Home Page of site for dental gain, health gain and social gain

Click on the slideshow to view Oral Ulceration tutorial, or go to CPD for a contents list on the index at left. You may link to the complete notes at ORAL ULCERATION NOTES

Opportunistic screening of patients for oral cancer can be done in just a few minutes. Click HERE for the NIDCR oral examination protocol.

NEW NEW NEW Updated webpages on cross-infection control. See under Health and Safety/Infection Control on menu.

Webpage available on NICE and US guidelines regarding antibiotics to prevent infective endocarditis

This is a short clip, about 2 minutes, from a 30 minute lecture on Soft Tissue Lesions of the Oral Mucosa. The lecture is one of a series on Oral Medicine delivered by Dr. Christine McCreary, Cork University Dental School and Hospital, and being made available on CD as Windows Media Video files (.wmv) to be played on a PC using the readily available programme Windows Media Player. This should prove an easily accessible means of delivering CPD as it becomes mandatory.

HSE establishes Medical, Training and Research (METR) Unit

The HSE’s new METR unit held it’s inaugural meeting in November 2008. The stated function of the unit is to coordinate the alignment of all education, training and research functions within the health service.

For further information on METR, email metr@hse.ie, log on to the HSE intranet, or for METR publications, visit www.hse.ie/eng/Publications/Medical_Education

The METR unit is to be distinguished from the National Committee on Medical Education and Training that was established by the Department of Health and Children and the Department of Education and Science in February 2007. It is noteworthy that of the 26 organisations represented on NCMET, only one, the PgMDB, had any interest in dentistry, and that one is now dissolved.

Postgraduate training transferred to HSE

As part of the public service reforms, the Post Graduate Medical and Dental Board was dissolved from 1st December 2008. The roles of national co-ordinator, course organiser and course co-ordinator are to be transferred to the HSE on the basis that they will become HSE posts for administrative purposes. Existing budgets will be transferred, with dentistry retaining its proportion of funding. Accreditation is being transferred to the Dental Council.

The PgMDB fulfilled a number of functions in relation to dentistry – the vocational training scheme, the regional dental committees, and promotion/accreditation of CDE. It is expected that the HSE’s new METR unit will be responsible for the VTS, and will continue to operate the RDCs in 2009. Future arrangements for RDCs will depend on the recommendations of a committee being established by the HSE with representatives from interested parties including the Faculty of Dentistry, the Dental Council and the Irish Dental Association. METR will also assist the Dental Council to take on the accreditation of CDE, which is expected to become mandatory until the forthcoming Dental Bill.

HSE announces new structure

Chief Dental Officer for HSE? Posted 3.7.2008

The Health Service Executive (HSE) has announced that proposals to change the body’s management structure would be phased in over an 18-month period. Authority for running hospital and community services will be devolved to new regional management structures. Under the new plans, regional directors would run hospital and community services in their area and determine how funding provided by the HSE at national level should be allocated. According to informed sources, there could be four or possibly up to eight new administrative regions.
The newly appointed HSE national director of human resources Sean McGrath, who is leading a management team overseeing the changes, said they would be introduced in a "planned and measured way" over the next 18 months and would “refine the way we are currently organised and build on the many achievements of staff. Taking account of feedback from today’s meeting with the staff representatives, as well as input from the senior management team and senior managers, we intend providing staff with more information on these changes early next week," he added.
The HSE is moving to integrate PCCC and the Hospitals directorate and proposes to appoint four National Directors in the area of Integrated Care, Clinical Care and Quality, Communications, and Planning.

Creation of a new position – National Director of Clinical Care & Quality
Integration of existing two national service pillars into a single role of a National Director of Integrated Care
Establishment of a National Director of Communications.
The integration of the Population Health, Corporate Planning & Control into a single role National Director of Planning

This will be replicated at regional level and there is to be decentralisation of decision making generally.

Regional level Clinical and Management structures will be modified to take account of the new National Director of Integrated Care
New Directors of Integrated Care at Regional Level responsible for ALL care Services.

