“I studied the lives of great men and famous women, and I found that the men and women who got to the top were those who did the jobs they had in hand, with everything they had of energy and enthusiasm.“
The Greatest Breakthrough Since Lunchtime #17 – Protection from periodontitis and related chronic diseases
Protection from periodontitis and related chronic diseases
From Medical News Today
A drug currently used to treat intestinal worms could protect people from periodontitis, an advanced gum disease, which untreated can erode the structures – including bone – that hold the teeth in the jaw. The research was published ahead of print in Antimicrobial Agents and Chemotherapy.
Current treatment for periodontitis involves scraping dental plaque, which is a polymicrobial biofilm, off of the root of the tooth. Despite this unpleasant and costly ordeal, the biofilm frequently grows back. But the investigators showed in an animal model of periodontitis that the drug Oxantel inhibits this growth by interfering with an enzyme that bacteria require for biofilm formation, says corresponding author Eric Reynolds, of the University of Melbourne, Australia. It does so in a dose-dependent manner, indicating efficacy.
The researchers began their search for a therapy for periodontitis by studying the symbioses of the periodontal pathogens, using genomics, proteomics, and metabolomics, in animal models of periodontitis. They soon found that the periodontal biofilm depended for growth on the availability of iron and heme (an iron-containing molecule related to hemoglobin), and that restricting these reduced levels of the enzyme, fumarate reductase. Since Oxantel was known to inhibit fumarate reductase in some bacteria, they then successfully tested its ability to inhibit fumarate reductase activity in Porphyromonas gingivalis, one of the major bacterial components of periodontitis biofilms. Fumarate reductase is absent from humans, making it an ideal drug target.
They also showed that Oxantel disrupted the growth of polymicrobial biofilms containing P. gingivalis, Tannerella forsythia, and Treponema denticola, a typical composition of periodontal biofilms, despite the fact that the latter alone is unaffected by Oxantel.
The researchers found that treatment with Oxantel downregulated six P. gingivalis gene products, and upregulated 22 gene products, all of which are part of a regulon (a genetic unit) that controls availability of heme.
Periodontitis affects an estimated 30-47 percent of the adult population with severe forms affecting 5-10 percent. It also increases the risks of diabetes, heart disease, stroke, arthritis, and dementia, says Reynolds. These risks arise due to the pathogenic bacteria that enter the blood stream from periodontitis, as well as from the chronic inflammation caused by this disease, he says. Additionally, periodontitis correlates with increased risk of cancers of the head and neck, the esophagus, the tongue, and the pancreas, the investigators report.
For the history of this “TGBSL” series read here
“Why do you keep mentioning the NHS, Alun?”
“Why do you keep mentioning the NHS, Alun?”
Is one of the questions that I am asked. Main answer: because I have a longish memory and have read a lot about the evolution of the organisation that, to quote the Tory ex-chancellor of the exchequer Nigel Lawson’s memoirs, “the nearest thing the English have to a religion”(google it for a day well spent reading opinions in support and otherwise.)
I started work in general dental practice on April 2nd 1981. There had just been an NHS patient fee contribution increase from £8 to £9 for a routine course of treatment; the principals in the practice thought this would deter patients from attending but, apart from the odd “I see you lot have another pay rise” comment, nothing changed, or so I gathered. The NHS reforms and the, Mrs Thatcher led, assault on professionals and their status was just gathering strength. Soon would come the abolition of the hospital consultants’ dining room, seen by some as an exclusive club but in many cases used as a secure and confidential place to exchange ideas, clinical opinions and get advice on patient care. Through the 80’s in dentistry came repeated maximum patient fee hikes until Kenneth Clarke’s introduction of a “percentage” of the total changed the model significantly so that dental charges were no longer the “prescription charges” for teeth but reflected the cost (tho’ not always the value) of the treatment delivered.
Enough of history.
The words of advice I was given in 1981 were:
- You’re a self-employed professional,
- You happen & choose to contract out to the NHS for each and every course of treatment,
- Never forget that you are an independent,
- Only you decide what you will do and under what model you choose to work,
- You studied a subject at a university to be used for the benefit of individual patients,
- Don’t make the treatment fit the system,
- Listen to these rules and you’ll keep your own sanity, your soul and you’ll be a success long term.
I never forgot those words especially the first couple of lines, and when the model offered by the NHS became unbearable for me to work with in the early 1990s I chose not to take their contracts and stood on my own two feet as a business. I think UK dentists especially the younger ones need to be reminded of their independent status before it has slipped away from them entirely. There is no such thing as an NHS dentist or an NHS doctor they are dentists and doctors, nurses, midwives etc etc all independent trained to be professional first, second and third.
