Friday, 16 August 2019

CQC Smiling Matters: Oral Health in Care Homes

At the beginning of July, I attended a round table discussion about the eagerly anticipated CQC report: Smiling Matters...

All the stakeholders at the round table discussion

You guys asked me for a summary of the findings of report so here you go! This report was something I had been waiting for as a clinician who regularly sees patients from care homes, whether they be older people or those with learning disabilities. 

The conclusions of the report highlighted the need to prioritise oral health in this vulnerable population of people and recommends the following:

  1. People who use these services, their families and carers need to be made more aware of the importance of oral care
  2. Care home services need to make awareness and implementation of the NICE guideline 'Oral health for adults in care homes
  3. Care home staff need better training in oral care
  4. The dental profession needs improved guidance on how to treat people in care homes
  5. Dental provision and commissioning needs to improve to meet the needs of the people in care homes
  6. NICE guideline NG48 needs to be used more in regulatory and commissioning assessments 

For some of you who regularly see patients who live in care homes (or who are cared at home) I am sure none of these conclusions are groundbreaking news for you. What is important is this report now gets this issue of the public platform with backing from an organisation with clout such as the CQC. But we need to take action and use this report at the grassroots making changes in our local areas!

To read my opinion piece on the report and the round-table discussion see my blog on the BDA

How can you use this report to make changes in the area you work? Any ideas out there to make meaningful change? Let me know in the comments below!

Wednesday, 17 July 2019

PLEASE VOTE FOR ME - Future Finance Scholarship public vote

Please vote for me HERE

I need your help!

You may know that I will be starting a Masters in Special Care Dentistry from September as part of my training. This is an expectation of my training programme; however, the Masters is entirely SELF-FUNDED!!

Please can you help me to be able to achieve this by sparing 30 seconds of your time to vote for me to win a scholarship which will go towards my tuition fees!

Without the funding, I will struggle to complete the degree. The final decision who wins the funding is made via public vote, so I would be really grateful if you could also share the link with your networks, family, friends... anyone! Voting closes on the 29th July.

My masters will help me to contribute to research in Special Care Dentistry - a field where good quality research is lacking. I have a passion to help those who find accessing dentistry challenging, specifically the homeless population and I would like to complete my research in this area by using an evidence base to design a specifically commissioned service for this vulnerable group of patients.

I would be super grateful for your support... again if you missed it the link is HERE. 

You can also find an example tweet at the end of this post should you be so kind to share it!

Do you have any questions? Let me know in the comments below!

Please tweet:

Please vote for to receive funding for her MSc in #specialcaredentistry Natalie B works in special care dentistry & has a passion for ensuring the homeless, marginalised & those w/ learning disabilities receive dental care. Vote here 👇

Saturday, 8 June 2019

NHS Business Services Authority... What do they do?

If you follow me on Instagram, you may have noticed my fellowship takes me all across the country for meetings and events; one of which was a trip to my old haunt Newcastle to visit the NHS Business Services Authority (NHS BSA)...

Before this day, my perception of the BSA was mostly dealing with sending off my FP17 NHS claims...but I have since learnt about all the roles the BSA have...

Who are the NHS BSA?

The BSA are an 'Arms length body' of Department of Health (like NHS England and HEE) and have 4 divisions:
  1. Primary care (prescriptions and dental)
  2. Workforce services (pensions, ESR, HR)
  3. Citizen (help with health costs, E111, student bursaries)
  4. Enabling services (information services, digital)
In total, the BSA administer £35 billion worth of payments! We visited the Newcastle offices which is the main offices of the BSA. The main office where the dental team work from is in Eastbourne.

As well as the everyday functions of the BSA, they have ongoing projects as the Pacific project which aims to save the NHS £1 billion, mostly through supply chain efficiencies. Together with this, many of you will know over the past few years, the BSA have been exemption checking all patients who claim they are exempt from dental charges (dental exemption checks - DECs) and have recovered over £179 million. Although what I learnt from the day is that when a Penalty Charge Notice (PCN) is sent to patients, it doesn't actually always mean that they have claimed their exemption incorrectly; but it could be for very innocent reasons such as the address of the patient not being up to date or the incorrect exemption box has been ticked by mistake. 

The BSA also provide assurance to communicate with NHS England any abnormalities in data, such as double claiming or any outliers in performance. This takes the pressure off NHS England when contract managing dental providers.  

