The Incisal Edge

View from the USA – Landmark UK decision keeps whitening in the hands of dentists

I enjoy reading US dental journals and websites. I think the general opinion on this side of the Atlantic is that US dentistry is way ahead of the UK, it’s not always the case.

They seem to think that we’re ahead of them with regard to the thorny issue of tooth whitening. It’s from Dentistry IQ & here’s the link.

Landmark UK decision keeps whitening in the hands of dentists.

By Eoin Holohan

As the dental board of North Carolina battles in the Supreme Court to be granted regulatory status over teeth whitening, dentists in America should take some comfort from a recent landmark ruling in UK courts in relation to the same matter. Dental bodies in the UK have battled against unlicensed teeth whitening operations for years and had a massive breakthrough in 2013.

Last year, the UK’s General Dental Council, which governs the provision of dental services, won its High Court battle with an unlicensed provider of teeth whitening confirming its regulatory status as teeth whitening was deemed to be the business of dentistry.

The British Dental Association and General Dental Council had been fighting against these “cowboy teeth bleachers” for many years, but the campaign was always lacking teeth without the necessary legal backing. The landmark case was taken against a qualified beautician named Lorna Jamous, who was carrying out teeth bleaching procedures in her beauty salon.
Initially a lower court ruled in favor of Ms. Jamous, stating she was within her rights to carry out teeth whitening. However, the ultimate court in the UK, the High Court, ruled that tooth whitening does constitute the practice of dentistry and, therefore, those who are not qualified as dentists and regulated by the GDC are prohibited from carrying out such treatment.
The consequence of this is that any unregulated person to carry out the procedure is carrying out a criminal offense and can be tried as such, allowing any future rogue teeth bleaching to be prosecuted through the courts.

Ms. Jamous was convicted of practicing dentistry and unlawfully carrying on the business of dentistry when not regulated by the GDC. For this she was given a 12-month conditional sentence and ordered to pay £350 toward court costs for the GDC. The punishment is light, but the verdict should be enough to scare off any nonqualified teeth whiteners, otherwise punishments will become a lot harsher.
The GDC is now fighting these “cowboy bleachers” with renewed vigor. One of its first steps was to enter discussions with Groupon, the main daily deals site in the UK that now only includes teeth whitening offers from regulated professionals. It will continue to identify these unlicensed practitioners and bring them to justice.

Eoin Holohan is founder of TeethWise, the first cosmetic dental clinic search and comparison website, based in Google Campus London. To learn more the popular dental blog or sign up for their monthly newsletter, click here. You may contact the author by email at ‪eoin.holohan@teethwise.co.uk.

The Monday Morning Quote #249

“The novelties of one generation are only the resuscitated fashions of the generation before last”

George Bernard Shaw

Seen in a second hand clothes shop in the “English Market” Cork

The Shuffle Chooses..

It’s my habit during the week to listen to podcasts or audiobooks when I’m running.

On Sunday I let my iPod Shuffle pick the music – here are some of the tracks it favoured today. I think either it its owner is an ageing hippy with folky leanings (but there weren’t any Slayer tracks to choose).

Jackson Browne Running On Empty

Jackson Browne Take It Easy

I love The Eagles’ version but this is the man who wrote (most of) it. Here’s me with Jackson standing on that corner in Winslow, Arizona:

Rumer – PF Sloan – http://vimeo.com/42686780

The Staves – FacingWest –

Frank Zappa – Valley Girl Never fails to make me laugh out loud.

Dave Edmunds – Promised Land I love this version of this Chuck Berry Song and I was running within a stone’s throw of where Dave was born and raised. My apologies to the people on Newport Road who may have been disconcerted by a sweaty man “duck jogging” and playing air guitar at 7.30 today.

Also featured on the run Jethro Tull, lots more Jackson Browne, some Fleet Foxes, Laura Marling and a bit of Tom Jones.

A view from the run The Scott Memorial Roath Park Lake

Oral Cancer Rates Up – but is the real truth hard to swallow? …reprised

I try to avoid repeating blog posts but in view of the changes and acceptance of the opinions I felt it was time to redo this one from August 2009. Stephen Hancocks’ editorial in the BDJ as always makes the point far more eloquently than I ever can. You’ll probably need to be a member to view the article but in the article (title HPV vaccine for boys).

