RiskmattersTopical issues and risk management for dentists at the start of their career

www.dentalprotection.org

UK and Ireland

Inside issue 30

Everyone is talking about YDC 2015Three articles prepared by this year’s speakers appear on pages 5–12–

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Dental Protection Limited is registered in England (No. 2374160) and is a wholly owned subsidiary of The Medical ProtectionSociety Limited (MPS) which is registered in England (No. 36142). Both companies use Dental Protection as a trading nameand have their registered office at 33 Cavendish Square, London W1G 0PS

Dental Protection Limited serves and supports the dental members of MPS with access to the full range of benefits ofmembership, which are all discretionary, and set out in MPS’s Memorandum and Articles of Association. MPS is not aninsurance company

Dental Protection® is a registered trademark of MPS

Horizons roadshowSave the date 3

News from Dental ProtectionBenefits of membership 4

Survival of the fittestReena Wadia’s top tips for professionalsuccess 5–7

Be preparedJulie Cross guides you through somecommon oral surgery pitfalls 8–9

It’s complicatedSimon Stone offers some help for thoseseeking endodontic success 10–12

The spirit of summerSarah Bradbury discusses the impact ofalcohol on oral and general health 13–14

ContactsWe love to hear from you 16

Contents

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Editorial

It may also serve to help some readers toadopt a more proactive, personalised andfocused approach to planning our learningneeds by way of a Personal DevelopmentPlan (PDP). The dental team is now beingencouraged to think more critically abouttheir actual training needs, to prioritisethem and formulate a plan to achievethem.

A PDP is basically a written scheme thatrecords all of these activities in an easilyaccessible format. It also enables us todemonstrate to any interested third partythat we are committed to a formalisedapproach to our learning.

It is an area of professional life that allmembers of the dental team should movetowards. It is also a concept which is slowlybecoming a feature of the General DentalCouncil’s registration process.

MoreAnother speaker from that conference wasReena Wadia whose tips on surviving thefirst years in practice offer a differentinsight into clinical practice.

I hope these articles will be inspiring forthose who missed the opportunity the first time round and serve as a practicalsouvenir for those who attended the event.Indeed the delegates are the ones who can confirm that education, learning andenjoyment are not incompatible, and I know that our events team will ensurethat this philosophy is maintained in allfuture events including the Horizonsroadshow in September. Recent graduatesare particularly welcome at these eventsand I look forward to seeing some of you there.

Best wishes,

James Foster LLM BDS MFGDP(UK)Senior Dento-Legal Adviser james.foster@dentalprotection.org

Dear Colleague,

It often seems that the most popular dentalevents are the ones which are perceived asbeing most enjoyable to attend; possiblybecause some of the subject matter isfamiliar. But popular appeal doesn’t alwaysdeal with more pressing educational needs.

Once the undergraduate course has beencompleted , the learning process has reallyonly just started and it is all too easy toselect only the subjects that seem topicaland speakers who are popular.

Knowledge gapsDental Protection has heard from members,about situations where a secondary careprovider has refused to accept a referralbecause it is felt that a general dentalpractitioner should be capable of providingthe treatment in question – frequently thisinvolves molar endodontics or oral surgery.

The dentist will often explain that they arenot particularly good at endodontics andoral surgery and so do not feel competentto undertake the treatment. Meanwhile,routine endodontics and exodontia isconsidered to be a core dental skill and assuch a GDP might normally be expected to provide treatment.

This scenario suggests a learning need that would pay dividends if the situationwere to arise again in the future. It was forthis reason that two of the speakers at this year’s Young Dentist Conference were chosen for their expertise in these two topics.

DevelopmentFor those who were unable to attend theconference, Simon Stone (endo) and JulieCross (oral surgery) have summarised themain points of the talk that they gave sothat a wider audience can benefit from their expertise.

James FosterSenior Dento-LegalAdviser

Dental Protection | Riskmatters 30

Horizons roadshowsSave the date!Dental Protection is pleased to announcethe dates and locations for this year’sHorizons roadshows; a series of eventsrelevant to the whole dental team.