Of specific relevance to dentistry it was confirmed by Prof. Drumm that a senior dental advisor is to be appointed, by competition, to work with the proposed new National Director of Clinical Care and Quality. This, of course, is what the dental profession had been advocating since 2004 to the HSE and the HSEEA. It remains to be seen if this also is replicated at regional level, as has also been proposed by the profession. The travel ban (see below) is already interfering with the regional roles that principal dental surgeons are supposed to use to influence oral health strategy and planning across services, both regionally and nationally.

HSE bans training and conferences

During the week starting Monday June 16, in an effort to reduce costs, the HSE issued a directive to all staff that all travel for purposes other than clinical necessity and essential maintainance of services is prohibited forthwith. Meetings are to be conducted via email, or teleconference. Exceptions have to be cleared with line management. Dental services are in the main clinical, and might not appear to be unduly affected. However, health promotional activity, carried out by dental hygienists and senior dental nurses employed specifically for this purpose, are clearly affected.
Items that were included as non-clinical, and therefore covered by the embargo, include "training" and "conferences". This latter gives rise to disquiet for all dentists employed by the HSE (and presumably for other medical staff). The dental profession are currently under advisement to register for Continuing Professional Development with the Post Graduate Medical and Dental Board. It is the stated intention of the Dental Council that mandatory CPD will be introduced in 2010 and will become a pre-requisite for continuing registration. There will be a five-year CPD cycle of 250 hours, 75 verifiable, of CPD. The Council recommends recording of CPD from 2008. Currently, verifiable CPD in Ireland is delivered only through the medium of courses and conferences. The HSE must take this into account when it determines what is permissable.

National Oral Health Policy

National Oral Health Policy - the IMPACT perspective - posted 17.4.2008

On 18th October 2007 the Minister for Health and Children, Mary Harney T.D. launched a new Oral Health Policy initiative to an invited audience of dental professionals and interested parties. The stated time frame aimed at the preparation of an Analysis Document and Public Consultation by year end (2007) with a Draft Policy by July 2008 and a Final Report shortly thereafter.
At the initial consultative panel meeting, a department official informed the Panel that the Department was preparing a consultation document which would be circulated to all stakeholders. The purpose of this document was to aid the preparation of submissions on the Oral Health Policy from the stakeholders. In the event, no consultation document was issued by the DoH&C and the stakeholders who made submissions to the Core Policy Group did so solely in the light of the presentations made on the day.

Among the submissions is that of the IMPACT Dental Surgeons Vocation Group. As IMPACT represents all grades of dental surgeon, dental hygienist, dental nurse and clerical-administrative personnel employed in the Health Service Executive, their paper reflects the current views of these professional groupings within the HSE following internal discussions within the Union. I don’t intend to precis the whole document here. Rather I am placing a hyperlink to it both as a Word and and an Adobe PDF at the end of this. The purpose is to inform all stakeholders, and any members of the press and of the public who might be interested, how those most qualified to express an opinion view the present status of the public dental service, and the potential for delivering a quality, equitable service into the future.
This writer has had sight of further submissions by other bodies representing the public dental service, and can verify that the main tenor of all such submissions is broadly similar in all important aspects.
It is important to note that members of the HSE dental service are the only stakeholders who deliver a frontline public dental service and as such are the people best-placed to comment on the public dental service. The Principal Dental Surgeons are prime examples of clinicians in management and are experts in the delivery of dental public health. As such, their opinion, as expressed over a number of submissions with different foci, should weigh very heavily on the Core Policy Group during their formulation of the new policy. Their initial omission from the Core Policy Group may have been an oversight on the part on the DoH&C, but it does beg the question as to how the managers of the public dental service are perceived; it also underlines yet again the effect of a lack of a clinical advocate for dentistry at a national level, both within the HSE and in the Department.

