Archive for April, 2007
April 26, 2007 at 8:33 pm by Ian Kerr
Filed under General
In the last blog entry I discussed the advice on the re-use of files and reamers (root filling instruments) that was given by the Chief Dental Officer, Barry Cockcroft. I have been trying to get a response from the General Dental Council or NICE or the British Dental Association and have had no joy to date. I have been told that all three organisations are looking to give a response in the next week or so but all appear to have been caught a little bit by surprise by the letter and it’s contents.
The one response that I have had to date is from my professional indemnity organisation,The Dental Protection Union (DPU) who have taken the stance that this letter should be taken at it’s word and the advice followed fully. This is a sad state of affairs as it puts an enormous strain on all those providing this type of work and a great financial burden on all patients at a time when there is no definitive evidence to support this move and literally millions of completed cases without one single record of vCJD being spread this way. The environmental impact of massively increasing the number of nickel-titanium files needed and then disposed off will be significant but does not seem to be considered.
Sadly,as is so often the way, the lawyers have had the biggest input and we at StoneRock feel duty bound to follow their advice. What this means is that all root canal fillings will need a set of new files each visit with the costs of this to be born by the patient. I am sorry that this has been forced upon us and hope (against hope) that some further input from the GDC and BDA will clarify the position but as it stands we have no choice. What I can say with 100% belief is that I have no concerns over previous treatments provided as StoneRock has always exceeded the (current) guidelines on cross infection control and I was happy to treat members of my own family this way and to have treatment on myself this way.
I guess it is always true that we cannot judge yesterday’s treatment by today’s knowledge but sometimes we should look back over the changes we have made over the past 20 years and wonder if they have all been in the patient’s and society’s best interest.
April 19, 2007 at 9:05 pm by Ian Kerr
Filed under Behind the Headlines
A news item on Radio 2 today highlighted a letter from the Chief Dental Officer (Barry Cockcroft) advising dentists that all files and reamers (instruments used in root canal therapy) should be made single use to reduce the risk of spread of variant Creutzfeldt-Jakob Disease (vCJD).
The debate about the spread of this disease via root canal instruments has been running for several years now and is based on the concern that dental pulp tissue could contain the tiny particles that spread this disease (prions) and that these may not be destroyed by current sterilisation processes. Previous risk assessments for the transfer of vCJD infectivity via dental surgery have concluded that the risk is low. That said the the Spongiform Encephalopathy Advisory Committee (SEAC) have maintained a watching brief and have now concluded “It is unclear whether or not vCJD infectivity can be transmitted via endodontic files and reamers. However, given the plausibility of such a scenario and the large number of procedures carried out annually, it would be prudent to consider restricting these instruments to single use as a precautionary measure. Since sufficiently rigorous decontamination of these instruments is difficult, single use of these instruments would eliminate this risk, should it exist.”
Early findings coming from research carried out by the Health Protection Agency show a possible pathway for TSE - Transmissible Spongiform Encephalopathies, the group of prion diseases that iinclude BSE, CJD, vCJD and scrapie to be spread via dental tissue in mice. It is these two findings that have lead to this advice being given.
It should be stressed that this is a letter of advice only and cannot be counted as a definite guideline to current best practice. There has been no response, as yet, from the General Dental Council or NICE, the institute for clinical excellence. It should also be stressed that there has been not one single case world wide reported of the disease being spread this way.
The implications of the advice are massive in terms of cost, both financial and environmental and as the title suggested all but removes this type of treatment from NHS care on financial grounds. To complete one root canal filling can take two visits and involve upto three sets of instruments (hand files, rotary files and special drills called Gates Gliddens). Each set costs around £20-£25 plus VAT, making a potential cost of £75 plus VAT extra per case. Currently, under the new NHS contract a dentist is paid £46 for a root canal filling. Clearly they will be unable to provide this treatment if they are paid less than the cost of the instruments alone (they would also need materials, staff and overhead costs to be met long before they could take a salary from the fee).
