An exhilarating journey

17 February, 2020 / editorial
 

As a new decade starts, we look back on 10 years of Scottish Dental magazine

When Iceland’s Mount Eyjafjallajokull erupted ten years ago it unleashed volcanic ash that caused major disruption of air traffic across northern Europe.

Fortunately, it didn’t cause the grounding of Edition one of the new incarnation of Scottish Dental, which had taken flight a couple of weeks earlier and was still dropping through practice letterboxes when the mountain was causing maximum mayhem.

While we don’t mind provoking a little disruption every now and again, our aim is to bring clarity rather than confusion. And, as a new decade starts, it seems apt to look back on some of the multifarious topics that have been illuminated, explained, debated and discussed in these pages over the magazine’s initial ten years.

Children first

Appropriately enough, Edition one included a feature on what has turned out to be one of Scotland’s most passionately discussed policy initiatives; Childsmile.

Back then, the programme had already been in existence for five years on a trial basis but was about to be implemented across the country.

As Lynn Brewster, at that time Childsmile’s West of Scotland programme manager, explained, the focus in 2010 was on integration and consolidation.

She told the magazine: “Childsmile is currently in an interim demonstration phase prior to being mainstreamed into routine dental services. During this time, 2009-11, a fully integrated programme encompassing Childsmile Core, Practice, Nursery and School will be embedded within Scotland’s 14 NHS boards. Members of the Childsmile board are currently working to embed the evolving dental care pathway within the child health system, to ensure programme delivery by an appropriately trained and skilled workforce and that it is supported by national payment systems and IT facilities.”The programme has become an established part of public dental policy. While its merits have been argued over there have been some indications of its impact. In December 2013 researchers from Glasgow University reported Childsmile had saved more than £6 million since it began with fewer children needing extractions, fillings or general anaesthetic.

Challenging

If Scottish Dental has a main purpose it is to reflect the concerns of the country’s dental professionals by challenging Scotland’s Chief Dental Officer. In June 2010 the since retired Margie Taylor made the first of many appearances in the magazine.

This time around she answered questions on, among other things, decontamination, NHS remuneration, continuous registration, salaries, recruitment and retention, and Scotland’s poor oral health record.

Initiative

Dental professionals’ initiative and willingness to try new ideas always impresses. In November 2010, a perfect example of this was featured. After spending thousands of hours treating victims of facial trauma, three surgeons from Glasgow had decided enough was enough.

Oral surgeon Christine Goodall had seen thousands of young men injured as a result of ‘recreational violence’. The cumulative effect of this led Christine and two colleagues at Glasgow Dental Hospital – maxillofacial surgeons Mark Devlin and David Koppel – to set up an innovative charity to try and stop violence before it happens. Medics Against Violence (MAV) was founded in 2008, becoming a registered charity the following year. Over the years they have helped reduce violent injuries, especially among the young.

Emphasis on stress

A recurring theme across the years has been the levels of stress endured by the country’s dental professionals. It was an issue first raised in the magazine in December 2010 when a report of UK workplaces undertaken by Professor Garry Cooper revealed that dentistry was one of the 10 most stressful professions in the UK, alongside firefighting, police work, social work, mining and medicine.

Despite initiatives like The Dentists’ Health Support Programme dental professionals were subject to higher than average levels of anxiety, addiction and both attempted and successful suicide. Mental health problems and addiction were by far the main reasons why a dentist might come before the General Dental Council.

Sadly, this issue has persisted. So much so that when the magazine underwent a radical redesign in August 2018 the first edition with the new look focused heavily on a profession in crisis thanks to the crushing effects of stress.

Structure and safety

The structure of healthcare scrutiny underwent a change in 2011 when Healthcare Improvement Scotland (HIS) took over from the Care Commission. The Scottish Government decided to have a new single body to scrutinise health services, with another separate body regulating care services and social work. HIS brought together a variety of functions, including the scrutiny of independent healthcare, which was the original remit of the Care Commission.

As featured in June 2011, there was a significant step forward for safety in the industry when Trading Standards withdrew its ‘blind eye’ policy on tooth whitening products. This resulted in one of the major suppliers of whitening products, The Dental Directory, ceasing sales of all products with immediate effect.

Good Show

Recognising the growing need for a serious and substantial annual convention the magazine made its own major contribution to the profession’s development by launching the Scottish Dental Show. Announced in October 2011, the first show was lined up for 24 and 25 May 2012.

Promising to be much more than a trade show, from the start it included an extensive programme of speakers and workshops that offered a significant volume of verifiable CPD.

The Show has become a ‘must-attend’ event for dental professionals across the country, and the latest, which will take place on 24 and 25 April at Braehead, promises to be as pioneering and forward-thinking as the first.

One benefit of creating the Show was the opportunity to give due recognition to people, practices and organisations across the sector who had developed new standards, services, ideas and technologies.

Most notable was the presentation of the first-ever Scottish Dental Lifetime Achievement Award. The inaugural recipient was Professor William Saunders, former dean of Dundee Dental School, who received membership of the Scotch Malt Whisky Society as well as a crystal trophy. A surprised but delighted Professor Saunders said: “I was completely overcome. In fact, my wife Jenny was very worried about me because I was so surprised. It is so unusual for a clinical academic to be awarded such a prestigious accolade over high profile general dental practitioners.”

