The Premier Symposium is a prestigious annual event held in London in early December and sponsored by Dental Protection and shulke. In spite of dreadful weather there was a near capacity audience and their efforts to attend were well justified by the high calibre of speakers.
Kevin Lewis, dental director of Dental Protection, hosted the day and introduced the first speaker, Prof Richard Palmer, whose topic was implants. Seven per cent (and growing) of all claims at DPL now involve implants. Prof Palmer looked at the surgical and biological complications. The success of the former are dependent on bone quality, implant length and width, and the torque used. Surgical damage could be caused to local nerves, adjacent teeth, poor location and the angle of the implant. Biological problems of the implants included risk factors such as periodontitis and smoking, loss of marginal bone and fracture. Prostheses could be lost through poor positioning, poor aesthetics or wear fracture. The list of risk factors also included bacteria, the implant surface, genetic factors, systemic disease, soft tissue recession, anatomical problems and parafunction. This was a powerful presentation representing recent cases at DPL – which should be noted by all those clinicians working with implants. We were left with the message to avoid smokers, periodontitis patients and certainly to avoid bruxers and use always strong components.
Nerve injuries, their cause and management, was the remit of Prof Tara Renton. She is a world leader in nerve damage and its management and her description of the pain, discomfort, social problems and general unhappiness of these patients was instantly sobering. A wide range of causes of oral nerve damage was covered. When giving local anaesthetic don't give multiple IDBs. When extracting impacted third molars Tara advises caution and, if it looks difficult, refer. For surgical removal she uses her own 'episiotomy' technique and never removes bone distal to the tooth – section instead. Endodontics can cause problems with the material entering the ID canal. Always check after the LA has worn off – if there is any sign of damage either remove the filling, or the tooth, or refer. Implants are another potential problem area. In all cases as soon as a patient reports numbness, altered sensation or pain they must be referred. A delay of three months means there is nothing that can be done to reverse the situation. All that is left is counselling. Fifty per cent of chronic pain sufferers are depressed and intervention surgery is only appropriate in 15 per cent of cases. For advice and help for patients go to www.OralNerveInjuries.com which is Tara's website. This was an extremely informative lecture - every dentist should have to listen to it.
Given the subject of HTM 01 05 Paul Jenkins made this more interesting than could be thought possible. In listing the 19 essential items which are Best Practice Paul highlighted some of the absurdities.
Storage of sterile packed instruments is limited to 21 days in England (28 in Wales) but in his operating theatres instruments can be there for one year before resterilisation. In some practices it has been recognised that there is limited space for recommended sinks so 'bowls' are acceptable! He felt that the British Dental Association A12 advice sheet would never ever say anything different to HTM 01 05. Paul also discussed washer/disinfectors and reported the NHS supply chain has produced a comprehensive list of washer/disinfectors – just phone 01924 328507 for advice.
He noted that the first official meeting of the Association for Equipment Safety and Infection Control in dentistry (www.aesic.eu) had taken place. The future of all infection control and hygiene is in their hands – access their website – see their thinking! Finally Paul cheered us up with some new initials to master. There is a possibility that HTM 01 05 will be changed to CFPPs (Choice Framework for Policy and Procedure) and we will be talking about CFPP-01-05. As he pointed out (with audible groans from the audience) nothing stands still. This was a very useful and timely presentation.
Prof Trevor Burke, chairman of DPL then made presentations to DCP undergraduates and VT winners in recognition of their written submissions which had been of impressively high standards.
The afternoon session can be a difficult slot to maintain audience interest. This was solved by Paul Redmond's Talkin' 'bout my generation. This hilarious theatrical event covered the generation gap between the baby boomers (45 – 61) and the X (62-72) and Y (78-99) generations. The world has changed politically, economically, socially, technologically and demographically. We are now in the midst of a fabulous array of unprecedented and utterly mind boggling stimuli and there is now a generation that says 'whatever'! There are 2.4m undergraduates fighting for the 16,288 graduate jobs presently advertised. An Oxbridge graduate has a 1:8 chance of an interview whilst redbrick and the newer university graduate has only a 1:235 chance. The sharp intake of breath from the audience was the last thing heard as the music started and the images associated with the generations came fast and funny but with strong messages. The baby boomers are idealistic, visionary, optimistic, family-orientated, property-owning people – able to retire at 60. They are trying to work with Y colleagues who are reactive, complex, cynical, with reduced social capital, middle managers with lack of career clarity and 'digital immigrants'. Add to that trying to understand generation Y who are connected 24/7, civic minded, self confident, opinionated, bored by routine and are lifestyle orientated but digitally mature and you can see why the generations have problems interacting. That was a fantastic hour that just whizzed by.
The final presentation of the day was from Peter Briggs who covered the risks and responsibilities in periodontal care. This was a witty and well-directed lecture on the pitfalls of supervising neglected periodontal disease. Allegations from patients of undiagnosed and untreated periodontal disease are on the increase in both frequency and severity. The main thrust of Peter's lecture was to pass the responsibility of the maintenance of oral hygiene back to the patient. This lecture was peppered with wonderful examples of spelling mistakes in referral letters. We often blame other colleagues for periodontal problems when the patient needs to be guided into good oral hygiene as we can't be there each day to clean their teeth. 'Briggsy's Rules' are about motivation, nurture and support. Identify and record modifiable and non-modifiable risk factors. Help the patient control modifiable risks such as poor OH, plaque inducing factors, drug induced gingival hyperplasia, smoking (offer smoking cessation) and alcohol. Record keeping is essential. Record local and general risk factors, do not lose conventional or digital notes and X-rays, warn of recession, record compliance, OH/progress/DNAs and the need for specialist referral.
This excellent lecture rounded off a thoroughly thought provoking day. In parts both entertaining and challenging, it reflected some of the recent very expensive cases that DPL has had to settle for patients. If every dentist took these tips on board wouldn't life be easy?