While we can use digital scanners for many lucrative mainly cosmetic services providing what many members of society want, we can use the same technology differently and help support what the vast majority need. This video explains how it could be carried out in the uk. Its carried out elsewhere in the world, why not the Uk? If legislation is a barrier for care, then the legislation is wrong, and should be changed. If we want to improve access and empower the underused dental team members such as therapists, then we need to change the system.

Yesterday I went to the BRI, as a mole on my back had started to bleed. I was referred by my GP, who hopefully one day will get the following device, or something similar at a reasonable cost. Our scanners are probably more accurate, but no one has programmed them yet, as there is more money in orthodontics.

It reminded me of a video I made about a year ago, on a British Innovation, but the  augmented device used seems to come from the USA?
I contacted the company involved in sending encrypted image files from the user, to the diagnostic centre, as outlined in the video below. The answer I had was they couldn't, as there was the potential for a false negative diagnosis, and they could get sued. It would seem at the expense of everyone else who may at least get reassured, or an earlier diagnosis.

When the trial is completed, it will then have to be implemented, and that pathway for this or another product, ideally made in the UK and sold to the USA could be set up now. If we are to have an integrated health system, health advocate DCPs promoting preventive cancer screening once a month, as well as promoting their other services will be able to highlight it as explained in this old animation. Why wait?

Access to care homes is a problem. The resources in NHS dentistry have been failing for years, especially if mobile care. Perhaps if we can change the delivery system, we can improve it. Improved oral health will reduce death rates from the well-documented historic pneumonia and the more recent Covid.
How can it be financially viable for a dentist? Does he need to be in the care home?
Why not continue with Asynchronous Teledentistry?

Many practices have scanners for those within to straighten teeth but could earn more money by scanning dentures. The dentist often delegates the scanning to a trained or sometimes untrained assistant, and they scan inside the mouth.
Losing dentures is a problem. Around 14,000 get lost every year in care homes and hospitals. If we scan the denture before it's lost, the patient can have a replacement the following day.
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Ideally, a hygienist and an assistant could go to a care home and work together to thoroughly clean the teeth before scanning the remaining teeth, if there are any. The assistant can scan the denture and then the mouth. A BPE can be taken, and OHI to the patient and the Oral Health Ambassador.
There can be a charge for the scan alone or the provision of a denture. The potential is there for a trained hygienist to take a reline impression, a new reline copy denture made, and the original denture retained. Many residents in care homes have the silver pound, which may help supplement those who can't access current NHS care.
More recent scanners are portable and so can be used when not required in practice, with the extra advantage of leaving surgery free for routine patients.

The dentist can review the scan at a different time and review the notes from the hygienist. Similar to bleaching trays, we could make reservoirs for silver diamine fluoride for suspicious lesions and monitor them. Ultimately, regular scans will be automated, similar to radiographs, and we will have valuable data in the future for everyone's benefit.
With direct access, it could be a viable business.

https://vimeo.com/502258441
https://healier.com/what-is-asynchronous-teledentistry/
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Evidence would suggest instead of providing a "scale and polish". We should have provided a disclose and advise, and used the ultrasonic if there was remaining time. It would have encouraged the public to take ownership of their health a generation ago. We could have said we would only charge for using the ultrasonic if there was bleeding.

I made a video for a cancer recovery unit, and added some references that they may find useful. It's quite easy to make a slideshow, but my laptop struggled with the length of the video, and this final bit I feel was more appropriate to the dental profession. It talks about the likely missed opportunities of Covid. The use of SDF, CVEK, and teledentistry which would be of benefit to the public, and ourselves.

There is a relatively new joke. "How can you tell if someone is vegan?
-You don't need to-. They will tell you."


When I qualified in 1982, if you were gay, you had to be discreet as it harmed your career. And more recently, on a flight, there was an announcement that some snacks were unavailable as someone on the plane had a nut allergy. Can you imagine if they said there were no alcoholic drinks?


On October 27, I went to a course run by Alcoholics Anonymous. Throughout the day there were a series of talks over an hour long. At the end the dentist I was sitting next to commented on how quiet the room had been and everyone had listened attentively. That doesn't apply to many of the CPD lectures I've attended over the years. When you have a talk by someone who generally has struggled and suffered, it makes you think how fortunate you are that you don't have the problems that many of these people seem to have inherited through no fault of their own. And similar to dementia and Cancers, the people who often suffer more are the immediate family supporting them.