NewcastleCopthorne HotelMonday 7 SeptemberSheffieldHilton HotelTuesday 8 September CardiffCopthorne HotelWednesday 9 September LondonCavendish Conference CentreThursday 10 September

Presentations will be delivered by DentalProtection’s senior dento-legal advisersand will cover the risky business ofdentistry, with examples from DentalProtection’s extensive archive of clinicalcases. We will be discussing how claimsare dealt with and what is happening withFitness to Practice cases at the GDC.

These events are the perfect opportunityfor you and your friends to meet andnetwork with established dentists andpractice owners in your area, so don’t missout, book your place now!

Email events@dentalprotection.orgor call us on 020 7399 2914 for moreinformation.

News

Renew onlineDental Protection now offers a new service for final year, first andsecond year post-graduation membership. That’s right you cansign up and renew your membership via our website.

The Dental Protection early bird renewal period has been extendeduntil 31 July. To take advantage of the great early bird discountrenew your membership for your second year post-graduation(September 2015 – August 2016) before 31 July 2015. This letsyou sort your protection arrangements early so you don’t have toworry about it later.

We’re a mutual membership organisation,and we don’t set our subscriptions tomake a profit. 75% of young dentists inthe UK are Dental Protection membersTo renew, please log into “My MPS” at www.dentalprotection.org/renewonline. If you do not have an account, you can register withyour membership number.

If you have any questions about your renewal, please contact theMember Operations Centre on 0800 561 9000.

Update your detailsAs a young dentist you may move around and in turn change youraddress. Please update your contact details to ensure you get themost out of your Dental Protection membership.

You can do this by logging into My MPS on the Dental Protectionwebsite.

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Choosing a new practiceThe last three issues of Riskmatters contained an article describingthe choices that have to be made whenever a young dentist wantsto choose a new practice. They were very well received and, inresponse to many requests from members, we have reviewed thetext and published it as a downloadable booklet. You will find it onthe website in the “Advice Booklet” section under the“Publications” tab.

theyoungdentist.comtheyoungdentist.com is a unique platform from Dental Protection,featuring content created by young dentists for young dentists tohelp support you in the early stages of your career with a widerange of articles, practical tips and case studies. You can also findout about our regular events including the annual Young DentistConference.

Why not write an article and share your own experiences withother dental professionals around the world? If you would like toshare your thoughts, please contacttheyoungdentist@dentalprotection.org

Young Dentist Conference 2015Dental Protection’s Young Dentist Conference 2015 featured fiveexcellent presentations from an exciting panel of speakers, andcovered contemporary topics such as endodontics, NHS/privatepractice and oral surgery. You can read more about thepresentations on pages 5–12.

Keep an eye on the website for the datesof future Dental Protection events. Don’tforget, as a member of Dental Protectionyou get a discounted rate on tickets

Don’t miss the next issue of Riskwisecoming in July. It’s full of topical riskmanagement advice

5Dental Protection Riskmatters 30

Young Dentist Conference 2015Over 200 delegates attended the 10th annual Young Dentist Conferenceat the Royal College of Physicians earlier this year

The Conference is organised by Dental Protection in conjunction with the British Dental Associationand the British Dental Journal. The programme is dedicated to the specific needs of dentists in their first five years of practice

This year’s programme featured a panel of five excellent speakers and we invited three of them tosummarise some of the key points oftheir presentation to share with those of you who were not able to attend

Reena Wadia, a young dentist with apassion for communication shared her top tips for success Julie Cross is anoral surgeon and she described theimportance of being prepared for thetooth that breaks during extractionSimon Stone discussed thepredictability of root canal treatmentin general dental practice and knowingwhen to involve a specialist

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1) Have confidence in yourself – and confidence to ask for helpYou’ve qualified and are now free to practise dentistry withouthaving someone peering over your shoulder – great! But, it can alsobe a daunting thought that you must now make decisions foryourself. Rest assured, your confidence will slowly develop – youwill generally do more work in the first few weeks of practice thanyou ever did at dental school! Always remember to keep thepatient’s best interests at heart.