There are 3 stages in contract management:
  1. Validation - i.e. whether performers are compliant 
  2. Education -  i.e. improving delivery of the service
  3. Escalation -  i.e. taking appropriate action

Roles of the BSA Dental Team

The dental team within the BSA have lots of different roles:
  • Payment of dentists via FP17 submissions (which now are all online)
  • Advise dentists on claims
  • Fraud prevention
  • Clinical advisers to review claims and outliers 
  • Student finance deductions
  • Reimbursement of expenses for Dental Foundation Trainees
  • Pensions 
  • Exemption checking 
  • Run reports for NHS England, Commissioners and Public Health England. For example, for the Starting Well Project or for local needs assessments 
  • Patient questionnaires distribution and analysis - this is a text message questionnaire
  • Distribute the BNF (although now this is signposting to the online version of the BNF)
Every year, NHS dentistry in primary care cost £2.11 billion and there are 39.9 million courses of treatment. 

To find out more about the BSA, please see their website.

Do you have any questions? Let me know in the comments below!

Saturday, 25 May 2019

BSDH Spring Meeting: Drugs and Homelessness in Dentistry

Back in April, I attended the British Society for Disability and Oral Health's spring meeting. I presented a poster WHICH I WON, but also learnt lots across the 2 days including lots about managing substance misuse... 

The 2 days of the conference were cram packed full of interesting talks, from learning about the city of Bradford, to the Special Olympics. I'm going to summarise a talk by Caroline Graham about drugs in dentistry since it really helped give me practical tips I could relate the work I have been doing with the homeless. 

Is Drug Misuse a Problem?

Depending on the area and the population you deal with, drug misuse can be a day to day occurrence with your patient group. Certainly in East London on the mobile dental van, it was something I came across all the time. 

1 in 11 adults have taken drugs last year, with 2.1% of the population using them frequently - most commonly, cannabis and cocaine. Often, the drug use has co-morbidities associated such as mental health problems, complicating medical problems (such as blood borne viruses), as well as complex social situations such as homelessness or domestic violence. 

How is Drug Addiction Treated?

There are some amazing drug and alcohol services out there. The services I come into contact with in Tower Hamlets is Reset and in Newham CGL: both provide amazing support for those engaged in their services and include outreach onto the streets. 

A client is often assigned with a specific keyworker who can support them. Treatment can be:
  • Substance replacement prescriptions e.g. Methadone
  • Harm reduction treatment
  • Detox
  • Family support


Many of you may have seen the effects of this replacement for heroin: Meth mouth. 

Methadone is gradually titrated as heroin use is reduced; eventually with the idea to wean completely off the methadone but people can be taking it for years. The overall success rate for methadone programmes is 26%. 

The problem with methadone which means it can cause significant caries is twofold; it causes xerostomia which increases the risk of decay, and traditional constituents were sugary syrups. Nowadays, services are more aware of the effect of sugars so often prescribe sugar free solutions. 

Methadone is a less potent analgesic than heroin, so once clients switch over, chronic pains such as toothache which were masked by the heroin become an issue. Prescriptions are usually given daily as among users there is a trade of the drug, especially since a tolerance is built over time.

Oral Effects of Drug Use

The effects we can see of current or previous drug use include:
  • Xerostomia
  • Oral Cancer
  • TSL (erosion due to vomiting, bruxism often in stimulant use)
  • Mucosal erosion/perforation (common in cocaine use)
  • BBV (50% of IV users are Hepatitis C positive)
  • Vascular damage from chronic injecting (DVTs, abscesses, increased risk of infective endocarditis)
  • Caries - due to chaotic lifestyles, poor OH and diet
  • Periodontal disease due to poor OHI and smoking
  • Late presentation of problems. Patients have marked pain and infection, acute anxiety and stigma 

Top Tips in Management

I really related to these tips for managing not only patients with substance misuse, but all groups that can experience social exclusion e.g. homeless, travellers, sex workers. 

