Monday, 10 December 2018

Winter Conferences: BSG and BSDH 2018

This December, it was time for the consecutive Special Care Conference duo of the British Society of Gerodontology and the British Society for Disability and Oral Health...

Yet another poster!

The 2 days were a great opportunity to catch up with familiar faces and to learn from clinicians across the country. This year both events were at the Royal Society for Gynaecologists and Obstetricians. What did I learn?

BSG


The theme of the Winter's conference was 'The Future's bright for older people and oral care in the UK?' with some really interesting topics from commissioning (my favourite topic at the moment), the oral microbiome, dementia and dermatology. One of the highlights for me was a talk by Dr Rosie Tope who spoke about her first hand experience of being a carer for a relative with dementia: her messages about communicating with these patients from caring for her late husband were really insightful and touching. 

My top take home messages were:
  • Commissioning services for older people will need to be co-designed with clinicians, patients and NHS England 
  • Patients with dementia understand us...it may just be they have lost their ability to communicate
  • Frailty can have a negative impact of a person's oral microbiome so they are more susceptible to infections e.g. aspiration pneumonia. 
  • Patients with dementia may show signs they are in pain e.g. lip biting, pulling at their face, grimacing - it is up to their carers and healthcare professionals to investigate to find the cause e.g. is there a dental cause?

Of course a conference often means the opportunity to present or share our clinical work - I presented a poster on a case I treated recently where unfortunately the patient died very soon after I treated him. To read my poster click here.

And I'm pleased to announce from this meeting, I am now a StR representative on the BSG Committee! 



BSDH



The theme of this year's BSDH Winter Meeting was 'Caring for the Unwell Special Care Dentistry Patient with again lots of information from chronic kidney disease, MRONJ and cardiovascular disease.

My top take home messages were:
  • Sepsis is a life-threatening inflammatory response which can be triggered by infection - there are decision support matrices for primary dental care in the recognition of Sepsis
  • There are 6 management strategies for sepsis: Give Oxygen, take Blood cultures, give IV fluids, start IV resuscitation, check lactate, monitor urine output
  • 10% reduction in body weight leads to 80% decrease in risk for diabetes
  • 40% of type 1 female diabetics are diabulemic - omitting their insulin purposely in order to lose weight
  • Patients with Down syndrome are predisposed to acute lymphoblastic leukaemia
  • 10 year survival rate of patients with multiple myeloma is 70% 
  • Patients with kidney failure can complain of lack of taste or unpleasant taste due to build up of urea
  • There is an increased risk of post operative bleeding in patients with kidney disease, not only because of being heparinised during dialysis but because of platelet dysfunction

Looking forward to the Spring BSDH where I will be speaking and the Summer BSG!


Did you go to BSDH or BSG this year? What did you think? Leave your thoughts in the comments section.



Wednesday, 5 December 2018

Top 10 Tips in Domiciliary Dentistry

Following my previous post explaining what Domiciliary Dentistry is, here are my top 10 tips for anyone providing a service for housebound patients...



1. Brush up on Guidelines


Before you even go out to see patients on doms, the best document I would recommend reading is the BSDH Guidance. This covers every aspect of domiciliary dentistry. 

Other guidance you should read is the Special Care Dentistry Commissioning Guidance and the recent FGDP Dementia Friendly Dentistry


2. Look after yourself


And your nurse! You have lots of equipment to carry and it can be easy to get into awkward positions when treating patients in their own home e.g. if they are bedbound. 

Make sure you have had appropriate manual handling training, have trolleys to help you transport equipment and be wary of your posture. Avoid hunching over seeing patients, move them if possible e.g. lifting their bed if they have a hospital bed, seeing them in high backed chairs and bend from the hip rather than stooping. Also be wary of environmental hazards such as pets, smoking and cables/clutter around the house. Risk assessments may be required either before going out to the visits, or while there to ensure staff safety. 


3. Teamwork


Fully utilising the dental workforce is essential in providing domiciliary dentistry: from all the paperwork and planning before the visit, to the doms visit itself, to continuing care. 