There have been a lot of mentions in the media over the past 10 days that the rates of Oral Cancer have risen in individuals in their 40s.

When I was a student & during my hospital career we were told that Oral & Lip Cancers were related to the “5Ss”:

Smoking,
Spirits,
Sepsis,
Sunshine
Syphilis.

Of these without doubt the greatest cause was and remains smoking; spirits were usually blamed but heavy drinkers frequently smoked heavily and there was a synergistic effect of the two. Sepsis was implicated because frequently victims were in poor condition already and heavy smokers’ mouths were never the best with widespread gum disease. Sunshine without doubt led to an increase in tumours of lips & facial skin. Syphilis well that shows my vintage; however we seem to retain some of our puritan attitude to talking about sex.

The recent news has picked, as ever, on the easy target ‘Alcohol To Blame For Rise In Oral Cancers’ said the Sky News headline, ‘A sober look at the rise in mouth cancer’ in The Times blames binge-drinking, (article now behind a paywall) a phrase that has only been in use for a few years far too soon for the effects to be measured properly. It is impossible to properly understand an epidemic until it is over.

As ever the anti-booze bandwagon has used this information to threaten doom, but whilst most reports mention there could be involvement of the human papilloma virus it gets very little publicity. As long ago as Feb 2004 BBC News reported “Oral Sex Linked To Mouth Cancer”. This is the same virus implicated in cervical cancer and causes genital warts, a vaccine is available and should be given to both girls and boys before they become sexually active. This much we can do easily and far easier than persuading sexually active and experimental young people into changing habits. I realise that the nay-sayers will tell you that it leads to promiscuity as it removes the fear of infection but that is really an unrealistic argument.

A recent study conducted by Dr. Maura Gillison at the Johns Hopkins Oncology Center furthered the premise that HPV is linked with certain types of oral cancer. In 25% of 253 patients diagnosed with head and neck cancers, the tissue taken from tumors was HPV positive and HPV 16 was present in 90% of these positive HPV tissues. This information helps to confirm that there is a strong link between HPV 16 and oral cancer. 25% of those diagnosed with oral cancer are non-smokers while the other 75% of those diagnosed have used tobacco in some form during their lifetimes. The research into the relationship of HPV and oral malignancies may give us clues as to the origin of cancer in those 25% of diagnosed individuals who did not smoke. Further research is being conducted into the relationship of HPV with oral cancers.

The habits that dare not speak their name?

I have added the final two paragraph from Stephen’s article. Please take action for the sake of the next generation.

It is therefore very pleasing that the BDA has also now thrown its weight behind the campaign for vaccination of boys as the letter from Stokes outlines in this issue.³ This lends further credence to the case that we have made here in recent years that as dentists and dental teams we have to become far more engaged in both wider health and medical issues, as well as politically more astute and socially conscious. To this end readers are encouraged to write to and lobby their respective members of parliament and/or the public health minister Jane Ellison MP at the Department of Health as well as visiting HPV Action’s website at www.hpvaction.org.

Vaccination also has one other important advantage in that it overrides claims that young people in particular should be taught to restrain themselves sexually, reducing promiscuity and the chances of contracting sexually transmitting disease (STD). Voluntary restraint is demonstrably ineffectual as levels of teenage pregnancy (the UK has amongst the highest rates in Europe) and STDs rise. Oral sex is a fact of twenty-first century life (and it has hardly been invented recently anyway) and it is a subject that, until vaccination is more widespread, may also be appropriate to discuss with some of our patients. If talking about tobacco and alcohol habits have seemed like difficult subjects to raise then talking about oral sex may present a further challenge but it is one we need to consider. It is, I’m afraid, obvious.

BDA research identifies dental jobs concerns

The three posts this week seem to reflect the current state of British dentistry. A bubble in NHS practice prices (perhaps), possible changes in employment status of associates and now tales of un(der) employment. Add to this the mismanagement of FD1 place allocations and it’s apparent that NHS dentistry is in as much of a crisis as the rest of the NHS.