  • Treat patients in the contexts of their lives i.e. should you just treat their symptoms and leave that retained root not causing an issue, should you address the class V cavities on their incisors rather than providing RSD?
  • Improve health wherever you can, make every contact count and signpost to other services the patient needs
  • Work out how you can improve motivation e.g. making them a spoon denture to replace a front tooth to improve self esteem which could motivate them to improve self care
  • Patient's pain tolerance can be poor especially if they have just started treatment with methadone. Make sure you have adequate LA
  • Note of possible cardiac interactions with LA for those taking stimulants. Consider reducing dose
  • Sedation is rarely appropriate and can be unpredictable, so treatment should ideally be with LA
  • Access to services is important and may need some adjustments e.g. drop in clinics, mobile surgeries, appointment reminders

My Poster

During the conference, I presented some of the work I have been doing with the homeless population in East London including background work before launching our Mobile Dental Surgery!

The poster that was displayed at the conference presented the planning of how we decided where the van visit as well as planning and logistics around this. 

To see a copy of my poster, click here.

Overall, I had a wonderful time up in York at the conference bumping into familiar faces and making new acquaintances! See everyone at the Winter Conference in London!

Have you managed patients with substance misuse problems? What adjustments did you make if any? Let me know in the comments below!

Tuesday, 21 May 2019

Top Tips in Managing Patients with Chronic Kidney Disease

Recently, I have been seeing lots of patients with chronic kidney disease. How does this impact the dental care I plan for these patients...?

Causes of Kidney Disease

Kidney disease can be mild, moderate or severe with the main 2 causes being:

  1. Uncontrolled hypertension
  2. Uncontrolled diabetes leading to diabetic nephropathy
This can manifest as chronic renal failure, or renal osteodystrophy where increase plasma phosphate leads to secondary hyperparathyroidism. 

Systemic Signs of Kidney Disease

Cardiovascular: Hypertension, congestive cardiac failure, atheroma, cardiac arrhythmia

Gastro-Intestinal: Anorexia, vomiting, nausea, peptic ulcers

Neurological: Headaches, tremor, sensory disturbances

Dermatological: Itching, hypepigmentation

Haematological: Anaemia, increased bleeding 

Metabolic: Thirst, nocturia/polyuria, electrolyte disturbances, secondary hyperparathyroidism

Treatment of Kidney Disease

Management of mild/moderate kidney disease can be to control causative factors such as anti-hypertensive drugs or more effective diabetic control. Otherwise in severe cases, treatment can be:
  • Peritoneal haemodialysis  (inside the body using the periotonium)
  • Extra-corporal haemodialysis (outside of the body exchange)
  • Transplant

Oral and Dental Manifestations of Kidney Disease

When examining patients with kidney disease, you may come across the following signs:

  • Oedema around the face (peri-orbital is common) or ankles
  • Oral ulceration
  • Pale oral mucosa 
  • Opportunistic dental infections e.g. candidiasis, herpes zoster due to immunosuppression
  • Gingival hyperplasia (induced if patient is taking ciclosporin)
  • Swelling of the salivary glands - parotid is most common

Tops Tips

  • Patients should be treated under local anaesthetic if possible, as sedation or general anaesthetic drugs will have a impaired excretion. Liaison with a patient's physician and anaesthetic team is recommended
  • Avoid NSAIDs and some antimicrobials e.g. tetracycline, erythromycin
  • Consider prescribing reduced doses of other antimicrobials e.g. acyclovir, amoxicillin, and recommend paracetamol for post op pain
  • Patients are at an increased bleeding risk mostly down to platelet dysfunction rather than the effect of the heparin used during dialysis (which has a very short half life). Investigatory bloods may be indicated and use of local haemostatic measures
  • Treat patients the day after dialysis to allow the effect of heparin to be eliminated and when patient is feeling most well
  • Patients undergoing haemodialysis may have an arterio-venous fistula access in an arm - DO NOT use this arm for venous access
  • If patient has had a kidney transplant, they may be immunosuppressed. If they are taking steroids, steroid cover for surgery may be indicated. Ciclosporin as mentioned above also can cause gingival overgrowth. Antibiotic cover may be necessary and consideration of bleeding risk if they are also anticoagulated. 

Overall, mild or moderate kidney disease should be suitable to be seen in primary care. For patients undergoing dialysis or who have had a kidney transplant it may be more practical for them to be seen in secondary care especially if co-coordinating care with their renal team. To read more about the management of these patients, see this BDJ article

Have you managed patients with chronic kidney disease? What adjustments did you make if any? Let me know in the comments below!

Sunday, 12 May 2019

5 Top Tips for Speciality Training Interviews

It's been over a year since my Speciality Training Interviews but with everyone's coming up in the next couple of weeks here are my top 5 tips...