This long preamble is in order for me to quote in full Roy Lilley’s blog piece today. He sums up a lot of my present thoughts. In Margaret Heffernan’s book Wilful Blindness she argues that our biggest threats are not the things we cannot see but those that we can. But choose to ignore.
“You already knew that!
Last week was another action packed week on the road. I found a clean BP petrol station loo! Thank you, everyone, for your warm welcome. At one event I was taken to one side by a very elegantly dressed lady of a certain age (Gucci Soho patent leather shoulder bag, Eleonaro black riding boots, Thomas Pink raspberry gingham shirt, Tyrwhitt black crepe suit… you know the type) a very experienced business woman and non-exec… she asked; ‘Do you know what’s going on… really?’
She laughed, I laughed and said; ‘It’s complicated!’
What is going on? I think this is what she meant. The NHS is in the SH-One-t:
- At the end of July 2013, almost half of non-FTs forecast a deficit for 2013/14. The collective position for all these trusts? A forecast deficit of £232 million for the financial year. Ouch!
- Crucially, margins for earnings before interest, taxes, depreciation and amortization (known by finance types as ‘EBITDA’) are nose diving across all Trusts, except specialist FTs. This is a crucial indicator of whether a hospital is financially viable. Double ouch!!
- Nearly half of non-FTs ended 12/13 below the 5% margin Monitor would normally require to grant FT status. A further 40 FTs were also below this benchmark! Translated; this means about a third of all trusts are financially flaky and bluntly, there is not enough money and there are too many hospitals. This is beginning to look like a melt-down. Triple ouch!!!
The solution? Trusts could up their game. However; the Nuff’s Trust research on 110 Trusts suggests that the rate of productivity growth has not improved since the beginning of QIPP in 2010/11. Better productivity won’t get anywhere near the savings at the levels planned. Forget it. More ouch!
How many governments have tried to provide better care for less, by treating people outside hospital? Sorry; it’s not happening. Spending on the secondary care continues to rise while GPs have seen real terms cuts. Reducing emergency admissions has been a key priority… I’m sorry to report… the most recent figures show that they are increasing. Even more ouch!
Shifting care out of hospital to GPs and primary care isn’t working. A number of evaluations show very limited evidence of these schemes reducing emergency hospital admissions in the short term… ouch. Just ouch… ouch… ouch.
Source The Fabulous Nuff’s latest report.
Got all that. It’s really code for; we have too many customers and not enough money and crucially, no idea what to do next. It’s, sort of, the private sector equivalent of over-trading and the road to hell in a hand-cart.
The Nuff’s fabulous Chief Economist, Anita Charlesworth said:
“The NHS faces an unprecedented challenge in finding savings of 4% per year. This will be difficult to achieve through productivity improvements and there are no clear signs of initiatives so far making savings by reducing emergency admissions to hospital.
Meanwhile, although pay restraint and management cuts have created large savings, these cannot close the long-term funding gap without threatening the quality or sustainability of care services.
We need to monitor the signs that this challenging situation could lead to an unsustainable financial squeeze on hospital trusts. Recent figures show that smaller hospital trusts and those which still have to become foundation trusts face particular difficulties. The weakest hospital trusts appear to be getting weaker but will still face pressure to increase spending following the Francis Inquiry and initiatives such as “seven-day” working. Policy-makers need to think about how they can deal with the situation.”
I don’t know why everyone at the top of the politico-policy food chain is so mealy-mouthed. Trusts are too busy dealing with demand on inefficient services that are very busy and can’t become more efficient because they are too, very busy… dealing with demand.
If the NHS was a business it would be broke, bankrupt and skint. If you bought it you would have to plunge a massive amount of money into efficiency-gains and hope to get a return in 40 years.
Last week I picked up palpable concerns that the wheels are coming off. In the meantime Le Tache and other NHS bosses run around like headless chickens saying ‘the NHS has to change’. My guess is they have no idea ‘into what’ and if they did they’d not have the cajones to say.
So, that’s what I found out last week… but I guess you already knew that! “
The latest ezine and an opportunity to make changes in your business life.
Last week’s Ezine – I forgot to share on-line at the time.
Time for change
I am aware that it has been a long time since my last newsletter but “tempus fugit” for me too. From now on it will be available once a month which saving me feeling guilty about missing a fortnightly deadline.
I will continue to:
- Write regular blog posts at theincisaledge.co.uk
- Tweet – follow @reesthecoach
- Please take the time to “like” the Facebook
- Finally after a tentative start and in spite of technical problems at Dental Showcase the podcast will be up and available from early next week. Subscribe through iTunes to theincisaledge.