More than one-in-ten young dentists completing their vocational or foundation training may be experiencing difficulties finding permanent posts, newly-published research from the British Dental Association (BDA) suggests. Approximately 12 per cent of those completing their training last summer had not secured a role before its conclusion, the 2013 BDA Survey of Foundation Dentists and Vocational Dental Practitioners found.

For the second successive year a growing proportion of trainees in England and Wales who participated in the research reported that they were obtaining posts in primary salaried or hospital dentistry, although whether this is a trend or not will only be more reliably established by future surveys.

The research adds to concerns of potential employment problems in dentistry identified by the BDA’s 2013 Dental Business Trends Survey. That research found that more than 10 per cent of current Associate Dentists satisfied the International Labour Organisation criteria used by the Office of National Statistics to be classed as under-employed; wishing to work more hours and being available to start doing so within two weeks.

And it follows warnings by Health Education England and the Centre for Workforce Intelligence at the end of 2013 that a potential over-supply of between 1,000 and 4,000 dentists may occur in England by 2040 if the current number of places for dental students is not reduced.

Dr Judith Husband, Chair of the BDA’s Education, Ethics and the Dental Team Committee, said:

“This research suggests that employment opportunities in general dental practice are not as readily available as they once were for newly-qualified practitioners. In doing so, it adds to the evidence base that must be considered as recommendations to reduce the number of places to study dentistry are contemplated.

“As the BDA has warned, these decisions must be thought about very carefully, taking into account likely changes to the way NHS dental care is delivered and safeguarding the needs of patients. But they must also be responsible to the young people who choose to invest time, money and dedication to pursuing careers in dentistry, and the taxpayers who contribute to the cost of their training.

“These are difficult decisions that must be made, implemented and monitored with great care, and in dialogue with the profession and the academic institutions they will affect.”

http://www.bda.org/dentists/policy-campaigns/research/workforce-finance/students-young/vdp-survey.aspx.

Associate Status (quo or no)?

Like many observers (i.e. neither a principal nor an associate) I feel that the self employed (S/E) status of associates (particularly those on fixed contracts as NHS performers, taking little or no risk, not providing kit etc) is likely to be reviewed by HMRC sooner rather than later.

I remember when the majority of hygienists were S/E and the change in the TaxMan’s interpretation of their status in the early 90s necessitated a bigger degree of proof from their accountants to stay classified as S/E.

What made me write this now is most definitely not to throw fuel on the “associates are parasites / principals are greedy” debate, as that has been done to death. Rather to make people aware that HMRC are looking at professions with positions that are traditionally considered S/E and the advantages that can bring.

My thoughts are that everyone needs to be very careful about S/E status whether they be business owners or associates and that it may be time to ensure that the evidence for your status is sound. (“We have always done it this way and there haven’t been any problems” is not an excuse).

With the current government seemingly shy to take on big business over tax – Vodafone, Starbucks, Google, Amazon etc they’ll have to get more from somewhere.

I sometime wonder if this was an extension of the last NHS contract, effectively nationalising NHS practices and then converting the “NHS dentists” (horrible term for a professional to accept) into employees. What did Sir Humphrey aided and abetted by Barry have in mind for the long game?

In the November edition of BDA News, James Goldman gave advice on ensuring that you stay self-employed. Here are some of his tips:

Ensure that your contact is clear, honest and in writing.
The associate has the right to engage a locum.
The associate must be seen to be taking a commercial risk. (Open to debate with a “fixed” contract – my opinion).
There is a licence fee arrangement so that the associate pays the practice owner for the use of surgery, equipment & staff.

James does quote a couple of legal cases and concludes that associates are closer in the eyes of the law to lap dancers than valets. In spite of his assurances I still feel that the day is coming when NHS associates (the term performers makes them sound like animals in a circus) will be liable to Tax & NI like other team members.

This from “The Lawyer” is what provoked me to put finger to keyboard:

Salaried partnership is one of the opaque mysteries of the legal profession. Falling in a grey area between having a slice of a firm’s equity and being the tea boy, the title means different things to different firms and almost nothing to clients. Now Britain’s taxman has twigged to the anomaly, realising that – if nothing else – salaried partnership status at LLPs has been a clever tax avoidance wheeze. But the loophole is closing, with our commentators at the London office of Debevoise & Plimpton pointing out that Revenue & Customs has noticed that ‘many LLPs have members engaged on terms more closely resembling those of employees, who work for the business, than of traditional partners, who carry on the business’. All of which will have some pretty profound implications on the national insurance front at large LLP law firms.

