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 New webpage available on Tooth Wear or Dental Erosion, under Oral Health Promotion tab on menu. Click HERE for easy access. Thanks Máiréad.

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.

New guidelines regarding antibiotics to prevent infective endocarditis

The Natonal Institute for Health and Clinical Excellence (NICE) has recently (March 2008) issued guidelines on the administration of prophylactic antibiotics for dental procedures to patients considered heretofore to be at risk of developing infective endocarditis. In a significant change to current clinical practice, the guideline recommends that antibiotics to prevent IE should not be given to adults and children with structural cardiac defects at risk of IE who are undergoing dental and a number of non-dental interventional procedures. Go to NICE to see all available documents, or download the guidelines HERE
You may also see the Dental Protection site HERE

However, the The American Heart Association also recently updated its guidelines regarding which patients should take a precautionary antibiotic to prevent infective endocarditis (IE) before a trip to the dentist.The guidelines, published in Circulation: Journal of the American Heart Association*, state that only the people at greatest risk of bad outcomes from infective endocarditis should receive short-term preventive antibiotics before common, routine dental and medical procedures.The AHA believes that patients at the greatest danger of bad outcomes from IE and for whom preventive antibiotics are stillworth the risks include those with

The AHA guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with

The relevant AHA webpage is HERE You can read the guidelines online or download as PDF

*Prevention of Infective Endocarditis - Guidelines From the American Heart Association: A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, a nd the Quality of Care and Outcomes Research Interdisciplinary Working Group Wilson et al. Circulation. 2007;116:1736-1754.

What the FDA really said about amalgam

The Daily Mail recently carried a front page story claiming the Food and Drug Authority in the USA had decided that dental amalgams were unsafe. The FDA's actual comment is to be found on their website. The link is www.fda.gov/cdrh/consumer/amalgams.html
A substantial body of peer-reviewed, scientific literature supports the safety of dental amalgam, including two clinical trials involving children published in the April 2006 Journal of the American Medical Association. The studies found that children with amalgam fillings do not experience adverse effects related to neurobehavioral, neuropsychological (IQ), and kidney function compared to a control group with composite (tooth colored) fillings. The ADA believes these studies support the existing scientific understanding that the minute amount of mercury released by amalgam does not adversely affect children's health.
The American Dental Association (ADA) believes the recent settlement between the U.S. Food and Drug Administration (FDA) and the group Moms Against Mercury simply sets a definite deadline (July 28, 2009) for the FDA to complete what it began in 2002 - a reclassification process for dental amalgam. As far as the ADA is aware, the FDA has in no way changed its approach to, or position on, dental amalgam.
For a differnt perspective on the future of the material, see Prof Nairn Wilson in the BDA news, Vol 21 No 7, July 2008, in which it is suggest that amalgam might gradually fall out of disuse.

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.

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

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.

Hospitals in Ireland and France

Reforms planned for French Hospitals - posted 27.6.2008

France's hospital system faces huge reorganisation if President Sarkozy accepts the findings of Gérard Larcher, the UMP senator given the task of getting value for money in a system that had a cumulative deficit of €500m in 2007. Larcher's proposals include:

Larcher has also proposed that doctors' salaries should be at least partly performance-related, and that hospital directors should be effectively chief executives to counterbalance the authority of the medical staff. President Sarkozy has said that the present chaotic situation where no one is responsible and "many have the power to say no and no one has the power to say yes" is to end. Does that remind you of anywhere else?

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

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.

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