Education, education, education or have I missed the point?

From The Times via BDA, the words of another one of those Johnson boys.

Universities urged to make more money from research

Universities are to be measured on how well they work with business, collaborate on research and development and sell their intellectual property. Jo Johnson, the universities minister, will say today that a “knowledge exchange framework” will be developed to analyse how good a job universities do at putting their research to commercial use. In Britain, more research takes place in universities than in comparable countries, at 26 per cent compared with 17 per cent in Germany and 13 per cent in the US. British university revenues from engagement with businesses are growing slowly, at only 1 per cent a year. American universities earn almost 40 per cent more from intellectual property licences as a percentage of their overall research resources than those in the UK. The University of Queensland in Australia earns more than any Russell Group university from this source. The Higher Education Innovation Fund, which helps universities to sell their intellectual property, is to be given £40 million by the government, taking it to £200 million in 2018-19.

No doubt there will be “World Class” hyperbole/BS that goes along with this. Remind me what is the primary function of a university?

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Should you lie in the sun?

I periodically share information gleaned from a well know dermatologist.

This time there’s also a video where, to celebrate an auspicious birthday, my little brother shows the results of his experiments in cloning.

It is well worth a watch, or two.

Dental Sedation Adult and Paediatric Immediate Life Support course

Lynn Fox has asked me to promote her course on Dental Sedation Adult and Paediatric Immediate Life Support. As someone who practiced sedation I believe that on going training and updates on sedation techniques and particularly Life Support are essential.

Details:

For clinical dental staff who wish to provide / assist with conscious Inhalation Sedation or both Inhalation and IV sedation for adults and children. The Dental Sedation Immediate Life Support course fully complies with IACSD standards for Conscious Sedation in the Provision of Dental Care 2015 who state “Practitioners must be able to provide age-appropriate immediate life support as defined by the main elements of the Resuscitation Council (UK) ILS and PILS training programmes. It is not essential to undertake a Resuscitation Council (UK) accredited ILS/PILS course. Alternative courses with equivalent content which are adapted to the needs of dental practice are acceptable: these might also include the management of common sedation, medical and dental emergencies.”

We are responding positively to this by offering these main Resuscitation Council elements on a non Resuscitation Council, tailor made, one day Dental Sedation Immediate Life Support course which has been developed specifically for the Dental team. This Dental Sedation Immediate Life Support course clearly combines the main elements from the RC Immediate Life Support Course (ILS) and Paediatric Immediate Life Support Course (PILS) in one day.

The course developer and lead instructor is Lynn Fox, a Resuscitation Council accredited instructor in ALS/ILS/EPLS/GIC. Lynn has 11 years of experience in teaching to hospital cardiac arrest teams and has previously lectured on anaphylaxis for the British Dental Association which is now a BDA online lecture. Lynn also teaches Dental Medical Emergencies to in-house dental practices and groups including The Oxford Post Graduate Dental School at Thames Valley Health Education.

Next open course date:

26th October 2017 in Oxfordshire.

Dental Sedation Immediate Life Support course content includes:

  • Causes and prevention of cardiorespiratory arrest in the adult and child
  • ABCDE approach including the management of dental, medical and common sedation emergencies in the adult and child including respiratory depression, aspiration, anaphylaxis and other associated emergencies
  • Basic Life Support and Automated External Defibrillation scenarios for adult and child
  • Adult and child airway management using basic maneuvers & airway adjuncts: BVM, OPA, NPA and supraglottic airway (i-gel)
  • Team roles and responsibilities
  • Assessment will focus on the compromised airway both for the respiratory and airway compromised patient and during cardiac arrest.

Certificate will show 7 hours verifiable CPD as per GDC requirements.

Link to the course website for more information and to book your place  HERE

 

If you’re in London on Thursday evening head for Kings.

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A smorgasbord of Dental talent.

Kishan Sheth and the KCL Dental Society join forces to bring you one of the most anticipated dental events of the year. Chaired by Dr Lewis-Greene, supported by Prof Dunne and sponsored by Henry Schein.

www.facebook.com/kcl.dentalsociety/

5.30-8.30pm

Thursday 8th December 2016

New Hunt’s House Lecture Theatre 1, Guy’s Campus, King’s College,  London

Speakers:

  • Dr Raj Ahlowalia
  • Dr Subir Banerji
  • Dr Anoop Maini
  • Dr Alun Rees
  • Dr Nilesh Parmar
  • Mr Kishan Sheth

Attendees receive 2.5 hours CPD certificates or certificates of attendance for students.

£3 donation upon entry for Evelina Children’s Hospital.

By the end of the evening we would like to have raised £1000 for this amazing cause.

Seats allocated on first come first served basis.

What’s not to like?

