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Archive for Behind the Headlines

Private dentists “putting patients at risk”

The MP Chris Bryant disgraced himself today with a a wholly unsubstantiated piece or rhetoric when he asked the House to look into private dentistry -Will the Secretary of State add laser surgery clinics to his list, and also private dentists, many of which are encouraging patients to undergo operations they certainly do not need?’

This sort of statement may seem relatively harmless but it is actually an alarming abuse of his power. To make the accusation “encouraging patients to undergo operations they certainly do not need?” without offering any proof or a an opportunity to reply is little better than school ground name calling but potentially much more damaging. As a profession dentistry has a constant up hill struggle to encourage patients to overcome their genuine, fears and concerns about treatment without having the likes of Mr Bryant trying to further his career by throwing cheap jibes like this around

 

It is not for me to say what each and every member of the dental profession does or how they discuss the various treatment options with their patients but I would say that every single patient should feel confident to sit and talk with their dentist about their care and not feel pressured into taking on any treatment without first having had time to consider all of their options. It is wrong of dentists to project their treatment preferences on patients without consideration of the patient’s wishes and it is equally wrong of patients to abdicate all responsibility and decision making to the dentist and then complain that they “did not get what they wanted”.

There is undoubtedly an urgent need for an honest discussion about the future of dentistry, one that looks at “Holy Cows” such as the NHS and asks is it genuinely giving patients value for money and quality care. One that also looks at the role of the newly formed CQC to see if it can hope to live up to its remit to police the entire UK medical, dental and associated health care professionals by the end of 2013/14. This discussion should look at ways of assessing dentists competence to practice, their levels of continuing professional development, their working practices and much more but it should not involve uninformed, self aggrandising MPs taking cheap shots safe in the knowledge they will not have to defend their claims.

Oh and by the way, if you were wondering if the MP Chris  Bryant was involved in the expenses scandal- yes, yes he was http://www.telegraph.co.uk/news/5334791/Chris-Bryant-changed-second-home-twice-to-claim-20000-MPs-expenses.html

There is a scandal brewing, but it is not this one Mathew Parris

Mathew Parris is usually some one you can rely on for sensible comment but on this occasion (Saturday’s edition of The Times 16.07.2011) he is guilty of rehashing a disappointingly familiar misconception of dentistry. In his article “The Next 20 Scandals” Mathew states -

Dentistry and the NHS are a murky business where the service and private practice appear to live in a baffling symbiosis on which dentists thrive and for which patients, both paying and would-be NHS users, choose between the queue and financial ruin. Dentistry should be like car repair: it’s only teeth, for God’s sake. Where’s the market?

This statements contains all you need to know about a lot of peoples feelings about dentists and dentistry but it really does not stand any degree of scrutiny.

1) “a baffling symbiosis”. The symbiosis between private and NHS is not in the least bit baffling. You either pay privately or you pay for NHS (unless you are exempt NHS charges). This is hardly baffling. Dentists are required to explain their fees before treatment begins and must indicate if work is being provided on a private or NHS basis. If they fail to do this it is not a fault with the system, more a fault with the dentist.

2)”On which dentists thrive“. Maybe its me being paranoid but the implication seems to be that dentists thriving is a bad thing. If it is a bad thing then lets look at a world where dentists don’t thrive- a world where they employ less people, generate less taxable revenue, invest less in training and technology, reduce the time and money invested in improving services for patients, spend less time on treatments to help them boost falling revenues, take fewer risks in expanding their businesses, leave the profession for alternative employment, give less freely of the time for teaching of students and their peers- is this really a better world?

3)”Choose between the queue and financial ruin“- really is that the only two choices out there. Are none of us offering staged treatment plans, payment options, prevention advice to lower disease activity, mixed practices to try and offer all service levels?

4) “dentistry should be like car repair” – what we after here- grubby surroundings, wildly unrealistic estimates, unlicensed premises with no regulator bodies, no compulsory post graduate training (no undergraduate training for that matter)? Would our patients be happy with no comfortable relaxing waiting areas, no highly trained and efficient reception teams, written treatment plans and estimates derived from careful discussion of their needs? Would they really prefer us to take one look inside their mouths, do the ubiquitous sharp intake of breath and say the immortal words “it’s gonna cost ya”?