At StoneRock Dental Care I provide many root canal fillings and see a great many patients from various practices in the surrounding areas. We have always provided above and beyond what is required for our sterilisation procedures and are confident that we have protected our patients at all times. If this advice becomes procedure then the costs will increase for this work. I have resisted making this decision on this basis but will wait eagerly for the next response to today’s suggestion. In the meantime if any patient is concerned and wishes to purchase a set of instruments that are to be used on them only then we will happily do this for them. The instruments will be stored in sealed packets for their use and can be used as a maximum in 5 procedures (giving 2-5 root canal fillings per patient, which is hopefully more than enough).
If you want to read the full article by Barry Cockcroft, Chief Dental Officer you can find it on www.dh.gov.uk
April 18, 2007 at 10:36 pm by Ian Kerr
Filed under General
The entire team at StoneRock has just complete 3 days of extremely intensive training in “comprehensive care” and I believe it has shown us all exactly how we want to care for all of our patients from now on.
Comprehensive care is a way of viewing every aspect of the health of the mouth (the teeth and any restorations, the gums, how the teeth meet and the appearance of the smile) and viewing that as an integral part of the patients general health and well being of that person.
We now know that gum disease, in particular, can impact on and be related to a number of systemic (general health) conditions such as heart disease, diabetes and stroke. Problems with how the teeth meet and the forces put upon them by clenching and grinding can lead to head and neck pain, jaw joint discomfort and worn and damaged teeth all of which can be prevented by appropriate care. Patients who are dissatisfied with the condition and appearance of the their smile can lack confidence and be held back socially and professionally by this. A comprehensive approach to their condition would look at this and would offer ways of correcting it as part of an overall plan to improve the health and stability of their mouth.
At StoneRock we are making a lifelong commitment to continuing development and improvement of the services that we provide. We are all very excited about this new stage and we are looking to encourage all of our patients to make a lifelong commitment to maintaining complete oral health. If you would like to know more about the services that we offer then please call the surgery on 01580 752202 and we will be happy to help.
April 18, 2007 at 10:21 pm by Ian Kerr
Filed under Behind the Headlines
When I qualified from Newcastle Dental School in 1989 I worked for 9 months in a very busy NHS practice in a very depressed area of the North East. It was my first job after qualification and “wet behind the ears” doesn’t come close to describing my clinical experience. One thing that was never a concern for me, however, was having to treat children, as decay was a rarity in all that I saw. The area in which I worked had been receiving fluoridated water for decades and it had more than halved the decay rates in children.
I left the North East and went to work in the Caribbean for 4 years (not a difficult choice to make, really) and worked in what was effectively a third world community without access to government funded dental health. Although I did see occasional cases of rampant decay in some children who had access to high sugar snacks, for the most part the children’s teeth were in excellent condition.
It was only when I returned to the UK and moved to the South East of England that I really came across daily levels of advanced decay in children, especially the under 10s. I have worked in several affluent areas of Kent and East Sussex, including Bromley, Tunbridge Wells and Wadhurst and have found increasing levels of decay in all of these areas in the past 10 years. According to the article in the News section of The Sunday Times, April 15th I am not alone in these observations. According to recent figures from a study by the British Association for the Study of Community Dentistry, which looked at 240,000 five to six year olds more than a third of them have decayed or missing teeth. This incredibly high figure has been linked to a greater prevalence of high sugar snacks and drinks and a greater exposure to these products in the form of advertising from a far younger age. It is also no coincidence that the number of children registered with a dentist has dropped over the past few years and is set to carry on doing so. As part of the same study 600 dentists were interviewed and 85% believed that the new dental contract had not improved access to NHS care and 93% believed that the new contract did not encourage better prevention of tooth decay.
Like I say, a depressing statistic: decay in children is on the increase whilst the access to and quality of the care available has not improved.
When I set StoneRock Dental Care up I asked for a NHS contract to provide care for children this way. My request was rejected on the grounds that there was not enough money for the existing dental practices in the area so the PCT (the group that funds public health in each area) were not prepared to develop any new services. This forced us to move outside of the NHS completely and we now provide children’s dentistry on a private only basis. What this has allowed us to do is invest in far greater technology to improve the quality of our care and provide much more time for each appointment so that the treatment is not rushed or compromised.
Providing private dental care for children was a big step for us but it has allowed us to provide the level of care that I would expect for my two kids and that really makes me feel good about what I do. If you would like to know more about the services that we provide for children and the maintenance schemes that we run for them the please contact the surgery and we will be happy to help you.
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