Never be afraid to ask for second opinions or discuss cases withcolleagues – we’ve all been there. When help is available, attemptdifferent treatments but remember, don’t be tempted to dive inwithout the help of an experienced clinician and be mindful of theextent of your competence, too, before practising new skills alone.

2) Fine tune record-keeping andcommunication skillsWith the time constraints of a busy NHS practice, it is easy to pickup bad habits when it comes to record keeping. But, time spent ondetailed records may save you hours of stress (and, possibly, alegal case). During the appointment, dedicate time to accuratelycompleting the patient’s records.

Actively listen to what your patients are saying, paying attentionto tone and inflection as well as to their body language. Take timeto try to understand their expectations; these may need modifyingif unrealistic. Treatment decisions should be made together after a thorough and balanced discussion.

If you don’t have a fantastic memory, jot down some personaldetails on the patient’s record to jog your memory. Remember,your patient is an individual, not a set of teeth looking for a treatment plan!

Survival of the fittestDentistry can be a testing environment;Reena Wadia offers a selection of ideasto help you evolve into the perfectpractitioner

There are more dental graduates in the UK than ever beforeand, with the uncertainty in the job market, competition isfierce. Today’s young dentist is also qualifying with lessclinical experience than his or her predecessor; a morelitigious environment and slashed NHS funding are extrachallenges, too. However, it is still possible to build asuccessful career in the current environment. These are mytop five tips to surviving – and excelling – as a young dentist

Reena WadiaReena qualified from Barts and The London. She is currentlycompleting part-time specialty training in periodontology at Guy’sas well as working in general practice

Seek a mentor – a senior clinician whosevalues and approach matches your own to be a trusted advisor and role model

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3) Invest in loupes with illuminationThere are ergonomic and optical benefits to wearing loupes – and the earlier the better as there is a steep learning curve. Leggat, Kedjarune and Smith (2007) found that approximately 53-82% of dental professionals suffer musculoskeletal complaintssuch as neck and back muscle pain. Often, poor posture is acontributing factor and loupes enable a clinician to work in ahealthier, more ergonomic position. If you can, add a light source to provide illumination, this will improve your vision and reduce eye strain.

4) Take plenty of clinical photosPhotographs can be a valuable part of your patient record and areuseful for patient education and liaison with the dental team too.Build up a portfolio of clinical cases – helpful when applying forassociate jobs. Importantly, having photographs of your workallows you to reflect, audit and continually improve.

5) Find a mentorSeek a mentor – a senior clinician whose values and approachmatches your own and who can be a trusted advisor and rolemodel. Throughout dental training and beyond, inspirational dentalprofessionals will prove an invaluable source of knowledge thatwill help you choose the most efficient route to achieve yourambitions.

Patient rulesKeep the patient’s best interests at heartActively listen and take notice of body languageSpend time discussing treatment plansDocument all the key points with comprehensive recordsYour patient is an individual, not a set of teeth with a treatmentplan!

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Dental Protection | Riskmatters 30

Never be afraid to ask for advice or to get a second opinion. You will protect the best interests of the patient and learn at the same time

Here to helpDental Protection does a lot more than just taking care ofindemnity arrangements. That’s why we have such a largeteam of advisers. Whatever problems you face, we have the experience to solve them