Making sure visits are fully prepared really helps the clinician out... this includes risk assessing, checking for parking, arranging patient appointments so they geographically make the most out of the time available, making sure medical histories and FP17s are up to date and contacting NOK if needed. 

Doms are also a fantastic opportunity for auxiliary dental staff to provide appropriate care e.g. use of hygiene therapists. 


4. Manage Patient's and Carer's Expectations


This is something I have found challenging when providing domiciliary dentistry. A common situation is seeing an older patient with dementia in a care home who have lost their dentures where family members are pushing for you to remake the dentures for the patient. In some cases of course this is a suitable treatment option; however, if the patient has poor cooperation and is unlikely to tolerate making the denture let alone wearing and adapting to a new set, then is forcing them through a prolonged course of treatment may not the best option for them.

Patients also expect that the treatment they receive on a domiciliary visit to be as good as in a dental chair - in most cases, the treatment you can provide at home will be limited due to access, equipment available, lack of the ability to take x rays and you need to communicate this to patients. 


5. Refer when appropriate


Although patients who are housebound may find getting to dental clinics very difficult, in some cases it is unavoidable and you need to know where you can refer patients if needed e.g. if they need crown/bridgework, extractions, more specialist treatment.

This may mean organising patient transport for the patient, or explaining on the referral the difficulty of the patient attending so that longer appointments could be made to minimise appointments they have to attend a clinic.


6. Combine Stages when Possible


Depending on what your service is like, combining stages may be something you should think about as waiting times for a home visit can be long - in my old service making new dentures would take around 4 months! This means you need to be sensible about how you stage your course of treatment.

You may need to adapt for patients for example with dementia where cooperation may vary, but often I would try to combine secondary imps and bite stages and if a patient requires fillings or cleaning I would try to do this alongside any denture stages to minimise multiple visits and make the most out of the time I would go out to see the patients. 



7. Time Management


When you first go out on doms, you need to be able to adjust what your normal time management would be in a clinic. While an impression may take you 15 minutes in the clinic, in someone's home you need to factor in time for driving to a person's house, finding parking, setting up in the person's house or trying to locate a patient in a care home, speaking to the patient's carers or relatives and then clearing down. 

When you see patients in care homes depending on the home, actually getting around to see the patient may take a while as you need to find the patient, if it is a time where the carers are feeding or washing the patient this can delay you or if you need to find out additional information from a patient's file. Always allow yourself enough time at the end of the day to write up notes and chase up information for patients e.g. contacting their NOK or doctor. 


8. Paperwork


As I've mentioned above, having someone who helps get all the paperwork prepared before the doms visit can make your life so much easier! If medical histories or FP17s are not completed before you visit the patient this can take up most of an appointment slot finding out the information which the patient may not even know themselves or be able to communicate. Some services will only book patients in for a doms visit once all the paperwork has been completed. 

Something I have found out doing doms visit is that the general public and care home staff are confused about NHS exemptions and assume everyone in a care home is exempt from dental charges. If they are confused about it, how can we expect our vulnerable older patients to reliably tell us if they are exempt or not! Supporting care staff with paperwork and exemption statuses can really help clarify what people are entitled to and I tend to leave HC1 forms and information with care homes so they can give to NOK to fill out when new patients are referred for dom visits. 


9. Assess what Equipment you need


As I've already mentioned, you have a lot of equipment you may need to take out with you on doms; but you don't want to take what is not necessary. Always communicate with your nurse what patients you have that day for what treatments so they can prepare the appropriate treatment so that firstly you don't have to take unnecessary equipment and secondly you have the appropriate equipment for what treatment you are providing as you do not want to get to the patient's home and not have enough alginate for example!


10. Consent


Really important in any setting in dentistry, but with domiciliary dentistry often many of your patients may not have the capacity to consent for treatment. Always carefully assess patients, as capacity may vary or you may need to adapt your communication. You may need to consult with another clinician if you wish for a second opinion but do not be forced into anything that you are not comfortable doing. 

