TRAINING Dental nurse - ESSENTIAL KNOWLEDGE FOR DENTAL PROFESSIONALS IN SCOTLAND FEBRUARY 2021 - Scottish Dental magazine
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E S S E N T I A L K N OW L E D G E F O R D E N TA L P R O F E S S I O N A L S I N S CO T L A N D
FEBRUARY 2021 RRP £5.50
Dental nurse
TRAINING
New ap p ro ache s to p re - regis tration sup p or t
p42FEBRUARY 2021
E N S U R E YO U CO N T I N U E TO R E C E I V E S COT T I S H D E N TA L M AG A Z I N E
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V i s i t W W W. S D M A G .C O. U K / E M A I L - S U B S C R I B E
05 Editorial
07 Insider
09 News
FEATURES
22 Shetland’s outstanding
oral health performance
26 Dundee finds ‘hope’
amidst challenge
22
32 Dental settings for public
health monitoring
36 Running for mental health
38 Scottish Orthodontics Conference
42 Pre-registration dental
nurse training
44 Spotlight: Tariq Bashir
MANAGEMENT
45 Susie Anderson Sharkey
46
Alun K Rees
47
Richard Pearce
CLINICAL
50
Dentistry during COVID-19
PROFESSIONAL FOCUS
51
Advice, expertise and supplies
64 Dental Laboratories
69
Focus on Orthodontics
26
73
Rep Profiles
77
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MANAGING EDITOR ADVERTISING EDITORIAL BOARD © Connect Publications
David Cameron Ann Craib Tony Anderson Peter Ommer (Scotland) Ltd
david@connectmedia.cc Tel: 0141 560 3021 Roger Currie Andrew Paterson The copyright in all articles
ann@connectmedia.cc Ulpee Darbar Professor J Mark Thomason published in Scottish Dental
EDITOR
Dr Michael Davidson Dr Donald J Thomson magazine is reserved, and
Will Peakin DESIGN
Toby Gillgrass Professor Angus Walls may not be reproduced
Tel: 0141 560 3019 Scott Anderson
Professor Mark Hector without permission. Neither
editor@sdmag.co.uk
SUBSCRIPTIONS Professor Richard Ibbetson the publishers nor the editor
Will Peakin Gordon Morson necessarily agree with views
Tel: 0141 560 3019 expressed in the magazine.
connectmedia.cc editor@sdmag.co.uk ISSN 2042-9762
February 2021 | 3Editor
Will Peakin editor@sdmag.co.uk
Follow Scottish Dental on Twitter at: @ScottishDental
Lockdown: an opportunity taken?
O
n 11 March last year, Scottish Dental magazine sat and take forward a new model of preventive oral health care for NHS
down with Tom Ferris, the Chief Dental Officer, patients”. The General Dental Service budget has been increased by
to hear from him an outline of the work being 0.6 per cent, or £2.4 million. A spokesperson for the British Dental
carried out to create a ‘new model of care’ for NHS Association (BDA) said: “This will go some way towards supporting
adult dentistry in Scotland; a model intended to the service in this tumultuous time; we are concerned that it does
fundamentally shift the focus from treatment of not go far enough.” The Scottish Dental Practice Committee (SDPC)
disease to prevention. A little over a week later, the has a working group collating views on a funding model to replace
UK went into lockdown, as COVID-19 took hold. In those early days, the Statement of Dental Remuneration; a “workable solution to be
many in the profession wondered whether they would still have a job presented to Scottish Government”.
or a business coming out of lockdown – let alone what kind of NHS care The BDA and SDPC have been told that they will be invited to
they might be contracted to provide in years to come. take part in discussions with the Scottish Government to consider
While NHS dentistry has since been remobilised, the capacity for a new funding model. Where this leaves the fledgling Scottish Dental
treating patients remains severely limited. The profession, like society Association (SDA) remains to be seen. It is conducting a survey via the
in general, has become more reconciled to being in this for the long Scottish Dental Network, a Facebook-based group.
haul. Alongside this acceptance, it is wondering exactly what kind Work on the new model of care comprises three streams: looking
of care it can provide long-term, and how – as a group of healthcare at the framework for an ‘oral health risk assessment and care pathway’,
providers – it will make ends meet. creating a ‘treatment toolbox’, and funding. Early adopter practices
Last month (28 January), the Scottish Government published its were envisaged to ‘go live’ from this autumn. It has been said that
Budget for 2021-22. It included a commitment to “provide £431 million lockdown has presented people with an opportunity to make changes
for general dental services [in 2021-22], helping to support their that everyday life had somehow prevented; the coming months will
recovery, accelerate the reform programme for NHS dental services reveal how those good intentions have fared.
February 2021 | 5Insider
Arthur Dent is a practising NHS dentist in Scotland
Got a comment or question for Arthur? Email arthurdent@sdmag.co.uk
Prepare to recover slowly
The drive in the profession to throw out the NHS payment system – can I suggest we put the brakes on that?
A
s I sat, pondering the announcement of a back to normal. Well, I know that’s not true; the first cut might not
second national lockdown in Scotland, be perfect but after a couple we’ll all be back in the usual pattern and
I felt void of emotion. At least this time the hair just keeps growing. It will be interesting to see how much
round we won’t have multiple changes of dentistry varies from that. There will inevitably be those who have
rules or guidance in a short period. We won’t been fine and will remain so. Equally, there will be those who stayed
have to create new operating procedures at home and have eaten and drunk their fill, with the associated
or re-train our staff, build screens or source dental fallout. It will probably inform the debate over recall periods
bucket-loads of PPE. This is something we have done before, very well, though.
something we were probably expecting post-Christmas anyway, I think the big battle will be how quickly we can get things under
new variant or not. Even in the first few months of COVID, there control. The longer our restricted practice carries on, the greater the
was an inevitability that the following winter would bring stress volume and complexity of need will be. In turn, the longer the waiting
to the NHS systems, regardless of the uncertain outcome of times will be as we programme this work into our schedules. Some
SARS-CoV-2. practices may choose to work from a zero point with examinations
Dentistry should remain unaffected, as we have reached a and others may have lists of postponed treatment plans.