1. Read the Personal Specification

As you will know, most of the information you need for StR and DCT posts is on the COPDEND website; but most importantly you must read the personal specification for your chosen speciality.

This will really help guide you to how many boxes you tick and how to answer questions in the interviews. If you're looking to apply to training in the future this is a good guide to identify areas to strengthen your application.

2. Prepare your Portfolio

For most interviews you will need a portfolio. Some will give you a template to work to, some there is very little guidance - you may have a dedicated station for this or just asked to bring it along to view at some point in the interview. 

If you don't have a template to work to check out my previous post which gives you a guide. Working on your portfolio is time consuming but really important so give yourself plenty of time. You may not think you have a lot to include but think laterally e.g. lunch & learn presentations, if you've written any patient information leaflets. Make sure you are succinct and organise the portfolio clearly. 

3. Know your Stations

Most of speciality training is via national recruitment where at the interviews are broken up into stations very similar to DCT interviews. Depending on your speciality these may include:

  • Clinical station - testing your clinical knowledge of the speciality
  • Academic station - testing your knowledge of research, academia and evidence based dentistry 
  • Practical station - depending on your speciality depends on whether you have this station and what practical skills are tested
  • Communication station - with a actor to test your communication skills
  • Portfolio station - testing your commitment to the speciality and achievements to date
  • Situational Judgement Test - not in every speciality yet but may be further in the future
Check on Oriel what stations you have, their length and structure or ask previous candidates for a guide. 

4. Practice, practice, practice

With all interviews I would recommend practising scenarios and interview techniques with peers and mentors to build up your confidence beforehand. By now you have done quite a few different interviews and had practice of these but from your reading of the personal specification and information on oriel you will know how this interview is structured so you can practice accordingly.

5. Be prepared

Set aside enough time to prepare for this interview it's a toughy! Don't worry if you don't get a post first time round, plenty of good candidates have to apply several times before they get a post. Depending on your speciality the material you chose to read before the interview will vary but generally I would recommend:
  • Read this Medical Interviews Book... it has excellent guidance on all types of medical interview. It is medical focused but you can apply most of it to the dental interviews. 
  • Read guidance that applies to your speciality e.g. NICE, SDCEP, BSDH, FGDP etc. 
  • Read recent published articles applicable to your speciality and pick a couple you really like and critically appraise them 
  • Read of any recent changes in your speciality and be aware of brief outline of the StR curriculum that applies to you
  • Be aware of national issues in dentistry e.g. Never Events, recruitment, WHO checklists

And finally good luck! Don't get too stressed and support each other. National recruitment is stressful but there is always another year to apply!

Do you have any tips for StR interviews? Let me know in the comments below!

Sunday, 14 April 2019

Homelessness and Oral Health: Podcast Interview with #HealthMeetsHome

You may have noticed that I've been featured on my fellow Clinical Entrepreneur's podcast Health Meets Home talking about homelessness and oral health...

Health Meets Home

Health Meets Home dives into the fascinating relationship between health, housing and why the places we live influence our behaviour, physical and mental health. Hosted by doctor, author and property enthusiast Dr Lafina Diamandis, tune in to hear from some of the nation's leading experts on health and housing and discover the latest innovations being developed to meet the changing needs of our population.

What do I talk about?

Recording the podcast with Lafina was surreal but so much fun! I didn't realise I could talk so much about this topic, in the podcast we discuss:
  • How homelessness affects oral and dental health
  • The stigma faced by homeless people accessing dental care
  • Innovative solutions for marginalised communities

Listen the podcast below!

Make sure you also check out Lafina's other guests who have been interviewed on her podcast!

Do you have any questions? Let me know in the comments below!

Sunday, 17 March 2019

Tax and Finance: Top Tips for Dentists

Becoming a dentist isn't just about clinical skills... managing your finances is a hugely important skill. Luckily, a new resource is out there to help out...

This book, written by Kalpesh Prajapat and specialist dental accountants Lovewell Blake LLP, gives an overview of basic financial information and how it relates to you as a dental professional. For me, trying to manoeuvre my first tax return as a dental associate was disastrous: it took me hours and I did it all wrong. It would have been incredibly handy to have this resource back then!

It is highly recommended that you engage with a qualified financial expert when becoming self-employed and completing your tax return.

Here's just a few tasters from the book. 

What does it mean to be self-employed?