- In addition I will continue to contribute to Dental Tribune, dentinaltubules and whenever anyone wants my contributions (just ask).
2013 has seen me make profound changes in my life, some harder than others. In addition to moving our main base from Gloucestershire to West Cork I realise that now is the time to give up clinical work completely. I have kept one hand in a nitryl glove and the other on a keyboard for eight years -the GDC will have to survive without my subscription in 2014.
A great outcome from this decision is that I am able at last to engage with some more clients.
Take a look at the following list and honestly mark yourself out of 12.
- I have a yearly, half-yearly and quarterly strategic plan against which the business is managed. (not just a To-Do list or a reaction to what the day-list brings)
- My diary is organised so that every week brings me three things 1)focussed clinical time where I am producing high quality dentistry for a maximum return 2) time to develop my business 3) space to concentrate on personal development.
- I have focussed and proven internal and external marketing systems that bring quality new patients to the practice in the appropriate numbers (as opposed to hoping and praying).
- My practice has a proven and focussed patient journey that is fully understood by all team members and produces clearly measurable results.
- My support team understand and embrace what the goals are for the business.
- All team members are committed to a programme of continuing development so that they are able to work at maximum effectiveness.
- I take time to develop and introduce new services and treatments for our patients that differentiate us so that we stay ahead of our competitors in the the market place.
- There is a system of financial controls that monitor outgoings, compares with budgets and prepares for whatever the future brings (as opposed to finding out on the 29th that there isn’t money left for the end of the month).
- I enjoy above average remuneration from patients who are happy to pay my fees.
- I am fully aware of the changes that are taking place in clinical dentistry and attend courses regularly where I network with my similarly minded clinical peers.
- My business planning and behaviour is challenged on a regular basis by a respected peer as it would be in a large company (as opposed being seduced by my own story or stuck in a rut).
- I enjoy my work and look forward to returning from holiday.
If you scored:
10 – 12. Congratulations you’re ahead of the curve.
7 – 9. You’re starting to struggle.
0 – 6. There’s a risk that you will be overwhelmed by events in the foreseeable future and you really do need some help.
My help
How do I work?
- Initially we have a “Chemistry session” call done on either telephone or Skype to discuss in-depth the challenges that you are facing in your practice.
- From that we decide whether we want to work with each other.
- My most successful clients work with me for at least six months or, more often, a year because there are no magic wands and change does not happen overnight.
- Fees vary on the amount of work, time needed and will be discussed at the Chemistry session.
I am in a position to work with another dozen, maybe 15 clients from January 1st 2015 so if you’re in the mood to make changes drop me a line and we’ll arrange to talk.
alun@dentalbusinesspartners.co.uk
+44 7778 148583 (UK)
+353 86 074 6723 (Ireland)
The Monday Morning Quote #240 – Remember
The older I get the more I realise the sheer bloody futility of so many wars. The millions of young men slaughtered for the sake of a politician’s point of principle. Remembrance Sunday leaves me in tears not only for those who whose lives were shed but also for those left behind who will never forget them. I wonder if the lessons are ever learned by Tony Blair, George(s) Bush and their successors.
“They shall grow not old, as we that are left grow old:
Age shall not weary them, nor the years condemn.
At the going down of the sun and in the morning,
We will remember them.”
(From “For The Fallen” by Robert Laurence Binyon)
- .
Dulce Et Decorum Est
Bent double, like old beggars under sacks,
Knock-kneed, coughing like hags, we cursed through sludge,
Till on the haunting flares we turned our backs
And towards our distant rest began to trudge.
Men marched asleep. Many had lost their boots
But limped on, blood-shod. All went lame; all blind;
Drunk with fatigue; deaf even to the hoots
Of disappointed shells that dropped behind.
GAS! Gas! Quick, boys!– An ecstasy of fumbling,
Fitting the clumsy helmets just in time;
But someone still was yelling out and stumbling
And floundering like a man in fire or lime.–
Dim, through the misty panes and thick green light
As under a green sea, I saw him drowning.
In all my dreams, before my helpless sight,
He plunges at me, guttering, choking, drowning.
If in some smothering dreams you too could pace
Behind the wagon that we flung him in,
And watch the white eyes writhing in his face,
His hanging face, like a devil’s sick of sin;
If you could hear, at every jolt, the blood
Come gargling from the froth-corrupted lungs,
Obscene as cancer, bitter as the cud
Of vile, incurable sores on innocent tongues,–
My friend, you would not tell with such high zest
To children ardent for some desperate glory,
The old Lie: Dulce et decorum est
Pro patria mori.