5) “it’s only teeth for gods sake” Perhaps the most telling comment of the lot and certainly the saddest. How an intelligent and educated man such as Mathew Parris can give voice to this view is beyond me. They are only teeth until they go wrong- then they are a source of pain, infection (potentially fatal), misery, social embarrassment, childhood teasing and bullying. Oral health and general health are intimately linked and the treatments are carried on people who often have complex medical and psychological concerns that need our expertise and understanding.  We help people with these problems on a daily basis and are happy to do it.  No one with tooth ache will tell you they are just teeth; no one who struggles socially and is desperately unhappy with their smile will say they are only teeth; no one who’s child has fallen of a bike and smashed their front teeth will say-don’t worry they’re only teeth.

6) “where’s the market”- Our market is the entire population who need our help, advice, treatment and care throughout their entire lives.

The saddest thing of all is that Mathew is right, there is a scandal coming but it is not the one he alludes to. You can take your pick from the effects of an ever increasing burden from unnecessary and restrictive bureaucracy (do MPs really need to discuss whether people should be allowed to have whiter teeth) , the continuing chaos in the General Dental Council (the fitness to practice panels struggling to cope) , the massive cuts in hospital based dentistry( multiple unit closures and reductions in consultant posts in London alone), the spiraling costs of providing care, the exponential increase in litigation fueled by “no win;no fee” lawyers……etc. I doubt these will be given much voice in the press as these require a more sympathetic view of dentists and their teams but these are the ones that will really shape the future for dentists and their patients. Lets start discussing these now, before it’s too late.

Dispatches – stating the obvious

Channel 4s “documentary” program endeavors to go undercover to expose wrong doing in various institutions and highlight the inequalities in systems throughout the UK. As with most of these types of programs it starts with an agenda to show the bad side of a situation so feels no need to balance its presentation.  The recent program on NHS dentistry stuck to form but did not really show anything new and actually made a stronger case for blaming the NHS funding system rather than the individual dentists.

It is always going to be easy to find examples of bad dentists doing bad dentistry because, sadly, there are plenty of them out there. Highlighting these individuals does not, however, give any insight into the workings of the rest of the profession. It was not coincidence that root canal fillings were picked on as an example of “gaming”. I made my predictions several years ago about what would happen to NHS root fillings and sadly they have been proved to be correct. If you pay a dentist £47 for the treatment but expect them to dispose of up to £45 worth of instruments each time it cannot come as a huge surprise that they are reluctant to provide this work. The government will not spend more money on this and it is an absolute inevitability that NHS funding for dentistry will be cut over the next 2-3 years. This situation will worsen and blaming dentists for being greedy is not the answer. If a dentist has to fund the setting up of their practice through bank loans often secured against their houses and then has to pay for all of the staffing costs and equipment they are going to need to make a profit or they will go bust. Relying on the “missionary spirit” of dentists to provide work consistently at a loss is wildly optimisitc but it is, in effect, what the government is doing.

As ever the best pathway to receiving good dentistry is to find a dentist who you like and trust and engage in an open and honest conversation about what work is required, what the alternative options (along with any pros and cons) and what the costs will be. Any dentist not prepared to have this conversation (and put it in writing for you) is not worth spending time with.

Another fine mess the government have got us into

Recent press articles may have been suggesting that tooth whitening is to be banned in the UK. Fortunately this is not currently the case but their is serious cause for concern that the department of trade and industry may be about to stick it’s oar into the debate by instructing leading dental suppliers to stop supplying it. The whitening industry in the UK is a multi million pound business and to  close it down would lead to major job losses in the dental supply industry and would deny patients a safe and easy treatment that can boost their sense of well being and happiness.

This current lunacy stems from a case involving the mistaken prescription of a higher dose in surgery gel for use at home by a patient. The dentist in question made a mistake and no one is denying this; the problem has however been leapt upon by the DTI who have gone after the dental supplier rather than the dentist to try and shut down the use of whitening products in the UK. This “battle” has been going on for many years and stems from a disagreement over whether whitening gels are part of a cosmetic process (which cannot contain >0.1% hydrogen peroxide) or a medical product which can. Clearly the dental profession feels that it is a medical device and exempt from these restrictions but for reasons unknown to any but a few in the higher levels of power the UK government feels it is a cosmetic product. (My oversuspicious mind has always felt that the government has a vested interest in it being a cosmetic product so it will not have to supply it on the NHS but that is purely my opinion).

The stance at StoneRock remains the same. Whitening teeth using 10% -15%carbemide peroxide gel in specially fitted trays (so called vital night guard bleaching) is the quickest safest cheapest and least invasive way of enhancing your smile. To deny patients this option is unethical. All aesthetic procedures need to be viewed as purely elective (ie done at the patients request only). A thorough pre-whitening examination is required and full written warnings regarding sensitivity etc should always be given prior to treatment commencing.

Hopefully common sense will prevail but you never can tell when it comes to governments and health issues.

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