static level of guidance regardless of the effects on the world Whichever method, the order books will get longer and longer.
around us. This point, it could be argued, should have been This creates clinical and financial problems. Clinically, if people
reached a few days or weeks into the first lockdown. However, have to wait longer for treatment, that treatment changes and
I am not myopic; I recognise the enormous struggles the becomes more complex; fillings become RCTs, RCTs become
profession faced with the uncertainty of transmission and the extractions requiring dentures, bridges or implants. People also
lack of evidence which resulted in the cautious approach taken. return for emergencies in between appointments because temporary
We are in a different place now. Our systems protect us from dressings fail; we are probably all seeing that just now. From the
patients with COVID. We just need to maintain high levels of business perspective, cash flow gets stretched, especially if we wait
control to avoid inter-staff transmission. for the end of plans to submit claims and get paid. This can put
We have adapted to the vastly different professional and enormous pressure on businesses at a time when many are teetering
community landscape we find ourselves in. Humans adapt, on the brink.
dentists adapt. Even if someone rips up the rule book, we will I’m trying to look forward, yet I only see greater travails, not great
write a new one. However, let’s ask ourselves a question; what times. In the meantime, I pray for us to be used in the vaccination
are we doing differently? Our processes have altered a little; PPE programme that will (hopefully) set us free. I hope that it is well
is the biggest shift. Our control of people entering our buildings organised and voluminous in both its administration and uptake.
is quite high at the moment when there was virtually none I hope that dentists get to help out and avoid further burden on our
before. We have probably changed the material we use to clean stretched healthcare system. However, whilst this last year has been
slightly. But what else has changed? We still drill and fill, access tough for most; I see 2021 as a far tougher prospect for dentistry. I
pulp chambers and make dentures. I grant you, in nothing like fear it will be several years before our patients get back to the levels
the normal numbers, but the processes are the same. We have of clinical consistency that we were at just a year ago. Dentistry, and
not had to change the way we perform dentistry; just get used to healthcare in general, is in for a bumpy few years.
doing it with a couple more layers of plastic in the way. So, the thoughts for the year: use our services to accelerate the
That said, there seems to be a drive in the profession to throw vaccination process; prepare our recovery and think hard about the
out the NHS payment system. Can I suggest we put the brakes level of work we are prepared to endure and for how long; get fit
on that? We have been supported (to varying degrees, according enough to cope with longer hours and harder work than we have
to NHS commitment); as has the country by the Job Retention done before. Be prepared to recover slowly; ‘Long-COVID’ is likely
Scheme and Self-Employment Income Support Scheme. We can to affect dentistry too.
all see how expensive that process has been, and we can imagine
how long it’s going to take to pay for it. I cannot see the benefit in
trying to renegotiate a contract at a time when the Government,
(UK or devolved or independent Scottish), has no money and
will be trying to cut left, right and centre. Now isn’t the time
to ask for more money or create an arrangement in which we
receive less.
I also think we’re going to be a bit busy (understatement of the
millennium). I think there’s going to be a huge backlog of work
THE BIG BATTLE WILL BE HOW QUICKLY
which will be more complex and time consuming than normal.
I don’t think that we are like a hairdresser; after one cut, we are WE CAN GET THINGS UNDER CONTROL”
February 2021 | 78 | Scottish Dental Magazine
NEWS
Guidance
updated, but
‘unchanged’
THE Scottish Dental Clinical
Effectiveness Programme
(SDCEP) has issued an update
to its Rapid Review of the
Mitigation of Aerosol Generating
Procedures in Dentistry within
The pods at Dundee a new appendix and as a
Dental Research
standalone document1.
Hospital and School
SDCEP published its review in
September last year and it was
noted that it was a ‘living
Dental hospital document’ and that the working
group would continue to assess
emerging evidence to maintain
installs pods for AGPs its currency in the following
months. The working group
met again on 13 January this year.
New members present included
Using standalone negative pressure isolation can the Chair of the SAGE
drastically reduce fallow time between patients Environment and Modelling
Group, who is an expert in
healthcare ventilation, and
SPECIAL pods are being installed at NHS, the firm has moved into the health additional representatives from
Dundee Dental Research Hospital and sector and is installing its new range the National Physical Laboratory.
School, allowing aerosol generating of products in hospitals in Dundee and The four-nation working group
procedures (AGPs) to be undertaken across the UK. The units are made in considered the implications of the
safely in otherwise open clinics. Dundee using locally sourced materials, substantial increase in prevalence
Twenty SafeClinic pods, made by Starn including flame-retardant PVC made by of COVID-19 infections in recent
Group, the Dundee-based energy services Angus firm Montrose Rope and Sail. months, the emergence of more
company specialising in hazardous James Downie, a project manager at transmissible variants of
working environments, are in the process Starn, told the Dundee Courier: “The SARS-CoV-2, no reports of
of being set up after £248,000 in funding Safehouse habitats we provide to the transmission associated with
from NHS Tayside was secured by the energy sector are used for welding dental care and the greater
hospital and school management. activities offshore and we have inline availability of testing and the
A spokesperson told Scottish Dental gas monitoring systems, so the air vaccination programme that has
magazine: “Dundee Dental Research that’s fed into the habitat is monitored recently commenced.