K. Lewis S. Willatt D. J Croser J. P Tiernan S. Boynton J. Foster S. Henderson

H. Kaney J. Merivale A. McKelvie B. Westbury A. M Cohen A. Collier B. D Edlin

H. Harvie R. Rattan M. C Clarke J. Barnes C. Boyd C. Chapman L. T D’Cruz

J. Densem M. Foster R. Hartley D. Hartoch J. Ingham R. Rattan L. Rees

S. Sanderson A. J S Seaton P. Shaw Y. Shaw T. Simpson B. Tiernan S. Twidale

M. L Butterworth

N. Boodhoo G. Baggaley J. Baydal A. Biddle E. Cook R. Dhaliwal

C. Dodd I. Gordon J. Griffiths S. Harford L. Harrison R. Heathcote-Curtis

P. Hodgkinson

J. Jagger J. Kocierz N. Manek A. Millen B. McLaughlin D. Monagham M. Morris

N. Palmer S. Pabary S. Patel A. Paterson S. Radia S. Ryatt H. Sayer

B. Swithern L. Taylor M. Valt C. Walsh A. Williams M. Woodhead J. Woodington

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Be prepared!There are many complications that canarise from oral surgery. Julie Cross scoutsaround the common pitfalls and maps outa guide to managing them

It is important to be prepared for the possibility of oralsurgery procedures in practice. Indeed, access to a basicsurgical kit is essential. Dental extractions are one of themost common oral surgery procedures carried out by GDPs

With patients retaining their dentition for longer and often havingextractions later in life, the procedure can pose more of a challenge than ever before.

Teeth that are more heavily restored, root treated and surroundedby dense bone, increase the likelihood of surgery so warn thepatient of this possibility. Unfortunately, fracturing a tooth duringextraction is common, too, and the secret to managing thesituation is all in the planning:

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Here’s the planInform the patientMake a decision regarding further treatmentDecide whether to continue or to refer Be aware of your limitations.

Get a mapTake a radiograph to assess the morphology of the retained root,the proximity of anatomical structures and any underlyingpathology.

Surgical extraction of teethFigures 1–5

Flap designConsider the anatomy and potential complications and think about the post-operative aesthetics in relation to the adjacentteeth. The size of the flap should be designed to allow good access for instruments.

Soft tissue surgical or bone removalRaising a flap may give adequate access for luxators, elevators orforceps without the need for bone removal. However, if there is no application point for these instruments, then bone removal willbe required. When removing bone, the clinician should ensure aretractor is used to protect the soft tissues from trauma. Using a retractor also allows a better view of – and easy access to – the surgical site.

Elevators and luxatorsElevators provide an application point for forceps or to move teethprior to using forceps. They can also be used to remove teeth orretained roots or apices. Luxators are used to create spacebetween a root and supporting bone for the application ofelevators or forceps. Care should be taken, particularly in themaxillary posterior region, as tooth fragments can be pushedupwards and into the sinus.

Socket debridement and closureOnce the roots or teeth have been removed, the socket should be debrided and granulation tissue removed. If the bony socket is sharp or rough, smooth it down to prevent trauma to themucosa during healing. Julie Cross

Julie graduated from Glasgow and currently divides her timebetween Oral Surgery Specialist Practice in Glasgow and the Oraland Maxillofacial Surgery Department at Crosshouse Hospital,Kilmarnock

When a tooth fractures on extraction you will need to plan what to do next

9Dental Protection | Riskmatters 30

ComplicationsSoft tissue damageMucosal tears can occur due to slipped instruments or forcepsincorrectly positioned on the lingual or buccal tissues. Thesemay require suturing and, in such situations, the clinician shouldalways inform the patient.

Root displaced into maxillary antrum (Figure 6)If a root has been displaced into the maxillary sinus during anextraction, the patient should be informed and it may meanreferral to a maxillofacial or oral surgery department.

Oro-antral communication following extractionIf the communication is small and the sinus lining is intact, this can be managed conservatively. The patient should beprescribed antibiotics and given nose-blowing instructions. A review should be arranged to ensure healing. If thecommunication is larger – or the lining is torn – then this will also require closure.

Fractured tuberosityFractured tuberosities occur when removing maxillary wisdomteeth or lone-standing maxillary molar teeth. Lack of alveolarsupport during extraction increases the risk. If the tooth andfractured tuberosity are minimally displaced, then a splint canbe used to support the fracture and allow healing.