Futility
Move him into the sun—
Gently its touch awoke him once,
At home, whispering of fields unsown.
Always it awoke him, even in France,
Until this morning and this snow.
If anything might rouse him now
The kind old sun will know.
Think how it wakes the seeds—
Woke, once, the clays of a cold star.
Are limbs so dear-achieved, are sides
Full-nerved,—still warm,—too hard to stir?
Was it for this the clay grew tall?
—O what made fatuous sunbeams toil
To break earth’s sleep at all?
The Weekend Read – Extraordinary Popular Delusions and the Madness of Crowds by Charles Mackay
The lesson that my father taught me was, “when every body is talking about how much their house is worth is the time to have nothing to do with the property market at all“.
In the week that Twitter shares were launched to overwhelming “approval” from the stock market and with the world still reeling from the last banking debacle I think it reasonable to feature this marvellous little book.
The Amazon review does it justice:
“First published in 1841, Extraordinary Popular Delusions and the Madness of Crowds is often cited as the best book ever written about market psychology. This Harriman House edition includes Charles Mackay’s account of the three infamous financial manias – John Law’s Mississipi Scheme, the South Sea Bubble, and Tulipomania. Between the three of them, these historic episodes confirm that greed and fear have always been the driving forces of financial markets, and, furthermore, that being sensible and clever is no defence against the mesmeric allure of a popular craze with the wind behind it.
In writing the history of the great financial manias, Charles Mackay proved himself a master chronicler of social as well as financial history. Blessed with a cast of characters that covered all the vices, gifted a passage of events which was inevitably heading for disaster, and with the benefit of hindsight, he produced a record that is at once a riveting thriller and absorbing historical document. A century and a half later, it is as vibrant and lurid as the day it was written. For modern-day investors, still reeling from the dotcom crash, the moral of the popular manias scarcely needs spelling out.
When the next stock market bubble comes along, as it surely will, you are advised to recall the plight of some of the unfortunates on these pages, and avoid getting dragged under the wheels of the careering bandwagon yourself.”
Reading this will be time well spent, or should I say invested?
It’s available from Amazon.
Bupa moves into supermarket dental clinics
Bupa moves into supermarket dental clinics from Health Investor
Bupa has acquired Instore Dental and Store Dental Care, which operate dental surgeries in six supermarkets, for an undisclosed amount.
The two companies, which are both co-founded by Dr Lance Knight, operate five clinics in Sainsbury’s supermarkets and one in a Tesco store.
Four of the Sainsbury’s clinics are in the Manchester region with fifth in Merton, London. The Tesco clinic is based at the store in Slough.This deal marks the first time Bupa will be offering dental services from a supermarket location.
Bupa Health Clinics managing director Tracey Fletcher commented that the acquisitions brought the company “a step closer to our aim of significantly expanding our dental business to 50 clinics and bring one of the UK’s biggest chains of private dentists”.
The acquisitions increase the number of Bupa-operated dental surgeries to 21.
Dr Lance Knight, clinical director and co-founder of Instore Dental and Store Dental Care said: “We are delighted to be joining Bupa. With Bupa’s backing we can grow to offer 
our range of services to even more people across the country.
“We know that people value our easy-to-reach locations and convenient appointment times with the guarantee of a quality dental service.”
Improving gum health may reduce heart risk – the evidence continues to roll in.
Researchers at Columbia University in New York suggest that if you look after your gums, you could also be reducing your risk of heart disease. They claim that improving dental care slows the speed with which plaque builds up in the arteries.
Writing in a recent online issue of the Journal of the American Heart Association, they report a prospective study that shows how improving gum health is linked to a clinically significant slower progression of atherosclerosis, the process where plaque builds up in arteries and increases a person’s risk of heart disease, stroke and death.
Lead author Moïse Desvarieux, associate professor of Epidemiology at Columbia’s Mailman School of Health, says:
“These results are important because atherosclerosis progressed in parallel with both clinical periodontal disease and the bacterial profiles in the gums. This is the most direct evidence yet that modifying the periodontal bacterial profile could play a role in preventing or slowing both diseases.”
For their study, the researchers followed 420 adults aged between 60 and 76 from northern Manhattan who were taking part in the Oral Infections and Vascular Disease Epidemiology Study (INVEST).
Measuring artery thickness
All participants underwent oral infection and artery thickness exams at the start of the study and at the end of follow-up, which was a median of 3 years.
The oral infection exams retrieved a total of over 5,000 plaque samples. For each participant, the samples came from several teeth and under the gums.
The oral plaque samples were analyzed for the presence of 11 strains of bacteria known to be involved in periodontal disease and seven control bacteria.