Refer to my previous post about the Mental Capacity Act to learn more about capacity assessments. 




Ultimately, I really enjoy domiciliary dentistry: getting out of clinic is really enjoyable and actually seeing inside care homes can really increase your understanding of that environment and what challenges the staff there have when looking after older complex patients. And domiciliary dentistry forced me to learn how to drive... learning life skills as well as dentistry! 


Do you provide domiciliary dentistry? What tips would you give? Let me know in the comments below.



Friday, 9 November 2018

Top Tips for Presenting: 3M Presentation Skills Course

In October, I spent a weekend in the Bavarian mountains with 3M on their infamous Presentation Skills Course. Here's what I learnt from the course...

Presentation 1 of 7!

Structure


1. Opening - Grab your audience's attention with a HOOK. This can be a photo, a stat, a story, a simple statement.

2. Body - The main content of your presentation. Make sure it is organised

3. Closing - End your presentation with a wow closing. Link the wow closing to the opening hook for maximum impact,


Rule of 3


For content, using the rule of 3 will help your audience remember your content. Examples can be:
  • 1st, 2nd, 3rd
  • Past, present, future
  • Beginning, middle, end
  • Yesterday, today, tomorrow


Top Tips


  • Do not say 'Thank you' at the end of your presentation unless it is to particular people. It is meaningless otherwise and does not add anything 
  • What is the purpose of your presentation? To inform, entertain, motivate, inspire, sell? Your listener should know this and learn from you so at the end of your presentation your message has reached them
  • Your body content is why your audience comes to listen to you speak, the hook and the wow finish frame this so that the audience remember your presentation
  • Vary your intonation of voice appropriately throughout your presentation so that your audience doesn't fall asleep!
  • Keep eye contact throughout the room/audience 
  • No need to introduce yourself, your audience will know who you are from looking at the programme and make sure you email a short bio to the organisers beforehand 
  • Make sure you have a plan B in case things don't go to plan e.g. projector doesn't work, you have less time than planned for 
  • Pauses can be useful for effect - do not feel you have to fill in spaces with filling words or erms
  • Have minimal text and information on slides as the audience will feel torn between listening to you or reading the slide 
  • Don't read from the slide - you can either use presenter notes, prompt cards or just PRACTICE
  • Think of alternative materials to present with instead of death by powerpoint such as flipcharts, cards, whiteboards, props or pincharts. Pictures speak to us... use them and think about your use of colour
  • Consider the use of storytelling to engage your audience - these can be good hooks. You need a plot, characters and a narrative
  • Know your audience and target your audience accordingly - be aware of different cultures


Over the course of the week we presented again and again, each time refining our presentation style and working on different forms of presentation (as well as learning how to give and receive feedback!). I met some amazing dentists from across the world - from Latvia to Algeria to Iceland!

Being in Bavaria of course we had to take advantage of... including a full on hike in the mountains! Thanks to 3M for the amazing opportunity, I'd recommend this course to everyone!


The fab group at the beginning of our hike... you can only imagine the after pic!


How confident do you feel presenting? What are your top tips? Let me know in the comments below.




If you have any queries please let me know in the comments below.

Wednesday, 31 October 2018

Why Do I Blog? Dental Nursing Journal Article

I've been blogging for over 4 years now... but why do I do it? What would be my top tips for aspiring bloggers?



Why did I start my blog?


I started my blog during the time between finishing university and starting my first job. I had 3 months to kill and while others were off travelling in their last summer before starting their careers, I spent the time setting up my own website: A TOOTH GERM

I always wanted to start my own blog after following a few others (mostly in beauty, fashion or travelling), but it seemed to take a back seat over university life! After a few months it became an addiction of mine; a creative outlet and actually it has really helped me develop my writing skills. 


What have I learnt over the years?