Seven steps to safetyPrepare several sterile oral surgery kitsTrain the dental nurse to assist with oral surgeryAssess patients ahead of time on a separate occasion Schedule oral surgery for the start or end of a sessionAllow more time than anticipatedKeep it simple at first and work within limitationsMaintain good clinical records.

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Figure 1Pre-operativeimage

Figure 2Buccalmucoperiostealflap raised

Figure 3Buccal gutter ofbur removed

Figure 4Application pointfor CouplandsChisel

Figure 5Interrupted suturesplaced after socketdebridement

Figure 6Root of upper rightfirst molardisplaced intomaxillary sinus

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It’s complicatedSimon Stone offers nine steps to ensuresuccess and shares some cases fromwhich we can all learn

Root canal treatment (RCT) can cause anxiety for youngdentists. It requires careful case selection, open patientcommunication, recognition of clinical limitations and anunderstanding of when to refer

There will always be endodontic cases that cannot be successfullymanaged in primary care that will benefit from specialist input.However, early in a career, when a difficult case involves anelement of supervision or assistance from a colleague, it can knockthe confidence of a young dentist looking to consolidate technicalskills.

The situation is not helped by the fact that clinical experience inRCT for younger dentists is variable, with dental schools strugglingto find suitable cases for students

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Interestingly, however, more dento-legal cases arise fromendodontics than any other dental procedures, and recentgraduates tend to have a disproportionate share of the problemsin relation to this procedure. Here is a short road map to morepredictable treatment outcomes.

Step 1 – communicationFrank, open discussions with patients are important. Be honestabout potential complications to avoid uncomfortableconversations post-treatment if it turns out that the restoration of the tooth is no longer possible. Be decisive at the planning stage,taking care not to be forced into treatment with a high likelihoodof failure. Document those conversations in case there is a need todefend your decision.

Step 2 – clinical comparisonsClinical trials report endodontic success rates in excess of 90%,but these are often very controlled studies. Are you working to the same protocols, using comparable systems, similar irrigatingsolutions, and for the same length of time? In reality, you areunlikely to know this until you have been practising for a number of years and have witnessed failures.

Step 3 – case selectionCase selection is critical, with restorability an importantconsideration. Assess the patient carefully to ensure future patientsatisfaction. Complex treatment may not be suitable for patientswith a high caries rate, extensive periodontal disease or limitedmouth opening.

Step 4 – clinical assessmentsClinical and radiographic assessments of the quality and quantityof the remaining tooth tissue is fundamental. If there is doubtabout a tooth’s restorability, removing deficient crowns orrestorations initially can inform this judgement. At a tooth level,providing RCT may be technically possible, but care should betaken if the remaining tooth tissue is limited or compromised.

Step 5 – diagnostic testsPatients may present with unusual symptoms that mimic a pulpalor periapical, odontogenic diagnosis. In these cases, the diagnosticthermal, electric, and percussive tests, along with radiographicinvestigations, will aid diagnosis. Where diagnosis is uncertain, seeka second opinion.

1Qualtrough, A. J. (2014) Undergraduate endodontic education: what are the challenges? Br Dent J 216, 361-364. doi:10.1038/sj.bdj.2014.227.

Simon StoneSimon graduated from Newcastle.  Following a mixture ofresearch, teaching and part-time general practice roles, he iscurrently a Clinical Lecturer in Restorative Dentistry and HonorarySpeciality Trainee in Endodontics at Newcastle University  

More dento-legal cases arise fromendodontics than from any other dental procedures

11Dental Protection Riskmatters 30

•••••••••

Figure 1Shows three heavily restored, root filledteeth in the upper left quadrant, deficienciesand caries noted in 14, 16. There have beenextensive excavations at 15 both in terms of depth and angulation in an attempt tolocate the sclerosed apical anatomy; thesehave resulted in a sub-bony perforation.There are extensive radiolucencies apically,and at mid-root level mesially and distally.The tooth is not a good candidate for RCTand should be removed