As a dental associate you are a contractor from the 'Provider' (if an NHS contract) or the practice owner or principal. You will hold an agreement with the provider/practice owner/principal to carry out a certain number of Units of Dental Activity (UDAs) as well as how the fess are shared in private treatments. You will be responsible to managing your own tax, national insurance, professional indemnity and annual retention fees. 

How can you become Tax Efficient?

Being self employed as an associate you must plan financially to pay your tax bill every year. It is recommended that you save this money aside every month but methods to help manage your money include:

  • Having separate personal, business and savings accounts
  • Making the most of tax-free savings e.g. ISAs
  • Investigating other assets e.g. bonds 

When should I seek advice from a Professional?

You may need assistance when planning and managing your finances. Professionals that can help you include:

  • Accountants
  • Financial Advisors
  • Lawyers
Accountants and lawyers may be members of National Association of Specialist Dental Accountants and Lawyers (NASDAL) which may be helpful for specific dental aspects of work. I think it's worth getting advice and assistance whenever you feel out of your depth... the risk of getting tax returns wrong is a hefty fine from HMRC so better to get it right!

For more information you can purchase the book here

Do you have any questions? Let me know in the comments below!

Sunday, 24 February 2019

Who are NHS England?

You may have heard of NHS England but what do they actually do? Before my fellowship with them this year I only had vague ideas about the role of the organisation. So what have I learnt that they do and how does it relate to dentistry?

A bit of History

Before 1948 and the introduction of the NHS, all dentistry was provided privately. For the first 2 years after the NHS was introduced, dentistry was provided free at point of service, but spiralling costs associated with high numbers of extractions and full dentures lead to the introduction of patient charges in 1951. 

Dentists were paid a fee per item of service which was considered to be complicated and confusing. This was in place until 1992 where a blended style of contract was introduced where there was a payment for capitation and also for quality and continued care. Most recently, the contract changed again in 2006 where our current UDA system came into play as I am sure you're aware where banded treatments simplified the payments patients made if they were fee paying and also for the first time allowed for there to be fixed NHS dentistry budget. Dental Contract Reform has been in place for the last few years where again the contract is going to be changed. 

The commissioning of dentistry has been overseen by NHS England throughout this time - initially known as the NHS Board. Commissioning decisions are now overseen by local teams rather than one central body who hold the budget and providers will be accountable to contractually. 

NHS Structure

NHS England (NHSE) is part of the Department of Health and Social Care (DOHSC) and its responsibilities are set out in the Health and Social Care Act 2012. These are:
  • Planning of NHS services
  • Budgeting of NHS services
  • Day to day delivery of NHS services
  • Responsible for commissioning of NHS services (I will explain this in a future post about the Commissioning Cycle)
  • Hold contracts with doctors and dentists
NHSE are under the Secretary of State of Health and their team at DOHSC (currently Matt Hancock) but are arms length bodies similar to Public Health England (PHE) and Health Education England (HEE). 

The Secretary of State annually publishes the NHS Mandate which sets out the goals NHSE have to work towards in the upcoming year. 

NHSE and Dental Commissioning

Budgets for paying for and commissioning health services are broken down into different teams within NHSE:
  • Clinical Commissioning Groups (CCGs) are given the budget (60% of overall budget) for hospital, urgent, mental health and community services. They co-commission GP services with NHSE
  • Specialised Commissioning e.g. cancer care, secure mental health
  • Dental
  • Optometry
  • Military and veteran health services
  • Health and justice
  • Public Health Commissioning (although the majority of this is commissioned by PHE i.e. local health authorities)
NHSE not only commission the service, they also contract manage and monitor services as well as holding the NHS dental performers list (which was contracted out to Capita in 2014). 

Engagement with the Profession

It is important that commissioners communicate and engage with the profession. For dentistry, there are formal routes that they do this regularly:
  • Local Dental Committees (LDC)- although hosted by the British Dental Association (BDA) are funded from the Levy collected from NHS GDPs through NHSE
  • Local Dental Networks (LDN)
  • Managed Clinical Networks (MCN)

I will blog about these separately. As well as these regular engagements, NHSE can engage with the profession during procurement processes or via professional bodies such as the BDA or other specialty-specific bodies.

I hope this clears up the role of NHSE and how it relates to NHS dentistry!

Do you have any questions? Let me know in the comments below!