Full article.

Practice Prices, will it end in tears or with an adjustment?

From Dentistry.co.uk

The latest goodwill figures from NASDAL show that the average price paid for all dental practices is 100% of turnover with NHS and mixed practices still commanding higher than average values.

The survey for the quarter ending 31 October featured the sale of 60 practices where a NASDAL lawyer or accountant had been involved. The average sale price for an NHS practice was 117% of turnover, for a private practice 88%, and for a mixed practice, 110%.

Alan Suggett, a partner in UNW LLP, and the NASDAL member responsible for the survey, said that large NHS practices continued to be valued on a multiple of their profits rather than percentage of turnover and this tended to push up prices.

The latest survey showed that some large mixed practices in the London orbit were fetching prices as high as 160% of turnover compared to practices in Wales, the Midlands or the north where practices were often selling for lower than 100%.

Said Alan: ‘Because there are a number of transactions which vary significantly from the averages, care should be taken when using the results of the survey, which reflect averages based on figures for the entire country.’

He continued: ‘We are seeing the big traditional corporates moderating their approach a little and not being so acquisitive, but other buyers remain very keen, regardless of the uncertainty surrounding the reformed contract due soon.’

Alan said he thought values might be ready to peak and the next survey in 2014 might reveal slightly lower prices across the board, but he retained an open mind. Although there is a lot of uncertainty about the future of the NHS for younger dentists, the 2006 contract had broadly been a positive experience.

‘My view is that young dentists continue to be optimistic about the future and those who buy practices are faring better than friends in different professions.’

John Grant, a dental specialist lawyer and partner in Goodman Grant, said that the ‘feeding frenzy’ could not be ascribed to one single factor, but he agreed that young dentists were helping fuel prices. ‘They recognise that associate rates of pay are unsustainable and they believe that the best way forward is to own their own practice.’

In his experience the dental sales market had never been hotter and he found some of the prices being paid for practices in London and the South East baffling.

(One simplistic take on this last line is that the days of 95% of young people moving away from home to university have gone – especially in London. So there are large numbers of graduates in or around the capital city who haven’t moved away and don’t want to move far from home who will pay a premium. Pure supply and demand.)

The Monday Morning Quote #248

“If you deliberately plan on being less than you are capable of being,

then I warn you that you’ll be unhappy for the rest of your life.”

Abraham Maslow in Motivation and Personality

Research Project – Dental Burnout – Help Needed

I was more than familiar with the twin beasts of stress and burnout as a Dental Professional. Jo Taylor’s last survey showed that it wasn’t just me (I think I really knew that but to see it in black and white was an awakening). Here’s news of her next bit of research with which YOU can help,.

Joanna Taylor undertook a survey on Stress in the Dental Team which was published in Dentistry Magazine in 2012. She is now following that up with a research project on “Happiness v Stess and Burnout in the Dental Profession”.

This is what Joanna has to say…

I would be very grateful for your help with a research project I am undertaking as part of my post-graduate studies for my Diploma in Psychotherapy. This survey is open to all qualified dentists. All data will be treated in the strictest confidence and will remain anonymous for the purposes of submission and any future publication of the research. I hope the results will go towards the creation of a system for positive change in the levels of stress and burnout amongst members of the dental profession in the future.

The survey should take between 5-15 minutes to complete and, if you choose to take part, you may opt out at any time; incomplete submissions will be deleted and will not form part of the research.

Although you are welcome for your answers to remain anonymous, I will be conducting further research and a pilot study later in the year based on the results of this survey, which will be looking at the creation of preventive measures against burnout in dentistry. If you feel that this might be something you could find of interest and you would like to take part, you are welcome to provide your e-mail address at the end of the survey and I will contact you with more information in due course.