Over the 4 years of blogging, my style has been refined and has changed alongside my professional development. The main things I've learnt are:

  • Pick your audience and tailor your style of writing specifically to them. Do not try to cover all bases as people come to blogs for specific reasons 
  • Quality not quantity is important. I used to blog every couple of days, but with every changing content, not only was my work-life balance not great, but readers could't keep up
  • Blog posts should not be too long. It's better to split into separate posts with links between them as readers want bite sized portions of information


Is blogging just for dentists?


No! Blogging can be for anyone; not even just individuals, but groups of dental professionals or dental practices. 

The important thing is to find your audience and blog about something you care about! Whether you're a dentist, dental nurse, dental technician or dental student!


To read the full article in the Dental Nursing Journal, click here


If you have any queries please let me know in the comments below.



Thursday, 25 October 2018

Demystifying Clinical Governance...

So with less than a month left until Dental Foundation Training interviews... time to brush up on that clinical governance knowledge...



What is Clinical Governance?


Clinical governance is an NHS quality assurance framework which ensures organisations are accountable for continuous quality improvement and safeguarding high standards of care. 

However you remember the definition of clinical governance, word it in a way you remember and what comes across naturally especially in an interview situation. 


What are the Themes?


A well known mnemonic to remember the themes is PACCER PIRATES. But what does this stand for?

Patient and public involvement - such as patient feedback forms, engagement events

Access - fair and accessible care to all groups as well as access to emergency slots

Clinical records - the 4 Cs of records: clear, complete, concise and contemporaneous 

Child protection and Safeguarding - appropriate training, recording of concerns

Emergencies - needle sticks, adverse incidents, medical emergencies

Risk Management - how to perform a risk assessment 


Prevention and Public Health - such as use of Delivering Better Oral Health guidelines

Infection Control - HTM 01-05

Radiology and Radiography - guidelines such as IRR and IRMER 

Audit - to read more about audit click here

Teamwork - scope of practice, effective teamwork

Evidenced-based Dentistry - to read more about EBD click here

Safety - patient saftey such as COSHH and RIDDOR



The important thing with clinical governance in interview situations like DFT or DCT, is that you link your knowledge of clinical governance to a particular scenario they may give you... this demonstrates understanding. If you list issues without linking them to a scenario, you are just proving you are good at memorising lists!


If you have any queries please let me know in the comments below.


Saturday, 13 October 2018

Dental Foundation Training: An Update with Dental Training Consultants

This year I have joined the fabulous Dental Training Consultants (DTC) Team to lecture on their Dental Foundation Training Mock Interview Course...

All set to go in London


This is the fourth year I've been lecturing about Dental Foundation Training (DFT) interview preparation and this year I've joined DTC on their courses across the UK; from London, to Bristol, to Leeds and Manchester next week. 

I've blogged every year about DFT recruitment, as the process changes (see last year's post here) and it's important for those applying to ensure they know the process inside and out!

Changes This Year


  1. Pre-release of scenarios: Last year, both stations were released a week before the interviews. This year this has changed again with only the communication station being released beforehand this year. 
  2. Minimum score on the Situational Judgement Test (SJT): This is completely new with the minimum score being 8 out of 80 (pretty achievable!). If this is not achieved, the candidate will be excluded from the recruitment process. There is no minimum score on the stations
  3. Timing of offers: This has historically been around January time; however, this meant that when BDS results were released in May/June, that offers had to be revoked and reallocated with those who did not achieve their BDS. This year, the offers process will be in June so that this situation is avoided. 

Top Tips


If you're still looking to attend a mock interview course, there are a few places left for the DTC course in Leeds next weekend (Oct 21st).... but here is a snippet of some of my top tips:
  • Preparation is key. You will not perform well if you do not prepare
  • Practice practice practice. With friends, colleagues, clinical supervisors both the PML and communication stations
  • Practice SJT questions, even try writing some example questions and ask your tutors to help you rank questions
  • Make sure you read all the emails through Oriel well and prepare any documents or paperwork days before your interview or SJT 
  • Make sure you know the GDC Standards of Care for Dental Professionals back to front
  • Look at the marking schemes for each station which are available on the COPDEND website

This process can be stressful, but it is as fair as it can be. You may not get your first choice, but ultimately DFT is only one year and there will be ways you can make the most of your year! Don't let it distract you from achieving that BDS! Good luck!



