Whilst most of you will be mature enough to have missed out on the whole 'txt spk' phenomenon, it seems there is little escape from acronyms in dentistry, even for those not in the NHS. The GDC are demanding CPD from you and your DCPs, what with that and CQC (something many consider OTT) it can be tough. But it's not all bad news for GDPs as there is the fun of exhibitions, those of the BDTA, BDA, and of course, the IDS for those who don't mind leaving the UK. However the option of doing sweet FA and spending leisure time flicking between BBC and ITV on the HD TV is long gone.
So when invited to the Denplan 'MI Roadshow' in St Albans there was a part of me that drew back in horror. Was nothing safe from abbreviation? Would the next generation only be able to speak in initials? My indignation was caused primarily due to the fact I didn't know what MI actually stood for.
Motorway Involvement
The events are taking place throughout Britain from Edinburgh to Southampton; the one I attended was at Sopwell House in St Albans, the former country home of Lord Mountbatten, a venue which managed to give the impression of being out in the country, despite being little more than a stone's throw away from the M25. The journey did involve hitting the dreaded motorway, but the bacon and egg rolls to greet delegates on arrival more than made up for any stresses and strains incurred on the journey.
Attendees were asked to arrive for 8.30am, so the event could begin at 9am. For a day not actually at work, this may have seemed like an early start but it was essential to begin on time as there was a lot to fit in to the one day.
Roger Matthews, Denplan's chief dental officer began the proceedings by welcoming everybody, before introducing the first speaker, Avi Banerjee.
Minimal Intervention
Avi is a world renowned speaker and senior lecturer at King's College London Dental Institute at Guy's hospital. Avi addressed the question that first struck me, what did MI stand for? Minimal intervention or minimum intervention? There is a difference, and indeed there is a debate within the industry as to which was the correct term to use or whether they are interchangeable. One is the oral physician's biological approach, the other the oral surgeon's mechanistic approach; Avi explained though that what MI really meant was a modern holistic approach to dentistry and caries management, looking at a long term approach to a patient's oral health. He then went on to look at the evidence base behind the theory.
Identify, prevent and restore were the three sections he highlighted in MI dentistry. When viewing a patient a dentist will identify and make a diagnosis, establishing patient susceptibility. Then comes prevention, and lastly, if restorations are needed it is important they are done in the least invasive way. All of these three stages are pinned into place by patient recall. Recalling patients is essential for the management of caries, and the keystone to any attempt at minimally invasive dentistry. Because of this payment plans are a great help as they promote regular attendance, but Avi believed MI dentistry could be achieved on the NHS.
Motivation Issue
With a litigious culture growing in dentistry Avi reiterated the importance of recording each process, especially when making a diagnosis. This reinforced Roger's introductory words when he had reminded delegates that though they can help with caries management, ultimately it is the patients that have to take responsibility.
Getting patients involved is key. Showing them the pictures of their mouths, highlighting the issues, and giving them an oral health plan was important.
The team approach was something Avi extolled the virtue of, and he explained how MI was not just something for the dentist to do when the patient sat at the chair, but was the whole approach to dentistry a practice should adopt, from the dental nurses all the way through to the reception team.
One tactic Avi explained was to get the receptionist to follow up an appointment with a phone call a few weeks later, to check how the patient was getting on, for example, asking the patient if they were able to get hold of the correct toothpaste, or had encountered any problems with interdental cleaning. Often patients will leave the advice and good intentions with them when they leave the practice door, so a follow up is a good way to re-focus motivation.
Managing It
The second speaker of the day was Louis Mackenzie, from Birmingham Dental School. Louis looked at what MI would mean in practice. Put simply he believed MI was the best advert for dentistry there was.
Avi had explained the importance of treating 'the patient and not the radiograph' and Louis continued in the same vein by explaining radiographs are a dynamic diagnostic process. Comparing similar shots over a period of months or years enables a clinician to see whether or not the problem is getting worse or remaining stable. Not all caries are active and as such do not necessarily need operative treatment. The point Louis stressed throughout was that the treatment should not be worse than the disease.
Vesna Zivojinovic-Toumba, an Oral-B representative, followed Louis to explain how to 'Continue the care that starts in your chair'.
Maximum Involvement
After lunch came the 'hands on' part of the day, with delegates breaking up into four workshop groups. Each group was given half an hour at a station. The first I visited was Oral B's, where Vesna (I won't be brave enough to try and spell her surname again) was on hand to discuss breakthrough technologies in action, whilst showing off some dental plaque imaging software.
The second was Velopex's, where delegates were shown the benefits airbrasion has in MI dentistry. Attendees were able to test out the capabilities of the Aquacut Quattro for themselves and consider the benefits of the product to a practice and patients.
GC had the third workshop and its representatives were able to display a range of materials and products enhancing a dentist's diagnostic capabilities whilst also aiming to improve patient motivation in oral health.
Roger had made it clear at the start of the day that the event was not a trade exhibition, and the workshops were a good opportunity for delegates to find out in more detail about some of the technology and materials suitable for MI dentistry without being given a glorified sales pitch.
The final workshop was perhaps the least formal, as Avi and Louis led a discussion group to go over any points that had arisen from the day and needed clarification. The small group size encouraged everyone to talk and engage, meaning the discussion was both frank and meaningful.
Mindset Innovation
After a final coffee break the group reassembled and Roger took the floor discussing how to make MI dentistry pay in practice. It is clear that while the technology is improving, along with the materials used, the biggest change needed may well be the mentality of the dentist, with an understanding of dentistry shifted to a holistic approach to oral health.
This may seem quite different to what was taught to several dentists, but that doesn't mean the change will not take place. Roger showed it could make financial sense, and of course it has a positive impact on the oral health of patients, so it seems a perfect fit. Attitudes will evolve in dentistry and MI will undoubtedly increase in importance. Who knows, in 10 years people may look back and laugh at how dentistry used to be taught... although by then no one will actually do that of course, they'll just lol!