Hospital and School is in the process of continuously. We create an overpressure However, the working group
having 20 SafeClinic pods installed to in the habitat where hot work or welding agreed that at present, despite
allow AGPs to be undertaken in a safe is taking place, and this pushes any these developments, the agreed
environment on open clinics. Each pod hydrocarbons away from the ignition positions and other conclusions
has a metal frame with flame-retardant source, which protects the person within the Rapid Review remain
PVC walls and ceiling and an airlock door, working within them. unchanged. The latest standard
converting the dental unit into a Class N “It also keeps the air free from operating procedures2 are
negative pressure isolation room. toxic and flammable gases, so if any therefore unchanged and the
“Each unit takes around eight hours hydrocarbons are detected in the clean dental IPC guidance remains the
to install and is compliant with NHS air, the sensor closes the damper and benchmark for safe practice and
guidelines, WHO guidelines and hospital maintains the integrity of the habitat. We quality care.
design and installation standards with a harnessed this technology and adapted The working group was keen
key aspect being that the air changes per it to provide safe environments for to re-emphasise the importance
hour can be varied from a minimum of 12 healthcare staff and patients.” of staff and patients continuing
per hour, which drastically cuts the fallow Work on novel ways of allowing dental to adhere to the precautions
time between patients. practice to continue during the pandemic which are specified in current
“Dr Brian Stevenson, Acting Clinical is increasing. Last month, researchers national guidance.
Director, and Joanne Cowburgh, Clinical at New York’s Cornell University
Care Group Manager, secured funding for published proposals for a helmet “to 1
www.sdcep.org.uk/wp-content/
this project from NHS Tayside in recent contain pathogen-bearing droplets in uploads/2021/01/SDCEP-
months to allow AGPs to continue during dental and otolaryngologic outpatient Mitigation-of-AGPs-in-Dentistry-
the COVID pandemic.” interventions”1. Update-25-Jan-2021.pdf
Starn Group makes a range of 2
www.bda.org/advice/Coronavirus/
equipment to deliver safe working Pages/faqs.aspx#latest
environments in traditionally hazardous 1
https://aip.scitation.org/
areas. Working in collaboration with the doi/10.1063/5.0036749
February 2021 | 9NEWS
Streamline vaccinator
recruitment, boards told
Government steps in after dentists tell of bureaucracy in the way of their involvement in programme
out of the vaccination programme should
Cabinet Secretary
Jeane Freeman
not be undermined by the number of
vaccinators available to deliver the jabs.
The UK’s Health Secretary has committed to
reduce the bureaucracy faced by vaccinators
and we urge the Scottish Government to
do likewise.”
Freeman responded by saying that she
was sorry to read of his concerns. She
added: “We recognise the important role
that dentists across Scotland can play
in delivering vaccinations and we are
committed to utilising your members
as the programme progresses.”
The Cabinet Secretary said that officials
had now written to health boards requesting
that steps be taken to ensure the process
for contractors to participate “is as simple
HEALTH boards have been instructed unnecessary elements and obstacles I as possible”.
to take steps to ‘diversify’ the COVID-19 faced”. He said: “As experienced medical Health boards have been told to register,
vaccination workforce, including reducing practitioners, dentists are fully capable of within their staff bank, all independent
the amount of bureaucracy facing dentists delivering vaccines and while I acknowledge contractors – dentists and optometrists –
applying to join. that some training is required, especially within their areas who want to take part.
It follows concerns raised by David as the vaccines are new, the current In a letter, officials at the Scottish
McColl, Chair of the Scottish Dental training programme is overly complicated Government’s Health Workforce
Practice Committee, in a letter to Jeane and bureaucratic.” Directorate laid out a series of steps to
Freeman, the Cabinet Secretary for McColl added: “While there may be some streamline the process. They were described
Health and Sport. He set out his personal factors limiting the vaccination of people in by an observer as “clear, direct instructions
experience of the training “including the Scotland, such as vaccine supplies, the roll for boards, and not [just] guidance”.
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10 | Scottish Dental MagazineFebruary 2021 | 11
NEWS
A clear vision of
oral health workforce to adapt and remain
equipped to deliver consistent care.
“Vision 2030 outlines the ways in which
we can integrate our profession within
health for 2030
global development agendas, including the
UN Sustainable Development goals and
the implementation of universal health
coverage, that determine important health
Latest FDI report outlines key strategies to improve priorities,” said Professor David Williams,
FDI Vision 2030 Working Group co-chair.
oral healthcare worldwide over the next decade Professor Michael Glick, FDI Vision
2030 Working Group co-chair, added:
ORAL conditions such as tooth decay, “How can we anticipate transformational
gum disease, tooth loss and oral cancer are changes and trends in the global
the most widespread noncommunicable healthcare environment? How do we
diseases worldwide – impacting 3.5 billion seize opportunities to become productive
people – and have severe and significant members of healthcare teams delivering
health, societal and economic impacts. person-centered care? These are some of
The FDI World Dental Federation is the questions we strive to answer.”
campaigning for oral health professionals to Achieving optimal oral health for all
be actively included in all efforts to improve requires strong advocates, said the FDI.
health for all, so that population-level Through the steps laid out in Vision 2030,
prevention efforts are effective and those in the oral health profession will be well-
need receive quality care. equipped to argue for the better integration
Coinciding with the 148th session of improve oral health and reduce inequalities of oral health within overall health, it added.
the World Health Organization Executive over the next decade,” said the FDI. The authors of the Vision 2030 report, an
Board in January, where an oral health The report recommends strategies expert team of professionals from diverse
resolution was on the agenda for adoption by to address the oral disease burden that sectors within the healthcare community,
governments, FDI released its Vision 2030: communities can adapt to their own emphasised the need to engage with the
Delivering Optimal Oral Health for All1, “a needs and circumstances, enabling them public, as well as other stakeholders.
timely report that offers a comprehensive, to implement relevant solutions. It also
inter-disciplinary roadmap on how to impact considers how broad societal shifts, such 1
www.fdiworlddental.org/resources/toolkits/
health policies and tackle challenges to as ageing populations, will require the vision-2030-delivering-optimal-oral-health-for-all
New wellbeing resource
available to dental teams
LAUNCHED in January, the we recognise the importance of
Wellbeing Support for the mental health and wellbeing for
Dental Team guide has been our patients. We may not
created for all team members, always recognise or prioritise
including students and our own needs. Stress is
non-clinical roles. It outlines common and a key driver of
how to assess your own mental burnout and mental ill health.
health and wellbeing and “These problems can affect
provides resources for self-care, individuals at any stage of their
including support organisations. career. For a variety of reasons,
in February 2020, there has been a reluctance
stakeholders from dentistry among the profession to speak
and beyond came together to about and seek support for
discuss the wellbeing of personal problems. Wellbeing
dentists and their teams. Since Support for the Dental Team,
then a group of colleagues have offers simple and practical
been collaborating to bring steps to know where you can
together wellbeing resources in find the support you need.”
a single document.