Ten Year Anniversary of Child Protection and The Dental Team

41u5Cb15IrL._SX392_BO1,204,203,200_I was pleasantly surprised to bump into my old friend Richard Welbury at the BDA conference 10 years ago, I hadn’t realised at the time what a milestone he and his colleagues were making. Richard was the first person I knew who shared the facts around oral signs of child abuse, his memorable talks produced a determination from everyone who heard them to do everything they could to ensure that children would stay safe. Their work is worth remembering and continues.

From The British Society of Paediatric Dentistry via Dentinal Tubules

A decade ago, dental neglect in children was a neglected issue. But this is no longer the case thanks to the guidance Child Protection and the Dental Team (CPDT) which was launched at the BDA conference in 2006 by the then Health Minister Rosie Winterton.

The document and its associated website (http://www.cpdt.org.uk/index.aspx) came about after Jenny Harris, a paediatric dentist in Rotherham, wrote to the Chief Dental Officer, Raman Bedi, to raise her concerns. This was in the aftermath of the death of Victoria Climbié in 2000 and Lord Laming’s Inquiry report in 2003.

Said Jenny: “I asked myself: If a child like Victoria walked into my surgery, would I recognize her. Would I know what to do and would I have done it? For months I checked the dental press but there was nothing new to educate us about child protection.”

Jenny had already set up a dental neglect working group in Rotherham.  Her job was to define best practice so that children in her area would not slip through the net. But she still felt the dental profession needed expert national guidance.

After receiving her letter Professor Bedi met Jenny and invited her to chair an expert group to produce an educational resource. She was given a generous budget but just a year to complete the project.

The input of Jenny’s paediatric colleagues proved invaluable. She sent out a questionnaire (1) to BSPD members who were asked about their knowledge and experience of safeguarding as well as to share examples of good practice.  This research is being repeated for the 10th anniversary to see how much has changed.

In the decade since its launch, CPDT has been highly influential. In 2008, a survey of GDPs (2) showed that dentists had taken on board the new guidance and it was influencing knowledge, training and policies in the practice.

And there has been extensive involvement with other bodies, both in and outside dentistry. Jenny has become:
• BSPD’s representative on the NSPCC’s Health Liaison Committee  – she presented a paper on dental neglect in children as recently as September 2015
• A contributor to the development of a NICE clinical guideline: When to suspect child maltreatment
• Lead author of the first BSPD policy document on dental neglect in children
• Initiator of a working group bringing BSPD together with the Royal College of Paediatrics and Child Health (RCPCH), the NSPCC and the Advanced Life Support Group (ALSG) to adapt standardized child protection training – a recognition and response course – for the paediatric dentistry specialty trainees

The May anniversary is also an opportunity to celebrate the valuable contribution of the rest of the expert group: Professor Richard Welbury, an early champion of child protection in dentistry, Peter Sidebotham, a leading community paediatrician, Ranee Townsend, a CDS clinical director, Martyn Green, a dentist and vocational trainer in Devon, Janet Goodwin, a dental nurse representative and Chris Franklin, postgraduate Dean.

Now working as a community-based consultant in paediatric dentistry in Sheffield, hardly a week goes by without someone somewhere in the world contacting Jenny for information or advice and she helps where she can. Child protection and the dental team has already been translated into Croatian and Greek, with work on Spanish and Arabic versions now in the hands of enthusiastic teams of paediatric dentists.

Jenny believes there is still some way to go: “We have got better at recognizing signs of child maltreatment and at referring it but it does make a huge extra workload for clinicians and that hasn’t yet been recognized.” Jenny also believes the dental profession needs to have someone in every region who is identified as being responsible for safeguarding children leadership. Currently too much is down to the goodwill and enthusiasm of individuals.

Said Jenny: “I am grateful to BSPD Council for encouraging me to forge links and raise awareness of dental health among other professions involved in safeguarding. There is much more interest in children’s teeth than when we started a decade ago.”

(1) http://www.nature.com/bdj/journal/v206/n8/full/sj.bdj.2009.307.html and http://www.nature.com/bdj/journal/v206/n9/full/sj.bdj.2009.356.html

(2)  http://www.nature.com/bdj/journal/v210/n2/full/sj.bdj.2011.3.html

Note to editors:
For more information, contact Caroline Holland on 020 8679 9595/07974 731396

A couple of Orthodontic posts from Kevin O’Brien

Orthodontics can be a hidden art and it’s often perceived by non-orthodontists as a secret language. Most undergraduates know a something about it, but not much, similar to knowing a few key phrases. “good morning”, “where is the bus stop?” and “two beers please”. That’s where it ends. After graduation it used to be kept (mostly) to the confines of those who had been through, what the New Scientist once called, “the years of crawling subservience under the gaze of the white coated moguls that control our great teaching hospitals”. Then, when deemed to be fluent in the language, the specialists with their M.Orths, headed off to their own planet in the Orthodontic universe to fiercely guard their patch and occasionally share a few simple phrases of ortho speak with their referring dentists.