If you have any queries please let me know in the comments below.


Saturday, 22 September 2018

The Chief Dental Officer's Clinical Fellow Scheme with FMLM

At the beginning of September I started my clinical fellowship with the Faculty of Medical Leadership and Management (FMLM) and the officer of the Chief Dental Officer...but what is it?




What is FMLM?


The Faculty of Medical Leadership and Management (FMLM) was established in 2011 by the UK Royal Colleges and Faculties and is an organisation supporting doctors, dentists and pharmacists in developing medical leadership. Their primary objective is to raise the standard of patients care by improving medical leadership.

The organisation runs a one year Clinical Fellowship Programme for all 3 medical professionals; the Chief Dental Officer's scheme was established last year and although we are in the minority in the programme, our numbers have increased from last year and hopefully will continue to! The programme aims to help dentists develop their leadership skills who may not have held senior leaderships roles before and aims to develop skills in leadership, management, strategy, projection management and health policy.


What will the year look like?


Each of the fellows are hosted in organisations such as Bupa, the GDC, NHS Business services, and the aim is that each will collaborate with their organisations in meaningful projects and be fully immersed in their organisation to gain insight into the skills needed outside of clinical work.  

My host will be the commissioning team of NHS England (South). This ties in really nicely with my specialist training, as one of the main projects I will be getting involved with is the re-commissioning of Special Care and Paediatric dental services across the South of England. As well as working in our individual organisations, we will have other events and opportunities throughout the year including visiting other host organisations and learning how to influence change. 


What did I learn from our Induction?


The first two weeks of the job involved an induction alongside all the other clinical fellows and I learnt so much from just networking with others about issues within the fields of medicine and pharmacy. 

We had lots of interesting speakers over the 2 weeks speaking from topic such as influencing and personal branding, to leadership styles and how to NHS structure works (which I will blog about in the future so keep an eye out!). 

Some of my highlights including going to Westminster to pitch health care reform ideas directly to MPs and working with Eden and Partners in a simulated situation where we were put into organisations such as CCGs and Foundation Trusts in order to respond to a poor CQC report at a Health and Scrutiny Committee. 


I am really excited about the year ahead to learn skills outside of clinical work, learn how policy and decisions are made and hopefully, how to influence the system! I will be blogging my experiences throughout the year if anyone is interested in applying for next year's cohort (which will open in January 2019), but in the meantime if you need anymore information, see the webinar below. 


Webinar: Chief Dental Officer's Clinical Fellow Scheme - What's it all about? from FMLM on Vimeo.


Do you think leadership should be taught on dental programmes? Let me know in the comments below!


Wednesday, 12 September 2018

IADH 2018: Getting Homelessness on the Agenda in Dubai

So last week I got back from presenting in Dubai at the International Association of Disability and Oral Health Congress 2018... What did I learn and what did I talk about?



The Congress

The IADH congress is held every 2 years and this year was in Festival City in Dubai. If you follow me on Instagram, you may have seen my spam of my pre-conference fun in Abu Dhabi and Dubai! In 2020 the congress will be in Mexico (see you there!). 

I had the opportunity to meet and network with Special Care dentists from across the world and there were some really interesting talks during the 3 days. My highlights were learning about the disparity of usage of General Anaesthetic for dentistry across the world - use/need in the UK being 70% compared to 0.5% in Israel and 33% in New Zealand; the use of desensitisation programmes for patients with Autism Spectrum Disorder in the USA and Spain (where one patient had 76 dental-related sessions in total!); and learning about how to set up IV sedation in Malaysia, where there is only one dentist in the entire country providing this modality of treatment!

To learn more about IADH see their website


The Assessment of Oral Health and Impact Profile within the Homeless Population of East London


As many of you may know, I have set up and run a homeless dental service in East London. I presented my preliminary work when assessing the oral health needs of this population which was used to win additional funding from commissioners back in April. 