A spokesperson said: “The www.supportfordentalteams.org
truth is, as dental professionals, to download your free copy.
12 | Scottish Dental MagazineFebruary 2021 | 13
NEWS
When time
is precious
Calls for guidance THE Planmeca Emerald™ S
digital intraoral scanner is a
on ventilation
smart choice.
Infection control is already
a big consideration for dental
surgeries up and down the
Government admits action needed as NSS reassures on PPE country, but now with the
addition of fallow time in
between patients, and in an
effort to minimise time in the
THE new year brought a flurry of updates on surgery for both the patient and
key issues facing practices dealing with the First Minister pledged dental team, the Planmeca
pandemic, including PPE supply, funding to look into funding Emerald™ S scanner is the ideal
for dentists
for ventilation upgrades and guidance for choice to get things moving.
private practices. The whole process is clean
Regarding PPE, NHS National Services and simple. Digital scanning with
Scotland (NSS) has confirmed that the current a handheld device leaves you less
arrangements for supplying dental practices with open to cross infection –
a limited amount of free PPE will be extended compared to using materials
to the end of June. This should provide some with trays – as digital files of
reassurance about the continued supply of PPE the scan data can be sent direct
to practices. It comes after our extensive work to a lab. No visiting the practice
with NSS on PPE supplies for dentists, including to collect models and discuss
reported problems with local communication case plans.
and provision. It’s also fast. Scan a precise full
Regarding ventilation, the Scottish we can treat. At the very least, dentists need clear arch in two to five minutes (less
Government has admitted that ventilation guidance from the Scottish Government about for an experienced user) with a
is a fundamental part of the “COVID armoury” – what they should be doing about ventilation.” preheated tip that prevents
despite recent suggestions that the new The status of, and restrictions on, wholly fogging. Tips come in different
Health Minister is unwilling to set aside private practices were also confirmed. The sizes so smaller mouths or
dedicated funding. National Clinical Director and Chief Dental interproximal areas aren’t a
Funding of £450,000 made available by Officer issued a joint letter to confirm that problem, and they are fully
the Welsh Government help cut fallow time dentistry is essential healthcare and that autoclavable too, lasting up to
considerably and allowed more patients to be wholly independent or private practices can 300 cycles.
seen. Dentist leaders have called for similar deliver a comparable service to that available
leadership in Scotland. When asked about this through the NHS. Light, fast and accurate, visit
issue, First Minister Nicola Sturgeon said: “I’m This letter also clarified that cosmetic or www.planmeca.com to find
unsure if the funding arrangements around aesthetic procedures are not regarded as out more about the Planmeca
dentists are exactly the same in Scotland and essential and must not be provided by any Emerald S, or call 0800 5200 330
Wales but we will look into it.” practice in level four areas. We had received
David McColl, chair of our Scottish Dental queries from members about an apparent
Practice Committee, has made its position clear: contradiction between what could be provided
“Dental practices still face tight restrictions that under private and NHS dentistry, and this letter
have radically reduced the number of patients should help to clarify the issue.
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14 | Scottish Dental MagazineFebruary 2021 | 15
NEWS
Dentists honoured during
‘exceptionally tough year’
East of Scotland Branch member John Glen among those recognised
SIXTEEN individuals are being celebrated Roz McMullan guidance development groups for SIGN
in the latest round of the prestigious BDA calling for and SDCEP.
Honours and Awards, for their outstanding award • Gill Greenwood has been a member of the
nominations
achievements, their commitment to the BDA, BDA for over 30 years and was nominated for
and their work for the dental profession. her substantial contribution to dentistry and
Roz McMullan, chair of the BDA’s Honours the Community Dental Services (CDS) Group.
and Awards Committee, said: “It is fantastic to • Pam Norman worked as a GDP since
see such a wide range of dentists nominated qualifying in 1979 has given many years of
for our awards this year. The COVID-19 support to the South Wales Branch, holding
pandemic has impacted right across dentistry, many roles on the committee and currently is
and we know this has been an exceptionally acting chair, even though she has now retired.
tough year for everyone, so we feel it is just • Neil Oastler is a very modest, hard-working
as important as ever that we recognise those hospital and community dentist who has been
who have gone the extra mile for dentistry. ever present in the oral surgery department
“We know so many members, and not just of the John Radcliffe hospital, Oxfordshire’s
those with official roles at the BDA, have Community Dental Service and its LDC for
given long hours and expert knowledge many years.
during the pandemic, and we are keen to on subjects relevant to clinical practice in • Dr Ivan Simmonds has given unstinting
ensure their achievements and efforts are primary care, where he also founded the UK’s service to the profession, the BDA and to his
acknowledged. During 2021, we want to find leading practice-based research network. colleagues and patients, and in his 80th year
dentists who have shown a commitment to Trevor is a massively influential teacher, continues to take an active role, including
advancing dentistry. We strongly encourage editorial director, researcher and examiner being an almoner for the BDA’s Benevolent
nominations from all areas of the profession from undergraduate to PhD level and has Fund since 1990.