Figure 2Shows tooth 11 with three separaterestorations, secondary caries mesiallyaround the restoration at 21. There is noestablished apical radiolucency. Whilst thecanal appears obvious radiographically,there is a perforation labially resulting frominappropriate access cavity angulation.Whilst prevention of these technical errorsis preferable, this high perforation would beamenable to surgical repair

Figure 3Shows tooth 17 which is minimally restored.Tooth 16 is a retainer for a long spanconventional bridge, the mesial abutment is notvisible. The root canals are not obvious withinthe coronal 1/3 of the tooth and the presenceof the bridge will likely limit vision and access.There is no apical radiolucency. Considerationshould be given to removing the bridge to helplocate the canal anatomy, predictability isuncertain in this case. There is amalgam debrisin the soft tissues, confirmed clinically by thepresence of an amalgam tattoo

Step 6 – clarity of visionWithout clear vision, identification of complex anatomy becomeseven more challenging. Magnifying loupes, with illumination, offerenormous help.

Step 7 – cavity preparationAt the access stage, procedural errors relate to the length, depth andorientation of the access cavity. Teeth are at a greater risk ofperforation if they have sclerosed pulp chambers and long, aggressivecrown (>8mm) burs are used in access cavity preparation.

Step 8 – canal cautionCaution should be exercised if instrument sequences are curtailedin the interests of cost saving or if instruments are forced intocanals to overcome obstructions. Both may result in greaterstresses on the instruments and lead to separation (breakage). Ifthis happens, assess the possibility of retrieving the parts – andkeep the patient informed.

Step 9 – criteria for referralWhen procedural errors occur, or the morphology and the lie of the tooth is unusual, there may be a need for referral to aspecialist. Most NHS referral centres will have published guidelinesand acceptance criteria. Make available any radiographs to aiddiagnosis but, if shared on email, take care to ensure that the datais encrypted so that a third party cannot access details.

Referral centres and you

When to consider sharing patient carewith a colleague: Diagnostic opinionsAnaesthetic problemsTrauma and its sequelaeRemoval of root fillings if proved difficultCanal locationFractured instrument retrievalRemoval of postsPerforation repairSurgical endodontics.

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It’s complicatedFigure 4Shows tooth a moderately restored 46with intact marginal ridges, the pulpchamber is visible as is the radicular pulp,there is a radiolucency associated with thedistal root and widening of the periodontalmembrane space mesially. This tooth has agreater prospect of successful root canaltreatment and subsequent restoration

Figure 5Shows 11 isolated with rubber dam andsealed with a caulking agent. The image is captured at low magnification using anoperating microscope offering optimal light and vision

Figure 6Shows safe ended MaxiProbe (left) andMonoject (right) needle designs, whichreduce the pressure at which irrigant canbe delivered through these syringes

Figures 7a and 7bShows clinical and radiographic views of a previously treated, symptomatic 12 withunusual root canal anatomy. Identificationof the second canal root was not possiblewithout the use of an operatingmicroscope. This tooth may have betterprospects with surgical root amputation

Figures 8a and 8bShows an odontome like 23, non-surgicaltreatment is possible with the help ofadditional imaging techniques and anoperating microscope

Figures 9a and 9bShows an adult with a previouslytraumatised 21 that has an open apex, theuse of an operating microscope was helpfulin controlling the placement of MTA in thewide apical region

Figures 10a and 10bShows external cervical resorption of a vital 21 that requires surgicalmanagement

Figure 4

Figure 5

Figure 6

Figure 7a

Figure 7b

Figure 8a

Figure 8b

Figure 9a Figure 9b

Figure 10a

Figure 10b

13Dental Protection | Riskmatters 30

1http://www.nhs.uk/conditions/Alcohol-misuse/Pages/Introduction.aspx

2http://www.nhs.uk/change4life/Pages/alcohol-lower-risk-guidelines-units.aspx

3www.hscic.gov.uk/catalogue/PUB14184

4http://www.dentalhealth.org/blog/blogdetails/93

And while the majority of us might enjoy such an eveningwith no major repercussions to our health, it could be time to step back and remind ourselves, and our patients, of thepotentially harmful risks of alcohol on our oral and generalhealth