Currently, the HSE dental service has posts for some 400 dentists, 60 hygienists and 500 dental nurses approximately. HSE salaried dental staff are committed and interested in maintaining high quality services, even in a low-resourced environment. Historically, many of the dentist posts have been difficult to fill due to the greater attractiveness of higher earnings available to dentists should they choose to enter private practice.
The majority of personnel spend the majority of their time in direct treatment provision, primarily for children up to the age of 16, and for patients with Special Need. For childrens services, this provision is targeted at three classes in primary school, which are usually 1st or 2nd, 4th, and 6th classes. While children in the other classes are not routinely targeted, in some areas these children are seen also if resources allow. A very great strength of the system is that all children in pain or in need of emergency care are offered same-day appointments. We believe that such groups should not be treated in the private sector, for very good reasons of public dental health, outlined in the section on dental contractors in the submission.

It is the IMPACT position that the salaried dental service provision should expand to cover the existing groups (for whom adequate provision has never been made), as well as new groups as outlined in the paper.
Particular areas of resource shortfall include the 13-16 year age group, which were given eligibility for public dental services in January 1995 (up to 14 years) and July 2000 (up to 16 years), with a promise of extra dental teams to be made available to the public dental service to meet this treatment need. These extra teams were never made available.

Members of the public consider that it should be a requirement that every child in our care has the opportunity to have at least one contact with the dental services every year. Such a contact will not need to lead to invasive treatment in the majority of cases and therefore the increase in manpower required could largely be comprised of auxiliary dental personnel, particularly dental hygienists and senior dental nurses upskilled in oral health promotion.
For example, auxiliary personnel could provide a tremendously positive role in promoting oral health by contact with pre-school children and their parents; hygienists, particularly given the expanded roles envisaged under the Competition Authority report on dentistry, could be expected to meet a large part of the maintenance needs of children once dentists had treated existing disease.
In our view, such programmes produce the best results when part of an integrated dental service. The proposed Primary Care Team model within the HSE will not be able to produce a similar integrated service, given that private dental practices are not distributed evenly across the country and that dental practices are not envisaged as being part of the core PCT in any case. READ THE FULL DOCUMENT IN WORD(419kb) or in ADOBE PDF(620kb)

HSE and DENTAL NEWS

Minister wants Chief Dental Officer and more Hygienists
The Minister for Health and Children, Mary Harney T.D. announced on 18th October that she considered the position of Chief Dental Officer "an important area where we need an advisor at a clinical level that is the CDO... as far as not just our international participation is concerned but even on domestic issues it is an important position." A decision is to be made very quickly on the post. More

Dental Council to assume responsibility for mandatory CPD
All registered dentists in Ireland will have received information on Continuing Professional Development (CPD) with their Certificates of Registration. It is the stated intention of the Dental Council that mandatory CPD will be introduced in 2010 and will become a pre-requisite for continuing registration. The Dental Council assumes that it will be assigned responsibility for monitoring CPD, and what follows is based on this assumption.
There will be a five-year CPD cycle of 250 hours, 75 verifiable, of CPD, following the UK model. The Council recommends recording of CPD from 2008 although it will not be mandatory until 2010.

Verifiable CPD must have

Concise, clearly stated educational aims and objectives
Clearly anticipated outcomes
Quality controls (i.e. there must be an opportunity to give feedback)
Documentary proof must be available of attendance/participation from an appropriate source

The Council states that it will give advance approval to courses. There is nothing in the announcement regarding the provision, availability or approval of on-line courses, which is a means of providing courses that do not require a hands-on component, or physical attendance at a stated location. This site has had CPD in Oral Medicine for some time. There is an opportunity here for dental schools to develop course-ware from within their teaching expertise, and to provide this on-line; this is clearly an opportunity too for a revenue stream for the schools – or for any on-line provider of courses that meet approval.
CPD will be a condition of continued registration. Each registered dentist will have to complete an annual statement of the number of verifiable and general hours completed in the previous 12 months. The Register of Dentists will be a public document listing qualified dentists, i.e. those who have maintained their competence through CPD Dentists who don’t comply with the requirements will face erasure from the Register.