Archive for March, 2011
March 30, 2011 at 10:34 pm by Ian Kerr
Filed under Behind the Headlines
In light of my previous posting I am very pleased to see this action being taken by the GDC; there is clearly a strong case for protecting the public and this now sets a legal precedent that should make further prosecutions much simpler. As ever, if you are interested in any work such as whitening or other cosmetic procedures, talk to your dentist who should be able to advise you on the advantages and disadvantages of each technique and what improvements you are likely to see at the end of it. All cosmetic dentistry is entirely elective which means it is done purely at the choice of the patient; there is no clinical need to make teeth look whiter.
U.K. regulators tackle teeth whitening by nondentists
March 28, 2011 — Two cases involving nondentists performing teeth-whitening services without the proper credentials — one in the U.K., the other in New Zealand — have made headlines worldwide.
The U.K. General Dental Council (GDC) has successfully prosecuted a nonregistrant for performing tooth whitening, which the GDC regards as the practice of dentistry.
It was the first such case of its kind in the U.K., according to the GDC.
Paul William Hill of Warrington, director of PW Healthcare Consulting, pleaded guilty March 23 to four offenses, including practicing dentistry while not registered as a dentist or dental care professional between October 2, 2010, and March 11, 2011. Under the Dentists Act 1984, it is an offense for nonregistrants to practice dentistry.
Hill has been ordered to pay a total of £6,265 in fines and costs and PW Healthcare Consulting, which traded nationally as Style Smile Clinics, has been ordered to pay a total of £6,765 . The amounts include costs of £5,500 for the GDC.
The GDC launched its investigation last year after receiving hundreds of complaints from members of the public and dental professionals about teeth-whitening treatments being provided by individuals who are not registered dental professionals.
The GDC, which regulates all dental professionals in the U.K., began criminal proceedings under the Dentists Act 1984 on the grounds that teeth whitening may only lawfully be provided by those who are registered dental professionals.
Charges relating to two other people and one other company have been adjourned until 18 May.
“This case has significant implications for the dental profession and for public protection,” said Evlynne Gilvarry, chief executive and registrar of the GDC. “The GDC will now consider its position carefully with regards to the hundreds of other complaints about the illegal practice of dentistry that it has received. We are concerned about the risk to the public posed by such potentially hazardous treatment being provided by people without the training and qualifications necessary for registration as a dental professional.”
March 29, 2011 at 8:14 pm by Ian Kerr
Filed under General
Here is an interesting statistic provided by Dental Protection “On a purely statistical level UK dentists are at least twice as likely as their colleagues int eh USA and Australia (for example) to find themselves under some kind of challenge from their professional regulator, and they are several times more likely to do so than their colleagues in Europe”
This is a real concern to the profession and should be a concern to our patients, not because we are so bad but because the cost of regulation and scrutiny is increasing at an unparalleled and currently uncontrolled rate. The introduction of the CQC has more than doubled the cost faced by dentists this year and the wording from this organisation seems to imply that they are softening us up with a lower fee for the first year, with much worse to come.
The number of cases in the “Fitness to Practice” scheme run by the General Dental Council is higher than for any other country in the world and the number of days spent on formal hearings is now at a level that exists nowhere else in the world. The decision to forward a complaint from a patient on to an Investigating Committee is now made much more commonly, in part because of the very wide drafting and high level guidance provided by the GDC itself. Investigating Committees will have only one dentist (or dental care professional) and four other lay members, the chairman is always a lay person. They are currently faced with 25-30 cases a day giving them 15-20 minutes per case to decide the fate of the dental registrant. Given the enormous impact that these decisions can have on an individuals life – loss of the business, right to work, increased home stress etc one would have hoped for a more even handed approach. Are we really to believe that UK dentists are the worst in the world and therefore need more cases than the rest of the world or are we just being crushed by needless red tape and heavy handed bureaucracy?
The situation we are now facing in the UK with spiraling costs for regulation and scrutiny coupled with the inevitable rise in indemnity fees to pay for our protection from litigation cannot be seen as a good thing for patients. Ian Kerr’s Law of Unforeseen Consequences states that “legislation designed to protect innocent parties will inevitably lead to creating an equal level of harm to them in return“. Ultimately patients pay for these increasing costs through taxes and dental fees. There is no reason to believe that an exponential increase in costs will be matched with an exponential increase in protection from harm.