We need to keep medical histories current, which used to be verbal, then written updates, and now online, before patients attend. I rarely discussed obesity, and more recently explained what HPV was, but discussing how to avoid it?? I did have some success with smoking cessation. My general line was, "Well, Tom, most patients I know who stop smoking do so after a stroke or heart attack-why wait?" As for drinking, most people, myself included, lie to you and themselves. 

My Dad lived with his dementia, and my mother cared for him for too long. I am just like my Dad. On refelection, some contributing factors to his disease were he went to the pub most nights, high cholestrol, smoking cigars, and in his day he was extremely good at heading a wet leather football. So I take some preventative measures. I don't smoke, and to his constant disapproval closed my eyes while attempting to head a football and take a statin with the understanding it roughly reduces my chance of a TIA or worse by around 1 in 250. Riding my bike probably helps a lot more. I also have a history of alcoholism among my relations,  as do many of you.


I have always enjoyed seeing friends in the pub. I ran peer review meetings For years, which we funded by paying the discussion lead with food and drink in the local pub. Menus in pubs often give the number of calories in the food and if it contains nuts. If you want to smoke, you have to go outside, as it's the law. I have yet to see a sign saying if you are allergic to alcohol.

Alcohol addiction is a huge problem, and the word alcoholic has a different stigma than if it was an allergy. Allergy promotes sympathy, but addiction is the opposite. You can be sure that some big pharmaceutical company will be trying to find a "cure" as long as you have to take a tablet for the rest of your paying life. Many of us have been drunk, and it's generally a choice. Being an alcoholic is not a choice. It's a progressive disease, and like oral cancer, early diagnosis and intervention improve outcomes. It is a mental health issue, which has a funding issue, and in Bristol, you need to be sober for three months to access mental health support. 


One thing that works better than anything in helping those with alcohol is AA. According to Cochrane, it is twice as effective as any other intervention. It requires no government funding, and while it's anonymous, it should not be invisible. It is a brilliant example of how a bottom-up organisation works, where many health top-down hierarchies fail. 


So how can we help? A nudge through our online medical histories? With technological advances, we should use them to signpost the public we see and those we don't, to access trustworthy resources to help. While there currently seems no funding available for dentistry, or mental health, there is for cancer and diabetes so any online medical form should have a section to access some discreet self-assessment and signpost support from where we have it. For quitting smoking, losing weight, having unsafe sex, reducing stress and risk of diabetes. Just a trusted link, embedded within these different sections that can be accessed by the user, for their benefit and potentially improve their habits through gamification that we may never see or record. It stays in their phone, with their history, and will be more accurate on what many tell us.

As a profession, we are trusted and have a large sphere of influence that we can exploit at almost zero cost. We can potentially improve the well-being of people we will never meet, which is the clear understanding of anyone who has completed the 12 steps in the AA fellowship group. We can utilise the mobile technology everyone carries 24/7. The AA website provides access to the next available support meeting for AA face-to-face nearby online through GPS. Why shouldn't we promote it within the alcohol section in the risk section?
We need to embrace other organisations on the periphery of health delivery,  as prevention is better than cure, and as we need to support ourselves. In many aspects of all health delivery we behave like a business cartel, rather than a health service. We should learn from each other.
We had regular peer review meetings as, like alcoholics, we understood and could help those with similar experiences and provide knowledgeable support. In general, informal peer review was the best of form of education and support I engaged in. The one on Mindfulness was unforgettable..

Today is my 63 birthday, but at ever-advancing years there comes the point when it is better to give than receive. I will be out with friends tonight and will have a few glasses of wine that I will enjoy, and tomorrow I will have a choice. 
Sometimes, we don't realise how lucky we are.
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References.
​The one with the * is the best on addiction. It’s half way in. It’s funny, he’s an expert, he should be at the next BDA conference.