– please consider putting forward a colleague supervised many of the research projects • Professor Damien Walmsley is the author of
you think deserves recognition.” carried out by the students enrolled on one many textbooks and scientific peer-reviewed
of the country’s longest running master’s articles and as an excellent communicator,
Fellowship programme at the University of Birmingham. he is always keen to share his knowledge and
• Eddie Crouch has been a consistently Alongside his career as a university educator, further the profession’s learning, especially in
strong voice for dentistry, appearing on Trevor acts as a friend, mentor and advisor the field of IT and social media.
national and local radio, particularly to countless clinicians throughout the UK • Brian Williams has been an outstanding
through the coronavirus pandemic, and around the world, and he is a key volunteer for the BDA’s Museum, following
voicing dentists’ concerns. opinion leader for most global dental a long and successful career in dentistry as a
• Martin Fulford was a renowned lecturer manufacturing companies. hospital dentist and a GDP.
on cross-infection control in dental practice
and gave more than 100 lectures across the Life Membership Certificate of Merit for
UK, helping to support dentists provide the • Jude Anderson, now retired, continues to Services to the Profession
highest levels of health and safety. lend her support, helping colleagues through • Shareena Ilyas qualified in 1998 and is
• Jonathan Randall takes an active role the COVID-19 pandemic, and plans to chair currently a GDP working as an associate in
in dental politics and has met with local the CDS Group session at the British Dental a mixed NHS practice in London. She was
MPs, as well as other stakeholders, to Conference and Dentistry Show in May. elected to the BDA’s board in April 2020, the
represent dentistry. • Bridget Ashton has been a lifelong member first Asian woman to sit on the board since
• Peter Ward’s mentoring skills have helped of the BDA and while she was a member of its inception.
to develop ‘deep-thinking’ dentists and staff the Plymouth Section, became the first female
which has been invaluable to many of our section chair in 1996, as well as serving as Roll of Distinction
elected officers and representatives. section treasurer for 20 years. • Ian Morley’s long career at the BDA began
• John Glen has always been active in the in 1992 as a legal adviser. He later took on the
John Tomes Medal East of Scotland Branch, working as a role as the BDA’s first HR Manager in 2001,
• Professor Trevor Burke is one of the UK’s GDP for over 30 years. He has served the and devised many of the BDA’s policies and
most well-respected and popular clinical branch continuously both as a Branch procedures, enabling the organisation to
academics. He is a sought-after lecturer, both Council member and as a member of the ensure transparent, equitable and consultative
nationally and internationally, and is famous Scottish Dental Practice Committee processes. Ian has been a fundamental part
for his hugely entertaining, evidence-based (SPDC) from 1998–2019 and the SDPC of the fabric of the association over such
lectures and hands-on training courses. Executive Committee from 2008 to 2019. He a long period of time, providing much
Trevor brought 20 years of experience in has served twice on the BDA Scottish Council wise counsel for colleagues and elected
general dental practice to his remarkable and was instrumental in the creation of a representatives alike.
academic career, via Manchester, Glasgow, Young Dentists Group in the East of Scotland
and Birmingham dental schools. His almost Branch. During his career, he always The deadline for the next round of nominations is
unprecedented 370-plus peer-reviewed had a professional interest in children’s 28 May. Find out more and nominate here:
papers and textbooks are entirely focused dentistry and was a member of two www.bda.org/about-the-bda/honours-awards
16 | Scottish Dental MagazineFebruary 2021 | 17
NEWS Practice confidence sustained Martyn Bradshaw, of PFM Dental, reflects positively on sales and prospects for 2021 AFTER a hugely disruptive 2020, COVID survived largely due to the continued a lower value for their practice as a result continues to impact on daily life but now payments. The value of this security is not of the missing months of lockdown. in 2021, as the vaccine rollout continues, lost on the current generation of associates Put simply, and due to the exceptional hope is certainly on the horizon. Healthcare and shrewd corporate buyers who make up circumstances, the answer is no. Values businesses and, not least, dentistry have the bulk of interested and motivated buyers. remain the same as they did pre-lockdown. been at the sharp end of the pandemic, Despite the safety net granted to the NHS This is because it is widely accepted that however confidence in the dental sector has sector, private practices have also been practices are being valued based on the been highly resilient. selling well in recent months. It has become financial income and expenses to February This was reflected in dental practice apparent (from the data we examine when 2020 (pre-lockdown). Therefore values are values as we emerged from lockdown 1.0 in valuing) that most private practices are no different to a practice marketed on the summer. After a brief hiatus, practices now generating between 70–100 per cent 1 March 2020. So the EBITDA (profit) is not came on the market as normal and sold with of pre-COVID income. A documented affected, and we use the same pre-COVID relative ease. In fact, for the five months rise towards normal turnover is therefore multiples of EBITDA to determine the from July to November we had 32 practices reassuring for buyers. Furthermore, most value as previously. For private practices, that were sold subject to contract with buyers appreciate that the sale process for we do however need to show the income legal work commenced, which is roughly private practices takes on average four to generated from July, month by month, on par with what we would expect under six months from offer to completion and so that we can establish that the income normal circumstances. the financials of practice during this time is on an upward trajectory. This gives the There is no doubt that there is confidence should get even stronger. buyers of private practice the confidence in the viability and long-term value of NHS to purchase. practices. It is hard to think of a worse Valuations scenario for dentistry than the one that A question that we are frequently asked unfolded in March 2020, yet practices by vendors is whether they might achieve martyn.bradshaw@pfmdental.co.uk 18 | Scottish Dental Magazine
February 2021 | 19
NEWS
22 MARCH 18-19 JUNE 1-2 OCTOBER
The new perio classification Scottish Dental Show ITI Congress UK & Ireland
D AT E S Dundee & Perth BDA, online Glasgow EICC, Edinburgh
FOR tinyurl.com/y5c4enaw sdshow.co.uk https://tinyurl.com/yyms8cyw
YOUR
DIARY 25 MARCH
The 1st UK Restorative Dentistry
18 JUNE
DCP Study Day, RCSE
12-14 NOVEMBER
BSP Conference
& Prosthodontic Conference https://tinyurl.com/y26s8u7n The Royal College of Physicians,
Better patient care through London
collaboration 25-26 JUNE https://tinyurl.com/yyh2bcq3
Glasgow The British Dental
DATE TO BE CONFIRMED Conference & Dentistry Show 3 DECEMBER
https://jointdentalconference2021.
24th Annual Conference for NEC, Birmingham FGDP(UK) Scotland Study Day
eventbritestudio.