I was very nervous presenting to this international crowd (especially as I followed one of my mentors who is a fantastic presenter). To summarise my findings from my research:
  • There is significant need for the oral health needs of the homeless population in East London
  • Their oral health negatively impacts their quality of life which can perpetuate their cycle of homelessness
  • There were high levels of disease observed: 66% had visible signs of gum disease, 51% had visible caries with 38% currently experiencing dental pain
Look out for future blog posts describing the homeless dental service and how you can get involved. 


To see my full presentation from the day click here.


I'd love to hear about your experiences of treating homeless people, so please them in the comments!


Monday, 20 August 2018

Empowering Women in Dentistry Interview: Working with the Homeless

This weekend I did some fabulous filming with Marukh Khwaja, founder of Empowering Women in Dentistry..

Me and my fabulous nurse Abdul on our mobile dental unit


What is Empowering Women in Dentistry?


Dr Khwaja is a general dentist working as an associate in London/Kent; but she was spurred to start this group to showcase women and empower women as a result of lack of female representation at leading dental courses. 

Through her website and social media, she is interviewing and learning from some fantastic women, not only in dentistry but in healthcare and business. 

In her words:

'I founded this passion project after feeling frustrated at the lack of female role models and connection amongst women in dentistry. I felt a sense of injustice by the inequalities present currently at conferences. All the course I had attended bar one, had been led by men and dominated heavily by the opposite sex despite a massive number of rising female graduates. The momentum for me felt like it was with women. But women are not being represented in the way I want them to be. So I felt it was time I founded Empowering Women in Dentistry.
I am keen to change the makeup of dentistry and challenge inequalities. I also aim to discuss mental health and well being amongst women. Holistic living and self care are topics that still need much more exposure. I hope that with actively challenging inequalities and having difficult conversations, there will be change.'

So far, Dr Khwaja has arranged social events as well as talks from some fabulous speakers. 

To find out more check out her Instagram, Facebook, or YouTube Channels. 

What do I talk about?


The first of a few interviews has been posted on the EWD YouTube Channel... my favourite topic Homeless Dentistry.

If you follow me on social media, you may have an idea about my Homeless Dentistry work, but in this interview I open up to how I got involved, what I enjoy about it as well as how general dentists can also get involved!

Check it out below...




Have you worked with homeless people in dentistry? What challenges did you encounter? Let me know in the comments below. 



Sunday, 12 August 2018

Dental Associate Interviews: An Ultimate Preparation Guide. FREE SAMPLE!

Another collaboration... Following my contribution to Foundation to Dental Core Training comes a preparatory guide for dental associate interviews. 



We are proud to introduce a new resource for young dentists wishing to pursue a successful career. This is new book titled 'Dental Associate Interviews: An Ultimate Preparation Guide.' Our team of experienced practice owners and associate dentists have compiled an invaluable resource for young and aspiring dentists.

What can you expect from this resource?


  • Essential CV and Cover Letter advice
  • Fundamental information related to the dental associate position
  • Real associate interview questions and answers
  • Critical factors to assess for in your prospective practice
  • A step-by-step guide on building an outstanding dental portfolio


Includes downloadable:


  • Model CV and dental associate CV template
  • Dental associate cover letter template
  • Personal Development Plan template
  • Dental portfolio template for each and every section of your portfolio
  • Key checklists for CV, Cover letter, PDP and Portfolio creation
Below you can find a free sample of one of the chapters, to download the entire chapter and get notifications when the book is launched sign up HERE.



The fabulous team of all of the contributors. 