Times have changed and with the relentless march of a thousand aligner systems everyone has a phrase book – or at least they think they do. Or could it be that they have the dodgy Hungarian Phrase Books?

I am not looking to fan the flames of the GDP v Specialist debate, there’s way too much of that about, rather to present Professor O’Brien’s last two blog posts for your consideration because I think they are both worth a read. I find him to be readable, thought provoking and that sometimes rare thing someone constantly questions what he does and WHY he does it.

First up:

A thinking about Orthodontics blogpost. In its entirety.

This is a short blog post to read just before the weekend, or just after if you are in Australia!  I have just attended a major symposium in the UK and I was asked to give a major lecture.  The preparation of this took some thought. During the meeting I listened to some great presentations and this got me thinking about orthodontics.  I have been working as an academic orthodontist and research since 1986, spent a large amount of time researching clinical matters, I have trained too many people for me to remember and spoken at many major orthodontic conferences.  But what do I know about orthodontics?  Here is a list of my academic knowledge and opinion.

This is a precursor to a more thoughtful blog post that I am going to post next week, so here we go. You may not agree with me..

  • Malocclusion is caused by a combination of genetic and environmental factors
  • There are many ways to treat particular malocclusions.
  • Evidence based orthodontics is a combination of clinical experience, patient opinion and scientific research.  The proportions of influence of these factors varies according to our level of scientific evidence.
  • Arch form and dimensions should generally be accepted
  • Functional appliances and other bits of plastic, pistons and springs do not change or influence facial growth. They tip teeth.
  • To my knowledge there is no high quality scientific proof that orthodontics, extractions, appliances, expansion, myofunctional orthodontics influence breathing, posture, academic attainment, sleep disordered breathing etc
  • Class I molar non extraction treatment is very easy
  • I wish that I knew how to intercept malocclusion…
  • Extraction of permanent teeth is required for the treatment of some malocclusion..but treatment mechanics are as important as the extraction decision
  • You can only “drive” upper molars 2 mm distally
  • Temporary Anchorage devices are better than other anchorage reinforcement method by about 2mm
  • Wire and bracket properties do not influence the efficiency of alignment
  • None of the new developments that are supposed to speed up orthodontic treatment seem to work; according to new trials..
  • There is no such thing as non-compliance treatment
  • I simply do not understand clear aligner systems
  • Self Ligating brackets do not have any advantages over conventional brackets.  The self ligating practitioner should explain this to their patients.
  • The alternative orthodontist should explain to their patients that there treatment is not mainstream.
  • The General Dental Practitioner who has been on a short  course to learn speedy orthodontics should explain to their patients the limitations of their training and knowledge
  • There has been and there continues to be great high quality research being done in orthodontics and don’t tell me that our evidence base is weak!
  • Nearly all orthodontic treatment relapses to a degree and this is probably caused by ageing and we cannot stop time…………….

That’s about it, does anyone want to add to the list?

Now here’s the second one:

Evidence based orthodontics is not as straightforward as it seems…

Should we practice evidence-based orthodontics?

This is a basic point and a good place to start.  It has been pointed out to me several times that orthodontics is different to other part of dentistry because it is more of an art than a science. Furthermore, it is difficult for us to do harm because the harms that we may cause are usually minor, for example, decalcification and root resorption. It is, therefore, not necessary for us to practice evidence based care.

I must disagree with this sentiment.  This is because we need to practice ethically by ensuring that our treatment is based on evidence, when it is available.  We also need to inform our patients of all the potential risks and benefits of treatment.  To this end we should be particularly careful of making statements that are not based on good research evidence.  I can think of the following examples, the proposed benefits of non-extraction treatment, methods of speeding up treatment and orthodontics that is provided to reduce sleep disordered breathing in children.

Continues here

Getting Started in Facial Aesthetics – Guest Blog from Harry Singh

Getting Started in Facial Aesthetics

Although frown lines and crow’s feet are natural signs of ageing, some patients may want to eradicate them. With this in mind, this piece will consider the role of wrinkle relaxing injections, describing their benefits and presenting an overview of their clinical use.

dermal-fillers-workshop-e1453464963739‘What do you think I need, Doctor?’ By far and away this is the most commonest question I get asked by my facial aesthetics patients. My standard response for the past few years has been, ‘No one needs wrinkle relaxing injections, its all about what you want’.