Dental Care Professionals www.thedentistryshow.co.uk Updates on treatments for perio
com/127204328571
RCSED, Edinburgh and endodontics.
https://tinyurl.com/y5bfduyt 17 MAY-17 JUNE 25-26 JUNE Glasgow Science Centre
National Smile Month Dental Technology Showcase fgdpscotland.org.uk/book-
15-16 FEBRUARY NEC, Birmingham
www.dentalhealth.org/national- glasgow-study-day/
International Conference on Oral www.the-dts.co.uk
smile-month
Dermatology and Oral Pathology
POSTPONED FROM
London TBC MAY 26-27 JULY 2021 TO 2022
tinyurl.com/y2lqc76u National Dental Dental Health Forum
Nursing Conference CTF, Manchester University 6-9 JULY 2022
25 FEBRUARY https://manchesterdental.org
(Normally co-located with BDC & EuroPerio10
A guide to MI caries management
DS; see above) Copenhagen
BDA online 10 SEPTEMBER
www.badn.org.uk/Public/Events/ (Postponed from 2-5 June 2021)
tinyurl.com/y3mv4age Dental Care for People
National-Dental-Nursing-
Conference.aspx with Cancer
26-27 FEBRUARY https://tinyurl.com/yyav7myx
Hands-on endodontics
BDA, London
https://tinyurl.com/yxjxkxr6
Dental Compressor specialists
Keeping Up The Pressure Les Ferguson 07885 200875
Alex Morrison 07495 838907
• Scottish Based
• Supply Office 01786 832265
• Repairs
• Service plan
• Installation
• Filtration les@dencompsystems.co.uk
• Inspection & Certification www.dencompsystems.co.uk
20 | Scottish Dental MagazineCOMMUNITY HEALTH
How teamwork pays off
Shetland is among the UK’s top performing areas for oral health in children. WORDS
WILL
Scottish Dental spoke to some of those involved in the programmes achieving results PEAKIN
T
he National Dental the most deprived areas had obvious dental which saw Lerwick Town Hall illuminated
Inspection Programme decay, compared with just over 13 per cent in in blue, the health campaign’s signature
(NDIP) looks at the teeth more affluent parts of Scotland. P1 children in colour. “The team is so enthusiastic and
of two school year groups the most deprived communities experience knowledgeable, getting the message across
– P1 as children enter more than four times the level of tooth effectively and with fun,” he added. Last
local authority schools decay – an average of 1.78 decayed, missing month, Scottish Dental caught up with some
and P7 before they move or filled teeth per child compared to 0.40 in of the team on Shetland.
to secondary education. In 2019-20 the the least deprived areas. The report said the Morag Mouat, oral health improvement
teeth of more than 3,000 children – 22.5 per gap had narrowed in recent years, but the team leader, is responsible for the
cent of the estimated P1 population – were British Dental Association warned decades of Childsmile, Caring for Smiles, Open Wide
examined across Scotland. improvement could be at risk as a result and Smiles for Life programmes. A dental
While the inspections in school are not of the pandemic. hygienist, she works in clinic two days
necessarily as rigorous as those conducted in The top performing areas in Scotland a week. “I travel to satellite clinics, both
a dental surgery, they do record decay where were Orkney (84.02 per cent of P1 children require a ferry crossing,” she said. “There
disease has penetrated below the white had no experience of dental decay) and are some interesting trips in winter!”
enamel layer. The latest findings, published Shetland (84 per cent). Antony Visocchi, Because of the pandemic, Morag has not
by Public Health Scotland (PHS) last October, director of dentistry for NHS Shetland, said: been in clinic since March last year. It was
showed that nearly 74 per cent of children in “Our NDIP figures have been maintained “all hands-on-deck”, supporting staff and
P1 had no obvious decay in their baby teeth – at a very high level for some years and I am devising ways to continue their work.
a three percentage point improvement on the glad to say we are still there after the results Morag did her dental nurse training in
previous year. When the programme began in were recently published. We are aware the Edinburgh before coming home to work
2002-3, only 45 per cent of P1 children were lack of access to dental services and the long for the then community dental team. “I
without evidence of tooth decay. The figures lockdown could have had a detrimental was fortunate to be involved in the fluoride
also showed the average number of decayed, effect on the dental health of all vulnerable research project in the isles in the 1980s.
missing or filled teeth per child had reduced groups across the island.” His comments Professor Ken Stephens, from Glasgow
from 2.76 in 2002-03 to 1.04 in 2019-20. coincided with the launch by the NHS oral Dental Hospital, was the lead and through
Despite improvements, PHS highlighted the health improvement team in Shetland of a this my interest in prevention grew.” Morag
link between deprivation and poor dental Facebook1 page and, during Mouth Cancer completed a hygiene course at Glasgow
health. Almost 42 per cent of P1 children in Action Month in November2, an initiative before returning to Shetland to launch
The Shetland oral health team,
during Mouth Cancer Action Month
22 | Scottish Dental MagazineFebruary 2021 | 23
COMMUNITY HEALTH
a preventative programme. She worked
in practice and joined the Public Dental
and welcome the opportunity to discuss
their child’s health. Michelle said she found
Team views
Service, assuming her current role in 2016. online appointments less bureaucratic, CLARE BALFOUR is an oral health
“I have seen how oral health has improved allowing more time for rapport-building, support worker and extended duties
since my first days of dental nursing,” she discussion and advice. “Usually, by the time dental nurse who, in normal times, visits
said. “I’m aware that projects we start may the paperwork is complete in a normal and supports nurseries and schools with
not see the benefits until many years in the clinic setting, children have lost patience,” the Childsmile programme and fluoride
future. Oral health was always a poor relation she said. “Online, we are able to get on with varnish visits.