The facts While many of us drink alcohol moderately, according to the NHS,more than 24% of people in England alone consume alcohol in away that’s harmful, or potentially harmful, to their health andwellbeing

1. For men, this is drinking more than the recommended

limit of three to four units a day on a regular basis and for women,more than the recommended limit of two to three units

2.

The Health and Social Care Information Centre’s Statistics onAlcohol – England 2014, published in May last year, paints apicture of our drinking habits: amongst adults who drank alcohol in the week before being interviewed, 55% of men and 53% ofwomen drank more than the recommended daily amounts

3.

The spirit of summerWith the long, warm summer evenings and the smell of BBQs filling the air, it’s all too easy to open a cool beer, bottle of chilled wine or mix up the Pimms

Patient health As a dentist, you may discuss your patient’s alcohol intake withthem, and are acutely aware how excessive alcohol consumptioncan impact on their oral health – as well as the fact that drinkingto excess is linked with oral cancer. However, regularconversations about their lifestyle and the recording of theirmedical history may also highlight potential overall health risks.

Writing for the British Dental Health Foundation, JonathanShepherd, Professor of Oral and Maxillofacial Surgery at CardiffUniversity, supports this by saying: “Since alcohol misuse affectspatients’ general health, addressing this in primary dental caresettings also enables dental professionals to meet wider healthpromotion responsibilities. Unlike primary medical care, primarydental care services are used by patients on a regular, prevention-orientated basis, with the majority of people attending for aroutine check-up irrespective of any oral health problem. Thisprovides the primary dental healthcare team with uniqueopportunities to intervene, particularly as asking patients abouttheir level of alcohol consumption is a routine component ofmedical history taking.”

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The UK is the sixth biggest wineconsuming country in the world despitefalling wine sales generally

www.harpers.co.uk

The spirit ofsummer

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Additionally, the BDA’s Oral Health Inequalities Policy suggestsdentists are ideally placed to inform and advise patients abouttheir oral and general health risks, including alcohol use

5. With

statistics showing that, every year, alcohol is responsible foraround 4% of UK cancers – about 12,800 cases per year – as ahealthcare professional, you have an important part to play ineducating your patients about the risks

6.

Your healthAs you are at the start of your dental career, it is an ideal time toknow of the risks that your profession is prone to, such asmusculoskeletal issues and stress. In a survey investigating stressmanagement in the dental team, conducted by Joanna Taylor, adental practice manager, accredited clinical hypnotherapist andNeuro-Linguistic Programming (NLP) master practitioner, out ofthe 178 principal and associate dentists who took part, more thanone third (36%) stated they were stressed about their work duringmost working days and nearly one fifth (19%) felt stressed everyday. The survey also found that popular stress management toolsfor dentists included alcohol, along with playing sport and reading

7.

Being mindful of your work-life balance could also go a long way in helping to minimise stress. In the New Scientist in January thisyear they published a new report stating: “The largest ever analysisof working hours and alcohol consumption has found that peoplewho work over 48 hours a week drink more than people withstandard working weeks. Marianna Virtanen at the FinnishInstitute of Occupational Health in Helsinki and her colleaguespulled together data about more than 330,000 people from 14 countries, including the US, UK and Germany.”

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Mindful of the dento-legal implications of uncontrolled alcohol usewithin the profession, Dental Protection outlined the importance of this in its 2014 Annual Review, maintaining that: “There is notmuch doubt that a healthy practitioner will be in a better positionto look after the interests of patients than one whose health iscompromised – for whatever reason.” The article in the Reviewwent on to say that “Drug dependency or addiction frequentlycompromises the ability to function at a high level and it is wellrecognised that the two agents that most commonly impact uponthe ability of members of the dental team to practise are alcoholand drugs.”