March 28, 2011 at 10:00 pm by Ian Kerr
Filed under Clinical Cases
This is a common dilemma for patients and dentists alike. When has a tooth had all the dentistry it can take and so should come out and when is it worth having one more go at restoring it. The answer is usually arrived at following a thorough examination and detailed discussion with tooth’s owner regarding all the possible treatment options along with a list of possible outcomes, relative costs and potential risks. It is beyond the scope of this blog to detail all the permutations of this sort of discussion but I will say that listening to a patients needs and wishes and helping them arrive at a decision that is right for them is a really important part of my job.
The decisions we make about teeth often take the form of a SHEEP score where we look at the amount of remaining tooth structure (S), the dental history of the tooth (H) the endodontic health of the tooth (E) the experience of the operator or the given procedure, including audited outcomes (E) and the periodontal (gum) health (P). In reality the process of decision making is not usually as structured as this but however we do it our decisions need to be supported by current evidence where ever possible. The case below shows a fairly typical re treatment of root canal filling that had failed to control the infection at the tips of the root (the dark area at the tip of the root in the first picture is an abscess that had been worsening and had begun to cause the patient pain). The tooth had been scheduled for extraction by one dentist but the patient was not keen and requested a second opinion. Current evidence seems to suggest that teeth that have been successfully treated with a root canal filling are just as likely to be present at 10 years as an implant retained crown (IRC). This is important because IRCs are a the biggest growth area in dentistry and are often seen as the solution to all ills. At StoneRock we are very proud of the implant work that we provide and we recognise that they are a valuable part of the dental “toolbox” but we also know that the natural tooth is still the best thing to do the job and we are keen to delay the loss of teeth for as long as possible. The decision to re treat the root canal filling was based on the fact that the original result was considered to be “sub-optimal” and the remaining tooth tissue was sufficient to warrant the effort. The gum health was not ideal but this responded to treatment as well and has since remained stable. The re treatment was provided by myself (Ian Kerr) as I have extensive experience in this field. The re treatment was successful as shown in the second picture taken 2 years later showing no shadow around the tip of the root, indicating that bone had returned to this area. The tooth is now present and symptom free almost five years later and is showing no signs of deterioration. The fact that this was achieved at less than the a third of the cost of an implant retained crown was certainly an added bonus for the patient!
When ever a decision is made to remove a tooth because “it cannot be treated” it is not unreasonable to ask “can it not be treated at all, or just not by you?” A tooth should never be removed simply because the dentist making the decision thinks the job is too hard for them. Every dentist has a duty of care to indicate when they feel a treatment is beyond their ability. There is no shame in this and I routinely refer to colleagues who are better skilled than me at various procedures; and on these occasions I always say “they are better, slicker and quicker than me- go and see them and you will get a better job then I can offer”.
Suboptimal root filling and abscess present
2 year review showing complete healing of abscess
StoneRock Dental Care supports the campaign to save teeth.
March 22, 2011 at 11:11 am by Ian Kerr
Filed under Behind the Headlines
Anyone who is interested in science and, perhaps more importantly, the dissemination of scientific knowledge through the press should, and probably does, read Ben Goldacre’s columns and book “Bad Medicine”. This column highlights a small but incredibly important point. Proper editorial scrutiny requires completely open and transparent referencing of all primary sources. Journalism, it would seem, does not. Headlines sell papers and are designed to grab our attention. This requires that they are short, punchy and eye grabbing. This does not lend itself to being accurate. The two most important words to look out for in headlines are “may” and “could”. “The sun could explode tomorrow; say scientists” is technically correct but absolutely meaningless.
When ever you read a health story in the papers we should always look for the primary source- if it not fully and accurately listed then ignore the story. If it is then go a read the source and see if you agree with the journalists interpretation. The days of believing something just because it was in the papers are long gone and the internet has given us an opportunity to scrutinies our “teachers” more than ever. Enjoy!