of medical health and I hope that during my the appointment immediately.” Michelle is “From working many years ago as a
time in this job I have worked hard in making collaborating with researchers from Dundee dental nurse and seeing the poor state
sure it is included in all aspects of care. University’s School of Dentistry on using of children’s teeth, it made me want to
“During the pandemic I’ve tried to do the observational analysis to evaluate Near help make a difference. Due to hard work
best I could in the ever-changing situation; Me appointments for potential permanent by staff – both dental and in educational
supporting staff and encouraging them to incorporation, into the standard Childsmile, establishments, as well as by parents –
think outside the box on how we can deliver Community and Practice appointment NDIP results have shown the children
oral health messages with new barriers in system, already well established in Shetland. here now consistently have among the
place. For the Childsmile team, who are used Angela Hopwood is an oral health best teeth in Scotland,” she said.
to daily interaction with children, this was a improvement nurse who works on all “I would like to keep that trend
massive change. Once we settled down and aspects of Childsmile, as well as liaising with continuing and keeping parents engaged
Teams came into the equation, they started to other health professionals and working with and appreciating how important good
brainstorm on how they could reach children vulnerable groups. “A small, but important, oral health is for all and why.” Clare has
and particularly vulnerable families.” part of my role is in the delivery of local begun training in Near Me consultations
Morag added: “Some staff enjoyed interventions for the national oral health and is looking forward to holding
working at home, others not so! Once we get and homelessness project, Smile4Life,” said Childsmile appointments online.
back to normal we will look at how we can Angela. Shetland does not have a rough “The consensus so far is that parents
make this work. We have all become more au sleeping population per se, but there are have been finding the appointments
fait with technology. We looked at setting up people not in settled accommodation. very useful, so we hope to build on that,”
a Facebook page for a few years, but this time “Routine dental care is an important she said.
has allowed the team to set it up and keep part of building self-esteem and improving Elizabeth White is also an oral health
it updated. The team, from being nervous mental health, and supporting a return support worker who, pre-pandemic like
about appearing in front of a camera, have to education and employment, which are Clare, visited nurseries and schools
embraced it. I’m really proud of them.” important parts of the route back into safe across Shetland. “Childsmile has greatly
Her aims for 2021? “To make sure staff are and settled accommodation,” said Angela. improved the oral health of children in
well and feel supported. I fear coming out With the help of specialist colleagues, Shetland over the past 10 or more years
of this pandemic may be more difficult than Angela has developed an autism and – we have been successful in getting to
going into it – a bit like staggering towards learning disability Patient Communication see every nursery-aged child in Shetland
your holidays and then ending up with a Passport for Shetland’s dental service. It for toothbrushing and oral health
heavy cold. Getting back into schools will be allows clinical teams to be briefed on a education – and the aim is to ensure this
a major part of our year for the Childsmile patient’s needs before they attend, improving continues. Hopefully we will be able to
team. I know they can’t wait to be able to compliance in treatment and reducing get back into nurseries and schools in
engage with the children again. Personally, missed or delayed appointments. She has the not-too-distant future.”
this is a time to look at how we engage with also developed sensory aid boxes for dental Colleagues Niki Madai and Zdenka
vulnerable, non-engaging families. This settings, for patents with autism or learning Mlynarikova both highlighted the
has always been a challenge and although disabilities and people with dental anxieties. benefits of thinking differently about
Near Me has been a success we have to “Raising awareness around mouth how to engage people. Niki commented:
understand digital poverty and not everyone cancers has been a huge driver for me,” said “While the pandemic meant face-to-
has, or wants, the ability to connect to us.” Angela. “We have always held campaigns face appointments and visits couldn’t
Michelle Sinclair is a senior dental nurse in Shetland to raise awareness. We include go ahead, it’s pushed me to be more
tutor and oral health educator. During the mouth cancer awareness in lessons with creative. Being able to reach people
pandemic, she participated in webinars secondary school pupils and more people are through Facebook has been a huge
provided by allied health professionals aware of mouth cancers, not just locally but success. We aim to keep enrolling
and the Near Me video consultation team across the country, thanks to the Oral Health children, even if we can’t visit them, and
to explore the use of online appointments Foundation’s campaign.” She added: “The to find new ways of encouraging people
for Childsmile Community and (dental) plan for 2021 is how we deliver programmes to pay attention to their oral health.”
Practice (CSC&P) appointments. Michelle under restrictions. We have concerns when Zdenka, who is also studying music,
hosted weekly appointments, mainly for schools are closed in regard to the content agreed: “Creativity seemed to be a way
children from six months to two and a half of snacks at home and the potential for forward in everything we have done,
years. “This is the age group who have had children to graze rather than have break using our spare time effectively to learn
the least oral health input as they have not times. This could impact on oral health. Near new skills, such as video editing or social
started nursery or school,” she said. Older Me appointments will go a long way to reach media insights.
siblings can take part and, said Michelle, families and encourage positive behaviours, “The Facebook page has been quite a
they have “engaged with the Near Me but we are mindful that it is going to be success so far, and our two-minute tooth
process, being honest about their oral health motivated families engaging with us so brushing song and video was shared by
regimes”. The frustrations of IT and lack of finding new ways to target hard-to-reach many health-related organisations
in-person contact aside, there are benefits groups is to me paramount.” within the isles and sent out to schools
to online appointments, she said. They are and nurseries, which we believe had
less prone to cancellation if a child is unwell, 1
www.facebook.com/ positive impact on children’s oral health.”
or the weather is bad, and even if the child oralhealthimprovementshetland
becomes distracted, parents remain engaged 2
www.dentalhealth.org/bluewednesday
24 | Scottish Dental MagazineFebruary 2021 | 25
INNOVATION
Creating H.O.P.E
from challenge
Collaboration between a dental school and designers has led to a low-cost 3D-printed
device allowing students to practise key skills remotely or socially-distanced in class
WORDS
CLEMENT SEEBALLUCK, WITH
TUNG HIN LAU AND DESMOND MANANGAZIRA
T
wo thousand of H.O.P.E. - Home Operational
and twenty Practice Equipment (if you have
was certainly a a good acronym, you are halfway
trying year for there). This is a device that has
our profession. the potential to allow students to
Virtually all practice key skills from home or
aspects of remotely for a minimal cost. The
dentistry encountered unique development of this was accelerated
challenges as we approached throughout 2020 and it proved to be
uncharted territory; lockdowns, quite useful in meeting some of the
social distancing, aerosol generating unique challenges we encountered.