Wrinkle relaxing injections is a wants based treatment. No one needs it, no one is going to get ill from not having it and certainly no one will die if they don’t undertake it.

Wrinkle relaxing injections work on motion lines, these are lines that worsen or appear when the patient contracts the muscle. Generally speaking, we are dealing with the upper third of the face, but I do use wrinkle relaxing injections in the lower face area (smokers lines, chins, gummy smile, Massetter, corners of the mouth). If lines/folds are present at rest and do not worsen when the muscles are contracted, then fillers will need to be considered.

There is the Glogau Classification of Photoaging. This was developed to objectively measure the severity of photoaging and especially wrinkles. It helps practitioners pick the best procedures to treat photoaging. There are 4 groups that a patient will all under:

Group 1 – Mild,  typical age – 28-35. No wrinkles. Early Photoaging present: mild pigment changes, no keratosis, minimal wrinkles. This group will not require any wrinkle relaxing injections as they have no wrinkles.

Group 2 – Moderate, typical age – 35-50. Wrinkles in motion. Early to Moderate Photoaging: Early brown spots visible, keratosis palpable but not visible, parallel smile lines begin to appear. This is the best group to treat with wrinkle relaxing injections, since they have no wrinkles at rest and only in motion.

Group 3 – Advanced, typical age – 50-65. Wrinkles at rest
Advanced Photoaging: Obvious discolourations, visible capillaries (telangiectasias), visible keratosis. We can still treat this group with wrinkle relaxing injections, since the wrinkles worsen when they contract their muscles. However we cannot guarantee to either reduce or eliminate any wrinkles they have at rest.

Group 4 – Severe, typical age – 60-75. Only wrinkles. Severe Photoaging: Yellow-grey skin colour, prior skin malignancies, wrinkles throughout – no normal skin, cannot wear makeup because it cakes and cracks. This group cannot be treated with wrinkle relaxing injections as the muscles are not causing any wrinkles.

Once the patient has elected to undergo any form of wrinkle relaxing injection, they, unlike our cousins across the Pond, what to achieve a natural result and not the frozen ‘I’ve been botoxed’ look. What does this natural look entail. In my eyes and my patients eyes, this natural look with wrinkle relaxing injections is achieved by the patient still being able to express themselves using the facial musculature without the appearance of, or at least the reduction of wrinkles on the treated areas.

The main benefits of wrinkle relaxing injections are based on the temporary nature of its effects. The toxin used will work at the neuro muscular junction to inhibit the neuro muscular messenger acetylcholine (a neurotransmitter) sending a signal to the muscle to contract. However after a few months (anything between 3 and 6) new nerve terminals reestablish connection with the muscles, allowing it to contract again. This gives our patients the confidence to try the treatment and if for any reason they don’t want to continue, they are restored back to their original appearance.

Patients also love that fact that the duration of treatment is very short and associated with this, the downtime is very minimal. On average the treatment of the upper third of the face should take no longer than a couple of minutes. Immediately after the procedure, the patient will have areas of swelling, but this should last no longer than 20minutes. This is where the media have latched on the phrase ‘lunchtime miracle cure’.

As we can see the main benefit of wrinkle relaxing injections is to smooth out wrinkles, however it has numerous medical benefits such as stopping excessive sweat, reduce/eliminate migraines, use in arthritis pain, blepharospasm, cervical dystonia and bladder control.

Considering whether to start a patient on wrinkle relaxing injections depends on balancing the risks of treatment against the potential improvements. Potential risks associated with this procedure can include, but are not limited to: swelling, bruising, headaches, flu like symptoms, ptosis of eyebrow or eyelid, non responsiveness.

As with all clinical procedures correct assessment, a detailed examination, informed consent obtained with an explanation of the realistic results expected are all mandatory.

Wrinkle relaxing injections when used on the correct patient will leave the patient more confident, looking fresher and appreciative of your work.

harry-picDr Harry Singh BChD MFGDP has been carrying out facial aesthetics since 2002 and has treated over 3,000 cases. In his last dental practice (focused on aesthetics) he ended up performing more facial aesthetic treatments than dental treatments. Due to the very high profit margins associated with facial aesthetics, he decided to concentrate on facial aesthetics and currently has over 700 facial aesthetic patients. He has published numerous articles on the clinical and non-clinical aspects of facial aesthetics, and spoken at dental and facial aesthetics conferences on these topics. Harry was shortlisted at the Private Dentistry Awards in 2012 and 2013 in the Best Facial Aesthetics Clinic category and was a finalist in 2012 at the MyFaceMyBody awards for the Best Aesthetics Clinic.

For further information on Harry’s courses and to download a video ‘Getting Started in Facial Aesthetics’ free of charge, please visit www.botoxtrainingclub.co.uk

2016 #27

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