Middleton is a dental therapist and founder of London Hygienist.

Anna Middleton

She was unfortunate enough to suffer with muscle fatigue when she first qualified, with sore wrists a concern due to hand scaling. These days, chapped and sore hands she tries to keep at bay – ‘I only use nitrile-based gloves and make sure I give my hands some TLC in the form of good hand creams and oils’, and her chosen delivery of hygiene care now mitigates against the risks to hand muscle health.

Hand-stabilising techniques, stretches and exercises help prevent damage and Anna has recently started using Cordeze to help stabilise the cords from her Airflow and Piezon scaler. She also always uses a finger rest.

‘I have a dental nurse to assist, too,’ she says, ‘so I am not holding onto the suction tubes,’ and, because she uses guided biofilm therapy that minimises the use of power and hand instrumentation, her hands and wrists no longer suffer.

She recommends hand stretches and massages to her colleagues, but adds: ‘If you do use hand scalers, then make sure they have a good grip and handle as well as being well sharpened.’

Anna believes that wearing the right gloves is also key to a comfortable delivery. Ansell offers two ranges of gloves that meet her expectations.

Ergoform Technology Gloves are engineered to reduce the strain and impact of repetitive tasks to mitigate the risks of RSI and carpal tunnel syndrome. And Ansell’s accelerator-free range are specifically suited to clinicians who suffer from allergies. 

Both are nitrile, but the accelerator gloves will also prevent chemical allergies that are a result of the glove manufacturing process.

Anna really likes them. ‘They fit like a glove.’ she laughs. ’But, seriously, they are very soft inside. I love the slightly textured fingertips, as they provide extra grip when the gloves are wet.’

She believes many colleagues neglect their own health at times because they are so heavily focused on their patient care. Since Covid-19, there has been a huge spotlight shone on the mental wellness of dental teams, but the physical toll of delivering care should never be overlooked.

‘It’s never intentional, but it happens,’ she says. ‘I suffer with my neck and back once fatigue kicks in and it is easy to compromise your position and so on when very busy or tired. Purchasing the best products to reduce physical wear and tear and prevent damage to skin is arguably just as important as finding the best tools or kit for treatment delivery. Excellent lighting, highly efficient loupes and ergonomically designed, skin-friendly gloves all help to mitigate against the physical risks to our health.

‘Factor in regular breaks and hand exercises and we can do a lot to prevent those occupational health hazards. After all, if we physically cannot practise, then what’s the point of any cutting-edge dental technology?’

For more information, visit https://www.dentalsky.com/.

Finnish Hygienist Scoops £3,000 Wand Unit

Nea Korpela is the lucky recipient of a Wand computerised anaesthesia unit worth around £3,000. The competition was organised by Dental Sky, who chose to promote it via Dr Reena Wadia, a keen advocate of the unit (@reenawadia). Nea started following Reena after attending one of her mentoring courses and had seen the unit in action at Reena’s Harley Street practice.

Competition entry was easy. All you had to do was like the @dentalsky and @reenawadia Instagram pages, share the post and tag in two dental professionals. A winner was selected at random. Nea, originally from Finland, was delighted when she was announced as the winner. “I’ve never won anything before so this was such a surprise”.

“I came to the UK a couple of years ago and gained my GDC registration in Feb 2020, one month before lockdown. So, after being given the green light to practice, I then, like the rest of the profession, had to down tools. It was not the start I’d hoped for in the UK”.

“However, once we were allowed to practice dentistry again in June, I haven’t looked back. I currently work at three practices, however, I’ll be leaving my Wand unit at one practice, Richmond Dental Suite, where I am most of the time”.

“The practice principal Dr Antimos Ouzounoglou is half Swedish, so we have a Scandinavian connection (he’s also half Greek!). We also share a passion for gentle dentistry, so I think he was as delighted as me with my win. For both of us the patient experience is as important as the results achieved”.

“I’ve just received my Wand unit and am most excited to see the expression on patients’ faces once they’ve been anaesthetised. However skilled a practitioner you are, it’s near on impossible to deliver LA painlessly, unless that is, you have The Wand! I will certainly be using it on my perio patients and those with sensitivity. Dental Sky are providing specialist training for me, which is great, as I know I will then be able to get the most from the equipment”.

“I would urge other hygienists to keep an eye out for offers and competitions on social media. Companies seem to be using these platforms more and more. Next time it could be you! It’s also an easy way to keep informed of new trends and products and to stay connected with your peers. The hygienist community in the UK is so encouraging and inclusive. I joined the BSDHT once my registration came through and am so reassured to be part of this supportive organisation.”