Please follow this link to take you to the survey: https://www.surveymonkey.com/s/happiness_vs_burnout_in_dentistry

Thank you so much to all those who choose to take part; your contribution is greatly appreciated. If you would like to know more about me and the work I do, you are welcome to visit my website at http://www.joanna-taylor.co.uk/

With grateful thanks

Joanna Taylor MHS (Acc)
Accredited Clinical Hypnotherapist
NLP Master Practitioner and Certified Trainer
Trainee Psychotherapist

Bridge2Aid urgently needs your help

A message from Mary Topley CEO Bridge2Aid, please read and then act.

Bridge2Aid urgently needs your help

Due to circumstances beyond our control, we need to raise at least £50,000 before the end of March 2014. Without these funds our vital work will be under threat.

Why do we need such urgent help?

In the past few months, two things have happened resulting in a significant financial challenge for us.

Firstly, Bridge2Aid (B2A) was recently the victim of a sophisticated financial fraud in Tanzania, orchestrated by an organised crime ring. Neither the police investigation nor our own review has shown any link with the B2A team. High quality counterfeit cheques were used the day after a grant payment was received to extract a large sum of money illegally. We have taken swift action to tighten procedures and continue to pursue the funds taken, plus we have switched accounts to a new international bank.

Secondly, we’re also facing a sudden, and large (70%), drop in funds from our main corporate sponsor, who dramatically announced during the latter half of 2013 that they would be slashing Bridge2Aid’s final payment of a three-year grant due to a large fall in their own profits. They have done this with all the projects they fund.

These two incidents combined mean that instead of starting 2014 with a low reserve, which we could manage, we now have a significant challenge to deliver treatment and training programmes in the first part of the year.

We are already 3 months into a new fundraising strategy that will deliver additional funds towards the middle of 2014. We have responded proactively by reducing programme numbers and costs for 2014, but we need your help in the short term to help us in recovering from these two unexpected events.

Our long-term strategy remains the same, and with our wonderful B2A family, track record, reputation and impact, we are very confident we can continue to fund B2A from June onwards.

Our current challenge

We need to raise at least £50,000 before the end of March 2014 to ensure we can continue our vital work through the rest of the year and beyond.

We’re doing everything in our power to rectify the situation, including raising additional funds and working with the bank and the authorities in Tanzania to retrieve our stolen funds. However, we cannot do this without your help. Our need is urgent.

Right now there is a very real threat to our work – and there are still millions of people suffering daily agony in East Africa who need our help. We have plans in place, a committed and gifted team, and hundreds of volunteers ready to deliver vital pain relief and training that would result in access to emergency dentistry for more than 3 million people over the next 3 years.

Please donate now to help us continue the vital work that so many people have generously contributed to over the past 10 years, and make a life free from dental pain a reality for communities in need.

Forgive the direct nature of this appeal but we need your help, and we need it now. Without additional funding B2A will be unable to continue its work in East Africa or anywhere else. The urgency of this appeal cannot be overstated.

We have a dental community of 50,000 people in the UK. If just 1,000 of those people are able to make a donation of £40, plus gift aid, we will reach our target.

Can you help us in what is a very real time of need?

We are looking for individual and private donations in units of £40, £80 and £100 that, with the addition of Gift Aid, will give us £50, £111 and £133 in total to replace the missing funds and reduced grant, enabling the planned programmes and pain relief for millions to go ahead.

In addition, we would be most grateful if you could share our message and need with your friends and family, as well as your community as a whole, to help support us in this undertaking. If you need help organising this, please do not hesitate to contact us at B2A.

Meanwhile, if some of our much-valued friends in the supply, corporate and retail sectors of dentistry could give larger donations, we can make our way through the shortfall period and carry on with our mission.

You can make a donation in the following ways:

Online via our website – www.bridge2aid.org/urgentappeal
Online direct to our bank, RBS, sort code: 16.16.20, account no. 10072646
Directly onto our justgiving page – www.justgiving.com/B2Aurgentappeal
By cheque made payable to ‘Bridge2Aid’ and posted to Bridge2Aid, Well House, The Chipping, Wotton-Under-Edge, Gloucestershire. GL12 7AD
By calling 0845 8509877

We face this huge endeavour with the courage of our convictions and the confidence that our many friends will gather around us and offer their time, talents and funds.

Thank you for your fantastic support to date and please continue to help us with our work.

Kind regards

Mark Topley

CEO Bridge2Aid

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