Peri-implant Disease

From The Blog of the Campbell Academy. – a routine “must read”.

“….It is absolutely crystal clear the patients who attend for routine maintenance get very little amounts of Peri-implant disease and the disease that they get is hugely treatable.

Whereas it is also absolutely clear that if they don’t attend the incidents of Peri-implant disease goes through the roof.

The number of dental implants placed in the United Kingdom over the last 10 years has rocketed and so here it comes.

Throughout that time there have been countless practitioners who have paid no attention to the fact that we have known for years that maintenance is the key to the reduction in Peri-implant disease…

….Peri-implant disease is a real reality even in the practices of people who do it properly, but for those who don’t it will be a disastrous long-term complication.”

 

Why wouldn’t you?

I have a hoard of unpublished blogposts, some half written, some one line ideas, they are the result of experiences, ideas, conversations, things read, seen or thought.

This one came about after talking to a client about his team routinely recording their patients’ blood pressure and pulse.

Increasingly dentists ought to be seen as Oral Physicians as well as Surgeons and should look at their patients overall health. Often dentists are in a better place to do routine checks than our medical colleagues and should do them before many procedures. This is good practice and those who embrace the role are to be encouraged. They, and their teams, do need to be competent at doing straightforward measurements. It’s something I started (but did not persevere) back in the early 1990s.

These are comments on three patients from the client

  • Nice outcome. Did patient’s BP and it was 210/99, sent her to her GMP as a matter of urgency.
  • Normally he would be hospitalised but treated under own doctor’s care, turns out to have high platelet count.
  • Had to send her away last time as we had potential cardiac issue on our hands. Saw her this time and she was still effusively grateful for us having found this. Saved her from heart attack or stroke.

The client continued:

“I cannot understand why “X” (client’s associate) is reluctant…”

“We should have been doing them years ago….”

Yerkes-Dodson is still relevant – if you want to enjoy your clinical career

Why should a “law” described first in 1908 be relevant to everyday Dentistry (and more)?

Robert Yerkes and John Dillingham Dodson described their tests with rats that could be encouraged to complete a maze when stimulated with slight electrical shocks. When the strength of the shocks was increased however the rats just ran about looking for an escape. They concluded that arousal levels helped to focus attention and motivation on the task at hand but only up to an optimum point and after that point fatigue appeared and performance declined.

Research has found that different tasks require different levels of arousal for optimal performance. For example, difficult or intellectually demanding tasks may require a lower level of arousal (to facilitate concentration), whereas tasks demanding stamina or persistence may be performed better with higher levels of arousal (to increase motivation).

The first image shows the classic inverted ‘U’ shape of a difficult task (placing implants, molar endo, treating some children are examples that come to mind). It also shows a continuation without decline of more simple tasks which can be maintained for longer without reaching a point influenced by fatigue (examinations, routine restorations on well adjusted patients).

 

 

The second image shows the typical “stress curve” where performance takes a while to peak if we are under too little stress, then goes through a short period of optimum stress before reaching too much and heading down through exhaustion to burn out.

The reason that I have written about this is that we need to look at the time periods that these curves represent from the short (an hour say) to long (months or even years). There are different challenges that dentists face with differing solutions.

Firstly of course there is the fatigue that comes from trying to do too much challenging work in a short period of time. This results in high stress levels and possibly poor performance on a daily basis. Often there are time management issues where we are obliged to match our performance to the patients availability. This can see a clinician “coasting” by dealing with the relatively straightforward whilst at their peak in terms of readiness and responsiveness but then having to find reserves of energy when the patient “demands” treatment at later times in the day. I have never understood why dentists are reluctant to tell the patient exactly when and why they would like to see them. My own experience in a practice with large numbers of children was to insist on seeing under 11s for any treatment (examinations excepted) first thing in the morning. For the most part when people have reasons explained to them and can understand that it is for their benefit then they will comply with your wishes.

Also to consider are the long term problems of fatigue that arise from the day after day, just doing it without time off. Even in the best time managed (at a relatively micro level) practice if there is often not enough time spent away to unwind, recharge the batteries and recover, then burn out will creep up on you. The prodromal signs are a lack of efficiency and, more importantly, effectiveness.

Dentistry is still a macho occupation for many who seem to get a perverse enjoyment from overwork. It’s sad but true that for many there is an opportunity to build the life they want but put obstacles in their own way as if frightened of taking control.

Time management on both micro and macro levels is hugely important, ignore it at your peril. Get help if you need it.

HPV vaccination – isn’t it time?

The science is there, isn’t it time the political will was there?

Dear Dr Rees,
I wanted you to be the first to know.
We’ve just got word that the UK Government’s scientific advisors have finally listened, and have recommended expansion of Human papilloma virus (HPV) vaccination programme to cover school-age boys.
HPV has been fuelling a surge in oropharyngeal cancers. And for years this profession has worked to win the argument for change.
Dentists are on the front line in the battle against oral cancer. So please, share this video.

We are now pressing all UK governments to move swiftly towards rollout of a national programme, so all our children can get protection from this devastating condition.
We have fought to put prevention into practice. This profession can take pride in what we’ve achieved, together.
Mick Armstrong
Chair, BDA

Link to the release here

 

Roy Lilley speaks…sense.

I often disagree with Roy Lilley (especially when he discusses dentistry) but his newsletter today makes a few points well, particularly these.

…the only way to achieve that is to de-pompous the GMC and NMC, strip them back to maintaining a register and stop hounding clinicians with all the masonic, legal palaver of hearings…

Clinicians are rarely criminals but they are always human beings and we make mistakes, get confused, get tired, get screwed up by poor systems, bad designs and pressure.

If people think owning up to a mistake could end their career, they’ll hide it and hope.  That is hopeless and serves no purpose.  We have to put a purpose into honesty.  The purpose is to keep us safe and that is all that matters…

…same sh*t, different profession…

I write mostly about what happens to dentists and the business of dentistry…but let’s not forget that the UK is a pretty lousy place for a lot of professions at the moment, especially the ones that put patient care at their core.

This from the BMJ via reestheskin

“Why do doctors feel the need to do this? A study in The BMJ in 2015 suggested that there is an association between increased defensive practice and a reduced likelihood of being involved in litigation.2 One might conclude that defensive practice is a logical behaviour in the face of a culture that leads to doctors being fearful of the consequences of making an error or even of a known adverse outcome.”

“No doctor sets out to practise defensively, but a system has been created where this is inevitable. The GMC acknowledges that medicine has become more defensive.3 Doctors often lack confidence in the fairness and competence of investigations and continue to see the GMC as threatening.”

An unregulated industry that’s exploiting people, including children,

How ethical is the cosmetic surgery market?

“We’ve got largely an unregulated industry that’s exploiting people, including children, by promoting often untested and unproven products and procedures. We need better regulation of the quality and safety of these procedures, the people who carry them out, and where they are carried out.”

These were strong concluding words from the Nuffield Council of Bioethics. Its recent report, focusing on the ethical issues surrounding the cosmetic surgery industry, makes for very interesting reading. The report highlights the significant concerns, concerns that are shared by many, surrounding the UK cosmetic surgery market.

From Penningtons Manches LLP. Full article HERE.

 

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