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5https://www.bda.org/search-results?k=Oral%20Health%20Inequalities%20Policy

6http://www.cancerresearchuk.org/about-cancer/causes-of-cancer/alcohol-and-cancer/alcohol-facts-and-evidence#alcohol_facts0

7www.joanna-taylor.co.uk/stress-in-the-dental-practice.html#.VDai9EuFb1o

8http://www.newscientist.com/article/mg22530043.900-long-hours-make-people-more-likely-to-drink-heavily.html#.VUC6DCFVhHw

9http://www.dentalprotection.org/docs/librariesprovider4/dpl-publications/annual-review-2014.pdf?sfvrsn=6

10http://www.bbc.co.uk/news/health-32418122

11http://www.newscientist.com/article/mg22530022.900-high-and-dry-party-drug-could-target-excess-drinking.html#.VUDlCiFVhHw

12http://www.newscientist.com/article/mg22530031.800-booze-binge-has-immediate-effect-on-immune-system.html#.VUC6PSFVhHw

The latest scienceAs well as being a regular feature in the national news with issuessuch “alcohol abuse costing the NHS £3.8bn a year”; the fact that“one in three of all A&E admissions are alcohol related”; and that“dentists should screen patients for alcohol abuse”.

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If you read the New Scientist you will see they also regularly reporton studies investigating the effects of alcohol on our bodies, aswell as scientists working to try to find ways to combat it’s harm. At the end of last year, the New Scientist reported that, “a patentapplication was filed for a drug that is supposed to give people apleasant intoxication as well as limit the amount they drink.” Thisnew drug, given the name “chaperon” still has to go throughdetailed tests to establish how safe it is, as well how it could beused in practice, before it is available for general release

11.

In January this year they also reported on another study that, forthe first time, looked at the effects alcohol had on our immunesystems. The scientists undertaking the study found that “At first,the immune system ramps up, but within a few hours there is ananti-inflammatory phase during which its responses areweakened….if binge drinking can start affecting a person's immunesystem – and the way they respond to illness or injury – within anhour, doctors should take this into account.”

12So it appears to be

a subject that is always heavily in the press.

As you and your colleagues enjoy a relaxing glass (or two) after a hard day at work, with the sun streaming through the trees,perhaps you should think about finding a way to ensure thatalcohol doesn’t become a coping mechanism for stress, now or in your future career.

Sarah BradburySarah is Head of Marketing andCommunications for Dentists’ Provident

When you plan for the future, you can live for today.Dentistry is a physically and mentally demanding profession and you could su�er from an illness or injury at any age. That’s why it’s important to ensure that your cover reflects your income, throughout your career. With experience of caring for dentists just like you, our members trust us to give them the peace of mind when they need it most.

Protecting your lifestyle. Securing your future. To find out more visit our website at www.dentistsprovident.co.uk or call our member services consultants on 020 7400 5710

Dentists’ Provident is the trading name of Dentists’ Provident Society Limited which is incorporated in the United Kingdom under the Friendly Societies Act 1992 (Registration Number 407F). Authorised by the Prudential Regulation Authority and regulated by the Financial Conduct Authority and the Prudential Regulation Authority (Firm Reference Number 110015).

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Telephone0800 561 1010Facsimile020 7399 1401

LeedsVictoria House, 2 Victoria Place, Leeds LS11 5AE

Telephone0800 561 1010Facsimile020 7399 1401

Edinburgh39 George Street, Edinburgh EH2 2HN

Telephone0800 561 1010Facsimile0131 240 1878

Service Centre Helplinefor membership enquiriesTelephone0800 561 9000

Opinions expressed by any named external authors hereinremain those of the author and do not necessarily represent the,views of Dental Protection. Pictures should not be relied upon asaccurate representations of clinical situations

Editor david.croser@dentalprotection.org© Dental Protection Limited June 2015

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