Sunday, 10 February 2019

A Day in the Life of an OCDO Fellow

If you read my post back in September, you will know I am an OCDO/FMLM Clinical Fellow based at NHS England part time... but what does that mean day to day?

Where I am based?

My fellowship is based with NHS England in the South East. I will be blogging about the role of NHS England and it's structure soon so look out, but basically South East covers a huge area from Kent across to Oxford and the Isle of Wright!

My regional offices are Kent, Surrey and Sussex where the dental team are mostly based in Tonbridge (which is pictured above), but we have offices in Horley and Lewes too where I may be if I have meetings. It would also be I have meetings or training in London, Reading or other venues across the South East! So it does involve a lot of travelling. On the flip side, if I don't have any meetings I can work from home - especially in the case of the snowy weather the other week!

What projects am I involved in?

My fellowship is part-time with half the week being employed by NHS England (the other half I do my StR training in Special Care Dentistry). I compress this into 2 long days, so I can't take on too many projects!

As well as learning about the general functions of NHS England the 2 projects I work on are procurement of general dental services in Kent Surrey and Sussex and the procurement of the community dental services across the whole of the South of England. This has involved adhering to statutory requirements for procurement, the writing of service specifications, patient and public engagement as well as learning about the tendering process and evaluation of bids. 

Having a completely office based job has been a bit of transition and learning curve for me - learning about hot desking, Gantt charts and taking minutes! I will blog about this soon! 

OCDO Days 

As well as office life, as an OCDO fellow we have days organised by the Chief Dental Office. These can be learning about the role of Sara Hurley and her team, but as part of the fellowship, each fellow hosts the others where we learn about the role of each of the host organisations such as Health Education England, NHS BSA, the General Dental Council. I will blog about each of these days soon too (so many blogs to get done!). 

FMLM Events

More events to attend! The Faculty of Medical Leadership and Management also hold training days and events on leadership in healthcare. I really enjoy these days as we get to mingle with the fellows in medicine and pharmacy. Social events are also organised where prestigious speakers come to speak to us - most recently I was at a dinner with Sir Sam Everington the chair of the CCG in Tower Hamlets. 

Overall I really enjoy my fellowship, it's an excellent opportunity to learn about how the jigsaw that is our health care system fits together and I get to network with so many people across the system and not just dentists! 

If you are interested in applying look on the FMLM website where the applications should open at the end of the month. 

Are you interested in the fellowship? Do you have any questions? Let me know in the comments below!

Saturday, 26 January 2019

NHS Clinical Entrepreneur Programme

Some of you may know that this year I was enrolled on the NHS Entrepreneur programme this year....but what is it?

NHS England's clinical entrepreneur programme is now in it's 4th year. It is designed to offer opportunities for health care professionals to develop their entrepreneurial (and intrapreneurial) skills. The programme offers the following:

  • Time for entrepreneurial activity with support to explore appropriate options such as less than full time training, time out from clinical duties
  • Mentoring and coaching from acclaimed mentors and achievers
  • Opportunities for placements, internships
  • Access to industry contacts and funding opportunities
  • Education via webinars and events which can used as accredited modules towards PGCert, PGDip etc. 
  • Networking events with investors, fellow entrepreneurs and leaders in medicine and industry

Who can apply?

Initially the programme was made for junior doctors but has been opened up to other healthcare professionals including:

  • Doctors
  • Dentists
  • Pharmacists
  • Midwives
  • Nurses
  • Allied Health professionals
  • Healthcare Scientists

What have I learnt so far?

The progamme has been really refreshing for me so far. It's great to be abe to meet and network with like-minded people throughout healthcare (not just dentists) and learn about subjects like leadership, entrepreneurship and business that I wouldn't normally have access to. 

Throughout the year, the programme holds Pitstops every month or so which are day/evening events for those on the programme to network but there are also talks and workshops to help us develop the skills, knowledge and experience to move our innovations forward. For instance, at our most recent Pitstop we learnt about Belbin and what roles we hold in teams.

We are are paired up with a mentor who we meet with regularly to help us move our ideas forward. 

What's my Innovation?

If you've read one of my previous blog posts about a weekend I spent with Cambridge Business School, you may already have a clue about my innovation's aspirations. 

Without revealing too much as this early stage, I want to apply the skills and knowledge I learnt from setting up the homeless dental service in East London in order to address the oral health of vulnerable groups. 