procedures and furlough. At
times, we think it is safe to say The problem
we all felt much the same as that I have been interested in the
first day at dental school, a heady integration of remote teaching and
mix of uncertainty and a drive to the early development of skills
ultimately become immersed in applicable to a broad range of dental
patient care. Married to a General procedures. Students learn skills
Dental Practitioner, and my own at their own pace; as a student, I
work as a clinical lecturer in witnessed first-hand that a ‘one size
dentistry, it became apparent to me fits all’ curriculum did not always Figure 1 The These problems have been
how varied were the challenges we work well. Students experienced initial equipment exacerbated in the past year.
set up used for
all faced. However, the solutions to genuine anxiety when they took a the early skills
Capacity of training spaces has been
these challenges all had a common little longer than their colleagues development greatly reduced to accommodate
theme: innovation. to develop a clinical skill such as exercises social distancing guidelines, with the
Problematic as 2020 proved to be, undertaking a composite restoration, inevitable consequence of students
it could also be viewed as a catalyst perfecting the form and function. having reduced hands-on experience.
for change. I stress catalyst rather Developing skills in a safe The opportunities to practice
than instigator. Dentistry, both in environment is key for dental and ‘self-discover’ have also been
training and practice has always been training. However, with limited negatively affected. Additionally,
an adaptive profession, striving to simulated training resources, as teaching moves to more online
improve. The events of the past year students don’t always get the time formats, there is less opportunity
merely accelerated and guided change. they need to practice and develop for impromptu informal discussions
I have witnessed countless their skills. between the trainees and trainers.
examples of innovative solutions
implemented by colleagues for
dental training over the past year
as universities have shifted towards
a blended online and practical
approach. It is unsurprising,
given the dedication we all have
to the profession, but nonetheless
A PEN SIMULATED THE ANGULATIONS OF A HANDPIECE TO
impressive.
I will detail here the development INSTILL BASIC PRINCIPLES OF INSTRUMENT ERGONOMICS”
26 | Scottish Dental Magazinethis time that we started collaborating
with Alasdair Napier, a colleague at
the renowned Duncan of Jordanstone
College of Art and Design at the
University of Dundee. For the past
year, he has provided invaluable
advice regarding 3D modelling
development and committed printing
resources towards the production of
rapid prototypes, and ultimately the
final product.
However, the most surprising
collaboration, that lead to the final
product, was with our current
undergraduate students. We must
always remember that our students
come to the course with unique
talents and an eagerness to shape
their education. They also have the
All this before we even consider the (Left) Figure 2 be printed. This had a number of most contemporaneous insight into
the final 3D
reduced clinical experience. rendered redesign
advantages over simply creating their training needs.
of our “training moulds. We were able to create a Tung Hin Lau and Desmond
Sparking the novel pen” design that could be modular and Manangazira had some experience
approach to the challenge adaptive, with an internal screw in creating and printing 3D models.
(Right) Figure 3
I was fortunate to have been teaching thread (Figures 2 and 3). I was amazed at how quickly they
The Printed version
during the transition in the Dundee of the pen being The second event that really adapted and developed these skills
Dental School to the new 4D used with our accelerated this project would for this project. Tung was working
Curriculum. I had the opportunity revised exercise be the first nationwide lockdown at home from an apartment in Hong
sheet
to work on the development of a new due to the COVID-19 pandemic. Kong at this uncertain time, with
early rotary instrument clinical skills Thus, several factors combined to limited access to computer resources
course. This course was designed create the perfect environment for Even with these constraints, he was
using modern educational principles, collaboration and creation: a silver able to produce incredible designs
and executed with less conventional lining in the midst of some rather within short time frames. Their
exercises, some of which required dark clouds. dedication and commitment, to say
the creation of new equipment. the least, continues to impress me.
It was in 2018 that the initial How it developed It was important that we made our
concept of instrument analogues was With the stay-at-home order in goals realistic. The functionality of any
implemented. The first iteration was effect, the idea of a cheap alternative training activity, undertaken outwith
a pen that simulated the angulations to a phantom head that could be a clinical skills laboratory, cannot
of a handpiece to instill the basic used by students at home or isolating require suction, rotary instruments
principles of instrument ergonomics (Left) Figure 4 seemed more relevant than ever. and pressurised air or water.
in early year students. This was Initial concept I collaborated with a former dental Furthermore, safety considerations
for baseplate
fabricated using expired denture with features to student, Yu En Cheah, to convert regarding potentially unsupervised
acrylic in a silicone mould (Figure 1). accommodate my concept drawing into an initial activities must be considered;
Using a mirror for indirect vision, Indirect vision 3D prototype. I had worked with Yu particulate generating and cutting
students would use these pens and positioning En on several teaching resources exercises were not practically
exercises
to navigate mazes created by my when he was an undergraduate viable as these would require close
colleague, Roddy Milne. Although (Right) Figure 5 and had every confidence in his supervision and access to costly
the course was positively received, initial print out of resourcefulness. equipment and air compressors and
production times and cost were an device. This was a We quickly created an initial high-volume suction.
single component
issue. There was also the limitation print, with limited prototype file and (Figure 4) printed We decided to focus on three key
of working on a flat surface rather application. for testing (Figure 5). It was around concepts that would provide good
than matching dental arch contours.
There were really two
serendipitous events that occurred in
the development of our equipment.
Later that year, the University of
Dundee opened a new Creative
Space within the main library,
where staff and students could work
with several crafts, including 3D
modelling and printing. Here I met
Richard Parsons, CIO Director of the
Library Learning Centre.
We discussed the overall concept
and together explored CADCAM
for streamlining the equipment
and creating a prototype that could
February 2021 | 27You can also read