Independent viewpoint

It might seem like a generation ago to some, but 2014 saw a rather important referendum take place on the matter of Scotland’s place in the UK. On Saturday 10 May, the Scottish Dental Show hosted an independence and dentistry debate at Braehead Arena. The debate, chaired by former GDC President and Edinburgh GDP Hew Mathewson, centred on the motion ‘Scottish general dental practice will be better for patients and dentists in an independent Scotland’. There were thoughtful contributions from panellists Clive Schmulian, Anas Sarwar MP, Gerard Boyle and Dr Willie Wilson. After recent events, there could well be a rerun of this discussion in the near future.

Northern light

While the magazine was busy being born so was Aberdeen Dental School. The first edition included news of the £17.7 million School’s official opening. However, the institution endured one of the darker periods of its chequered history in early 2015 when a 52-page GDC report catalogued a long and damning list of errors and deficiencies. The report was the third consecutive critical inspection of the school to reveal significant issues.

Thankfully, better times were ahead. In January 2016, the magazine highlighted its re-birth under a new Head, Richard Ibbetson. He was determined to realise the School’s potential to be a quality centre of education. As he said: “Aberdeen’s here; it might be small, but it’s going to stay. It might take five years, but it’s going to be very, very good!”

The ‘B’ word

The United Kingdom’s latest constitutional rammy, Brexit, was wryly observed by the magazine’s insider columnist, Arthur Dent, in July 2016. He (or was it she?) showed incredible foresight when noting “…nothing is going to happen very soon. The government must trigger Article 50 by officially notifying the EU of its intention to leave. Once triggered, there is a two-year period in which the terms of the leaver’s exit are negotiated. At the time of writing, there is no timescale for this to happen, leading to a longer period of uncertainty.”

Having got Brexit out of the way temporarily, a more immediately significant revolution for Scotland’s dental profession then raised its head.

OHIP

In September 2016, it was announced that Scotland’s new Oral Health Improvement Plan (OHIP) would be put out to consultation for 12 weeks. Promising a radical rethink of how patients are treated, and dentists are remunerated, the document also set out plans to introduce a new preventive care pathway, with the aim of moving dental services away from a restorative approach. Also, in prospect, was a review of the SDR and introduction of an Oral Health Risk Assessment (OHRA) for all patients at 18 years of age and at regular intervals.

The Plan was subsequently launched with much fanfare in early 2018. At the time Health Secretary Shona Robison said: “The Oral Health Improvement Plan will support the profession to spend more time on what they do best – providing excellent care for the patients who need it most.

We will continue to work closely with them as the recommendations are implemented. It will ensure people get the personalised care they need, when and where they need it.”

It wasn’t too long before questions were being asked. In August 2018, we reported that Scotland’s dentists had deep concerns about implementation of the OHIP given the absence of new investment to make the plan a reality.

BDA Scotland said it agreed with the principles at the heart of the plan, but the lack of detail on vital issues including funding and timescales, as well as lack of involvement from the profession in implementation, could put NHS services at risk.

Complex topics

Scottish Dental has always been ready to take an in-depth look at complex topics. In October 2018, we examined the issue of consent as influenced by the Montgomery case of 2015.

As the requirements, legalities and practices around obtaining informed consent are a major part of the teaching in dental schools, it seemed appropriate to consider a lack of clarity in the profession as to how much Montgomery should affect existing practices and relationships with patients, if at all.

With the support of the Royal College of Physicians and Surgeons of Glasgow who had been looking into the issue in detail, we brought together a group from across the dental world in a round-table discussion on what consent meant in a post-Montgomery world.

Another concern for everyone involved in healthcare is the impact of Scotland’s ageing population. With more people living longer, the healthcare system is under increasing pressure, especially the dental services for those living in care homes.

In February 2019, the magazine talked to some of those with expertise in this field. They outlined the challenges involved in providing efficient dental care to people who are living into their 80s, 90s and beyond, taking a plethora of medications, have more of their own teeth and have undergone a variety of procedures such as root treatment and have had implants fitted. The profession still has to get its head round this problem.

Technology rules

New, ground-breaking technology invariably creates interest among dental professionals and the public alike. In August 2019, we showed how Artificial Intelligence (AI) could affect the future of dental care, not least the development of a toothbrush that detects wider health issues. It seems the boffins at Procter & Gamble have been busy creating the Genius X, a toothbrush that boasts AI as a key feature.

In a similar vein, the October 2019 edition reported how Dundee University had taken what it believed to be a radical step in modernising the way dental students learn. Dr Andrew Mason, Clinical Senior Lecturer at Dundee University’s School of Dentistry explained: “At its heart, the curriculum integrates clinical science with clinical practice. That means, at Dundee, a dental student will carry out clinical practice from week one; that’s huge.”

Then, in December 2019, the innovation theme continued. We reported how Scottish biotech firm Dentherapy had produced Toothboost, a technology designed to remineralise teeth ‘on the go’.

Last word…?

It’s been an ever-present in our lives since June 2016, but our final edition of 2019 reflected on ‘Lessons from history’ and the effects Brexit will have on the profession. Michael Donaldson, Consultant in Dental Public Health and Head of Dentistry at the Northern Ireland Health and Social Care Board, has spent time trying to predict the outcomes. His summary?

“The consequences for the UK and Ireland are likely to be significant – though not wholly negative.”

As we enter a new decade, here’s hoping for even more topics that will rile and rouse our readers… and a journey that’s not always turbulence-free.

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