You must be doing something right when nearly 280 dentists and their teams give up a Saturday to go to a dental meeting. The recent symposium sponsored by Dental Protection Ltd and Shulke -was held at the Shaw Theatre, St Pancras, and well justified the time and effort put in to organising it. It was chaired by Kevin Lewis Dental Director of DPL
Professor John Gibson, from Glasgow discussed “When medicine meets dentistry”. This was extremely useful and full of updates for dental practitioners. Professor Gibson gave advice on patients with Staphylococcal mucositis (common in the elderly), as well as the diabetic immunocompromised denture wearer (check that it isn’t vitamin
B12 deficiency) and those who have severe heartburn and as such are more likely to develop squamous cell cancer. Chlorhexidine can cause anaphylactic reactions – so it is important not to irrigate open wounds with Chlorhexidine; warnings should be given to patients using it routinely as a mouthwash.
For medication-related osteonecrosis of the jaw (MRONJ) John advocates treating patients in dental practice but advocating good oral hygiene, educating the patient and obtaining consent – patients should always be warned of the potential side effects. Other subjects covered included sleep apnoea which causes dry mouth, and the oral contraceptive, there is no need to give extra instructions when giving antibiotics unless the patient experiences vomiting and diarrhoea.
John’s presentation was some start to the day! He was followed by Ken Hemmings, current president of the British Society for Restorative Dentistry, his presentation was titled “Wear today – gone tomorrow.”
Patients with evidence of extreme wear included farmers and swimmers. Other factors influencing tooth wear include Bulimia/GORD and chewing Vitamin C tablets and sand(PICA)! This was an inspirational presentation with impressive before and after case photographs. His messages are:
- select carefully; check for bruxers;
- use composite provisionals;
- mix composite with conventional restorations;
- consider using an overdenture, implants don’t last as well in tooth wear patients;
- zirconia is ill advised;
- carry out endodontics where you can in preference to implants; the more dentine that’s left - the better the bond;
- lower implants against an upper denture can last up to 30 years.
Infection control, a subject dear (in many ways!) to the hearts of dental practitioners, was given an update by Paul Jenkins, decontamination head at the new Bristol Hospital. His key messages were:
- we have to be safe; effective; caring; responsive and well-led; CQC reports will have a section for patients to sign up for ‘alerts’ – about your practice, and patients are also able to “share their experience” with others;
- we need to have KPIs in place for our decontamination procedures;
- Bag and moisten dirty instruments you can’t sterilise (Friday late evening comes to mind!) ready for the Monday morning procedure;
- storage in sterile pouches is now 12 months;
- there is an abolition of spray bottles;
- tracking traceability of instruments is not here yet but coming soon!
Paul advocated each practice has its own ‘decontamination technician’. Go to www.cityandguilds.com for more
information. This was a really useful presentation, it reassured my practice team that we are complying with ‘best
practice’ but to keep an eye on the CQC websites.
The afternoon was kicked off with a ‘Masterclass in Dental Indemnity’ provided by Dr Mark O’Brien who is International medical consultant to medical Protection Society. Mark explained that only one per cent of dental patients complain, and when they do the cause is mainly the attitude of the dentist. An error or mistake can lead to a complaint and/or a claim, but poor communication is a factor in precipitating a complaint. When it comes to communication how you say something is as important as what you say, and of course patient expectations need to be managed. Dentists should find out what patients hope a treatment will achieve and be realistic in terms of outcomes. Be clear, and connect with the patient. Listen to what they have to say (without interrupting), empathise with them – this reduces patient anxiety. Ask a patient what they want so you understand their expectations. Recall and check what they have told you, prove to them you have been listening.
This was all common sense but we all have to remember it for every patient - and that will reduce our chances of being sued.
The final talk in this fantastic day was Professor Callum Youngson, who has to be one of the most entertaining speakers in dentistry. His presentation was entitled “A bridge too far”. Photographs of historical road bridges that had failed was a great start. Poor foundations, maintenance and overstretched resources related to common failings of bridges in the mouth. Callum was thought provoking comparing what the GDC requires of dental schools and teaching compared to what will really be required to conserve and restore the dentate mouth in the future.
Complaints to the Office of the Independent Adjudicator from students are reducing whereas those to the GDC are rising – mainly about older dentists. Survival and reduced fracture of metalceramic bridges were significantly higher than all ceramic bridges. Evidence shows that one third of fixed partial dentures need replacement by 15 years. One survey showed survival to be 72 per cent at 10 years. In other words, don’t work outside your experience levels and when things do go wrong be prepared to make amends
It is impossible to list all the tips, advice and best practice gleaned from this symposium. But I would recommend everyone takes every opportunity to hear these knowledgeable and entertaining speakers. Congratulations must be
given to DPL and Shulke – they must be very proud to have put on such a day.