Chapter 6: 25 Top Tips for Young Dentists


  1. Become excellent at photography
  2. Gather outstanding testimonials
  3. Display confidence and maturity at all times
  4. Develop enhanced organisational skills
  5. Master time management
  6. Have a 5 year plan
  7. Continue learning and developing
  8. Observe and learn
  9. Join organisations, societies and study clubs
  10. Learn to embrace failure
  11. Become leader and team player
  12. Focus on providing quality
  13. Invest in magnification
  14. Develop outstanding communication skills
  15. Network and build professional relationships
  16. Seek mentorship
  17. Embrace change
  18. Give back
  19. Know your limitations
  20. Enjoy a work-life balance
  21. Build a portfolio
  22. Develop a unique selling point
  23. Keep up your record-keeping skills
  24. Get published
  25. Be attentive with patients



What tips would you give to young dentists? Let me know in the comments below. 


Monday, 6 August 2018

Response to recent Guardian Article claiming Homeless people cause NHS missed targets.

This blog post is a response from a coalition of dentists, charities and homeless organisations..

Free dental screening I have provided at a homeless hostel in East London

In a recent article published in the Guardian, the head of the British Dental Association referred to people experiencing homelessness as “no hopers” in the context of current dental commissioning. We—a coalition of members of the dental profession, dental charities and homelessness outreach organisations—strongly reject the message that this article is sending to vulnerable individuals and the wider public.
The chaotic and dangerous nature of homelessness can make it difficult for individuals to be at a certain place at a certain time. This is not a failing to be condemned, but a challenge to be met: it is our professional responsibility to make services more easily accessible to the growing number of vulnerable people in our society.
Commissioning models need to be sufficiently flexible to embrace innovative approaches to providing high quality care to those most at need. Good examples include Community Dental Services who provide dental care for homeless people at multiple locations across the country (like the service I run in East London). Based in Plymouth, Peninsula Dental School offers free care at four locations, and supports dental students to provide outreach advice at local homeless shelters. Den-Tech provides same-day denture services for people experiencing homelessness. In Manchester, Revive Dental Care offers drop-in clinics for vulnerable people. Dentaid holds free monthly clinics in Southampton and their ‘mobile dental unit’ visits night shelters and soup kitchens around the country.
In November, these and many others will meet in Birmingham for the ‘Homeless and Inclusion Oral Health’ conference, organised by homeless health charity Pathway. I will be speaking at the conference. The commitment of these groups is beyond doubt, but their tireless efforts should not give space for government to ignore its responsibility to commission or develop adequate healthcare services.
Instead, we should marry lessons learned in these contexts to resources available within the NHS, and push for greater inclusion at all levels: policy, commissioning, education, training, service design, and inter-professional collaboration.
Until then, we will continue to share experience and resources, establish new partnerships, and innovate in delivering services to members of our society whose requirements are not easily met by existing structures. We believe strongly that there is hope.

If you would like to contact us, please send your email to: inclusivedentistrygroup@gmail.com. A full list of signatories can be found at here.

Please leave your messages of support or comments below to show that there IS hope for homeless people in dentistry!


Friday, 27 July 2018

Gerodontology for General Dental Practitioners

This blog post is based on a talk by James Shaw, a Geriatrician who spoke at the East Midlands CDS BDA Study Day.



In Geriatrics there are 3 main complexities:
  1. Frailty - where multiple body systems lose their inbuilt senses. Can physical or cognitive. 
  2. Polypharmacy
  3. Multimorbidities 


5Ms of Geriatrics


According to the British Society of Geriatrics, there are 5Ms every health care professional who deals with geriatric patients needs to know:

Multi-complexity - multiple morbidity

Mobility - impaired gait and balance. Falls risk

Mind - dementia, delirium, depression

Medicine - polypharmacy, adverse medication effects

Matters Most - an individual's own meaningful health outcomes and care preferences


Top tips when Prescribing in Polypharmacy 


  • Obtain an accurate medical history
  • Use the BNF
  • Assume reduced renal function in the elderly 
  • Be aware of side-effects and interactions e.g. warfarin and miconazole 
  • If you are in doubt, call their GP or pharmacist 
  • Be aware of anticoagulants/antiplatelets
  • Avoid NSAIDs in over 80s as around 50% will get GI side-effects
  • Use the smallest dose co-codamol when prescribing 
  • Avoid dihydrocodeine and tramodol as high risk of constipation 
  • Antibiotics which start with C (clindamycin, clarithromycin, co-amoxiclav) have increased risk of developing C. Difficile when prescribed in the elderly


Dry Mouth


This can be as a result of the increased prescription of anti-muscarinics for over active bladders. These increase the risk of dry mouth. Of course there can also be other factors such as polypharmacy, side effects of many medications or immunosuppression. 