Samples of fluid from around the gums were also taken and assessed for levels of Interleukin-1β, a marker of inflammation.
The extent of atherosclerosis, was assessed using high-resolution ultrasound scans to measure artery thickness or intima-medial thickness (IMT) in both carotid arteries.
The results showed that both improved gum health and a reduction in the proportion of bacteria linked to periodontal disease correlated to a slower progression of atherosclerosis, as measured by IMT.
These results did not change significantly when adjusted for factors that could influence them, such as body mass index, cholesterol levels, diabetes and smoking.
Previous studies have linked an increase in carotid IMT of 0.033 mm per year (about 0.1 mm over 3 years), to a more than double increase in risk of heart attack and stroke.
In this study, the participants whose gum health got worse over the 3 years showed a 0.1 mm increase in carotid IMT, compared with the participants whose gum health improved.
Co-author Panos N. Papapanou, professor at Columbia’s College of Dental Medicine, says:
“Our results show a clear relationship between what is happening in the mouth and thickening of the carotid artery, even before the onset of full-fledged periodontal disease. This suggests that incipient periodontal disease should not be ignored.”
Atherosclerosis and periodontal infections
Although the researchers did not look into how bacteria in the mouth can lead to atherosclerosis, one theory suggested by animal studies is they increase inflammatory markers, which can trigger or worsen the inflammation in atherosclerosis.
In a previous study that took measures at one point in time, the team had already found that higher levels of disease-causing bacteria were linked to thicker carotid IMT. This new study builds on those results by looking at the participants over time.
Prof. Desvarieux adds:
“It is critical that we continue to follow these patients to see if the relationship between periodontal infections and atherosclerosis carries over to clinical events like heart attack and stroke and test if modifying the periodontal flora will slow the progression of atherosclerosis.”
Funds from the National Institutes of Health (NIH), the National Institute of Neurological Disorders and Stroke (NINDS), the Institut National de la Santé et de la Recherche Medicale (INSERM), among others, helped finance the study.
In 2010, UK researchers reported that gum bacteria can increase risk of heart attack and heart disease, because the same bacteria that cause dental plaque can escape from the mouth into the bloodstream and trigger clots.
Written by Catharine Paddock PhD
Intra-oral cameras are great – but apparently not good enough for everyone.
This piece was inspired by a conversation on Facebook with someone I have never met who was getting excited about having an intra oral camera.
I bought my first intra-oral camera 21 years ago, I bought the second at exactly the same time, with the same order, on the same invoice. Compared with today’s cameras they were bulky, lacking in features, not spectacularly clear, difficult to manoeuvre and expensive. But and it’s a very big BUT, patients loved them. They loved the high “techyness”, the fact that they had never seen their teeth, gums and, in the case of children, their ears before – it was a great ice breaker with children.
Being able to share images with patients had differing responses.
- The sight of a failing huge amalgam filling that would best to be replaced with a crown brought a sage nod of agreement from many including those who didn’t have the first idea what they were seeing.
- Being able to take a new patient on a tour of their own mouth was memorable for the patient and a real practice builder.
- Evidence of calculus on buccal surfaces of upper molars was a great encouragement for some.
- Redness and generalised “kippering” (my term) of the palatal mucosa in smokers was often another drip of evidence to persuade them that the time to stop was nigh.
- Comparing and contrasting labial and lingual surfaces helped to inform many.
- The “yeuch! that can’t be my mouth” response after showing patients the calculus, plaque and generalised inflammation was a great motivator.
Notice something about that list? Mostly it’s about gums, health and motivation. The bedrock of all dentistry. You see the second (or was it really the first?) camera that I bought was for my hygienist. I knew that she needed every tool she could lay her hands on to help, to educate and to inform our patients in how best they could control the diseases in their mouths.
We knew that different people needed different ways of having information presented to them.
Being able to see inside their own mouth was a “wow” factor second to none in dentistry.
So why, more than two decades later, is the idea of a hygienist having an intra-oral camera not the norm?
When I visit practices some of the questions that I ask are:
- “Do you have an intra-oral camera?”
- “Do you use it on the majority of your patients?”
- “Why not?”
- “Does the hygienist/therapist have one?”
- “Why not?”
Generally the answers are non-committal. “I suppose we should”. It would be a good idea” and so on.
If you want your patients to truly experience and understand what is happening in their own mouths then it’s not enough to tell – they must be able to see.
If you want your hygienists and therapists to do their best for patients they need the best tools.
The Monday Morning Quote #239
“The single biggest problem in communication…
… is the illusion that it has taken place.”
George Bernard Shaw
The Incisal Edge 