To read more about the current cohort of entrepreneurs click here.

How can you apply? 

The applications will open in March. If it's similar to last year, there is an online application form (which included a 60 second elevator pitch, click here to see mine) and then you were invited to face to face interview. 

To read more or register your interest click here

Are you involved in the entrepreneur programme? What have been your highlights? Let me know in the comments below. 

Monday, 14 January 2019

Eating Disorders in Dentistry

Dentists need to be aware of common dental manifestations of eating disorders as we can be the first health professional who identifies a problem. Here is a summary of a talk I gave to undergraduates about dental management of eating disorders...

What are Eating Disorders?

Eating disorders are a group of related but with distinct disturbances in eating. Development is multi-factorial but can be stress, trauma, abuse even genetics. They are mental health conditions classified under the Diagnostic Statistical Manual of Mental Disorders (DSM).

What examples are there of Eating Disorders?

1. Bulimia Nervosa - a condition of binge eating then purging (typically by vomiting but also can be laxatives). The person is of normal weight.

2. Anorexia Nervosa - Type 1 is food restriction, Type 2 is where there are episodes of binging and purging. The person maintains a weight <85% of their expected weight.

3. Binge Eating Disorder - recurrent binging episodes without purging leading to obesity/becoming overweight

4. Pica - eating of non-nutritive substances e.g. chalk, tissues

5. Night Eating Syndrome - binge eating during the nighttime often with combined with insomnia

What Dental Manifestations are there?

There are lots of warning signs dentists can pick up from their patients if they have an eating disorder such as:

  • Palatal erosion of upper anterior teeth due to reflux or vomiting
  • Palatal haematoma/erythema from trauma from self-induced vomiting
  • Caries from high sugar binges
  • Toothwear associated with pica habits

How do we manage these patients?

When treating these patients we need to consider:

1. Dental management - including lots of preventative advice, high fluoride toothpaste, fluoride varnish and considering of composite to treat any wear. Dahl may have to be used if there is loss in vertical dimensions. 

2. Signposting - it's important to be able to signpost any patients who open up to you about having a problem onto their GP or other appropriate service (e.g. charities such as Beat). 

3. Safeguarding - if you suspect someone is suffering from an eating disorder this can be a difficult thing to discuss. Don't directly accuse a patient but explain what you are seeing clinically. If they don't open up ensure you document fully but in some circumstances you may need to consider safeguarding referrals e.g. if a patient is under 16. Always discuss with your safeguarding lead. Read more about safeguarding here

To see my full presentation click here.

Crisis at Christmas 2018

After two years of volunteering at Crisis at Christmas, this year I became a Shift Leader for the Service...

One of my amazing teams this year

What is shift leading?

The previous years I had volunteered with Crisis I spent my time seeing guests on the mobile vans, manning reception, (trying my best!) on decon, or going to other day centres  on triaging to bring guests back for treatment on our vans. 

This year as shift leader I did not personally see guests (although I recognised a fair few!) but instead I was in charge of co-ordinating the 3 shifts I leading on. This involved contacting volunteers to answer any queries they had, setting everything up for the day, assigning roles for volunteers, ensuring the smooth running of things throughout the day and clearing down at the end of the day. 

I was lucky to have some really supportive clinical dental supervisors on my shifts who looked after any clinical aspects of care for the guests (such as a particularly stubborn lower 6 that didn't want to budge for one patient) so I could focus on my duties and make sure all my volunteers were happy and supported. 

What did I learn?

Leading a team of up to 20 individuals can be tricky with varying experience and needs but I had fantastic teams all the days I lead who were eager to do their bit and work hard to ensure the service we providied to the homeless was first class. 

Something that I had to learn was when to delegate to others... I was so used to trying to do everything from clinical aspects to the running of reception, on the first day i was automatically doing too much. Quickly I realised I needed to use my team and a huge thank you to everyone who did their bit!!

On board one of the mobiles!

This year was a record year for the Crisis at Christmas Dental Service with 459 guests seen on the 4 mobiles over the week.

Many  thanks to all the volunteers, sponsors and donors which allowed the service to go ahead (especially CDS CIC, KCH and KCHFT who donated their vans), all the shift leaders and the organisers Nahush and Janine for all their hard work.

See you at Crisis 2019!

Did you volunteer your time for Crisis this year? What were your highlights? Let me know in the comments below. 

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