If the effect is profound following prescription of anti-muscarinics, it may be worth referring back to their GP as in fact only around 50% of cases these drugs are effective in managing over active bladders. 

Some clinical tips in managing these patients include:
  • Prevention of caries is essential in these patients. Regular recalls, hygiene visits, fluoride applications and prescription of high fluoride toothpaste are recommended
  • Biotene oral gel used appropriately can help alleviate dry and sore tissues
  • Saliva sprays, gels, pastilles are options to help with symptoms but many patients prefer to manage with frequent sips of water or use of sugar-free chewing gum 
  • Consider referrals to their GP or oral medicine to investigate where appropriate


Osteoporosis


Osteoporosis should cue warning flags for dentists... we all know about MRONJ and it's association with dentistry. 

Oral alendronic acid taken once weekly has a very low incidence of MRONJ <0.01%, whereas IV bisphosphonates such as as zolendronate have an increased risk. IV bisphosphonates are more clinically effective and in some cases patients prefer zolendronate as instead of a tablet taken once a week (which is often forgotten), is a annual infusion IV. 

To read more about MRONJ and guidelines in dentistry see my previous post here


Team photo with the delegates from the day

A huge thank you to James for his talk and Charlotte Waite for organising the day. Look out for future posts summarising other talks from the day...


Do you treat geriatric patients? What challenges do you come across? Let me know in the comments below. 


Friday, 20 July 2018

Align Bleach and Bond. Another Awesome Raffle Prize with IAS Academy

Another incredible raffle prize won at the Make a Dentist summer party...



My raffle prize was a free place on the first day of the Align, Bleach, Bond (ABB) course with IAS Academy's Tif Qureshi in London.

Who are IAS Academy?


IAS Academy are an orthodontic training academy to help train GDPs in varying orthodontic systems to allow dentists to treat their patients with a range of appliances. They continue to support the dentists they train through an online forum with support from other GDPS, specialist orthodontists and technicians. 

The ABB course is essentially one of the first courses the academy recommend for beginner GDP ortho - and they don't refer to GDP ortho as 'Short-Term Ortho', rather 'Anterior Alignment Ortho'. With the correct case selection, AAO can help align teeth in as little as 6-16 weeks!

The first day taught us about ClearSmile clear aligners and the Inman Aligner. The Inman can move teeth faster and the lab bill is cheaper than clear aligners but patients may prefer wearing clear aligners. 


Benefits of Early Orthodontic Intervention

  • Better aesthetics
  • Prevent further crowding which worsens with age
  • Avoid expensive corrective treatment later in life
  • Prevents uneven tooth wear that accelerates with age

Movements possible with Inman Aligner and ClearSmile aligners


Both devices focus on movement of the anterior teeth only. 
  • Tipping
  • Rotations
  • Very minor bodily movements
  • Very minor intrusions/extrusions
  • Minor expansion


What Ortho records do I need?

  1. 13-15 Orthodontic photos
  2. Study models
  3. OPG/PAs
IAS also run a photography course. 


The day was structured as theory in the morning and in the afternoon we had the chance to get some practical skills with hands on doing IPR (interproximal reduction) and bonding a fixed retainer. I have been on other GDP ortho courses before, but I felt the background and theory Tif taught gave me more understanding of assessment and treatment planning rather than just relying on a lab or ClinCheck. 

The advantage with IAS is not only a strong support network, but also the chance to enhance your skills by enrolling on some of the more advanced courses. If any GDP is looking to start an ortho journey, IAS will give a solid foundation of knowledge. 

Check out the highlights video of the day!





Have you been on an IAS course? What did you think? Let me know in the comments below. 


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