To find an AA meeting
https://www.alcoholics-anonymous.org.uk

To find an Al-anon meeting
https://al-anon.org


Youtube on AA
There are many, this is short. 
https://youtu.be/ZqORUQ5ahIs


Ted talk on health alternatives through experience
https://youtu.be/WQ2PFoHptK8


Prof David Nutt, one of many on alcohol
https://youtu.be/hAl1MlOZldU


*Alexei Sayle’s Imaginary Sandwich Bar. Satire helps.
https://www.bbc.co.uk/sounds/play/m001df6c

Details on Fellowships, and how to support them
https://www.visiblerecovery.uk/home

A new All Party Parliamentary Government unit to help addiction
https://www.12stepsappg.com

DENTAL SUPPORT

Dental Health support trust
https://www.dentistshealthsupporttrust.org

Confidential
https://www.confidental-helpline.org

Mental Dental Facebook Page
https://www.facebook.com/groups/1521725241212609/about/

There is no CPD with this. And there is no CPD for learning how to engage our patients digitally. HEE should provide it for ALL the dental team.

Not every practice has a website, but most do. I used a company in Poole years ago, and they were excellent. For them to build a basic website now is over £5000, and a monthly maintenance fee of around £30. So this is a list of the pros and cons of an App. Click on the picture for the article or google another review.

I looked at buying a dental App about seven years ago, and they did everything I wanted but did not have an interface for the user to monitor themselves. These "dental apps" were standard templates and were not possible to customise for the user at the time. So I decided to investigate making my own. So first, to address the cons above. If we indervidual dentists collaberate.

The expense - NO. Not if we share the cost, and it's free for most DCPs. 
Compatability-NO. Initially, the App worked well on both platforms but needs regular updating, and we need to pay the developer.
Expensive to maintain and update-NO £10 a month is not costly for dentists.
Difficulty getting approval-NO it's approved and available on both platforms.

​Download it now to check. It's a free download on Android and IOS.

The most significant benefit for the dental team is it promotes and protects you. Send the patient their BEWE via email on your practice software, and you have a record of their periodontal advice, and you can also promote further procedures you recommend, or they may want. Click here for the template I used and on the business card for the PDF.
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Handing out the business card to the patient, with their information on one side and yours on the other, is old-fashioned marketing and enhances the second most common form of building your client base. The first one is retaining your current patient list by improving the service you provide for your patients. Suppose they share the App with those you may never see. It may encourage the public to see someone, especially with the oral cancer nudge within the App traffic light system, which is one of the many advantages of an App over a mobile website.
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Save a life, SHARE teeth4life.

If you can do this and have the time. Why not register the rest of the dental team? You could charge pro rata at their hourly rate🤔. The more people on the App, the more likely it will be shared. If anyone wants to customise their three free services when registering as a Hygienist or DCP, contact me and I'll add it to the resources. Many of us work part-time and have other interests, such as a dog walking service, reflexology, art and you could include it here to help boost awareness and potentially your income😁

Type in teeth4life on your App Store, and download it for free. The App enables anyone to have an internet presence to which they can direct their patients and engage with social media as much or little as they want. In My Dentist, type in Bristol, then search for my virtual practice, Teeth4life, for some profile examples. If you can see your practice, but no one appears registered, it's because the dentist registered, but they are unaware I have started charging £10 a month. Please give them a nudge. It will remain fixed for the life of the App for the first 100 to register. I will then be in a position to rebuild the App following further feedback from the public and the profession. If more register, we can add a few more features, as shown here, including a teledentistry platform that could enable us to save more time, earn more money, and improve our well-being. If we collaborate, we can provide our DENTAL HEALTH SERVICE. ​

The App promotes you, and you can do as much or little marketing for yourself. You can update your profile at any time and add all your work practices. Just put your individual hours on your profile, and ensure the practice opening hours are correct for the practice, not just you. Link to the practice website details if you have one. Especially if you have online booking, which personally I think is poor, Teledentistry will work better. 

To engage the user, your patients can personalise it for themselves and their family. It engages your patients in a manner that a webpage can't. It is full of video animations that follow the government's regularly updated, delivering better oral health toolkit. You have to highlight the videos you feel most appropriate to their needs. From your services, you can also address their wants.
The App would benefit more if a dental professional body endorsed it.
​Want to help?

ORAL CANCER SCREENING
I remember on qualification, or at least I seem to remember that I would see two Oral Cancers in my practising lifetime. I distinctly remember the first one, which was a classic in an alcoholic with a loose tooth, in my second year as an associate around the time I made my trip to the GDC. The PA showed a large radiolucency beyond the film's perimeter, so I referred him to the Dental Hospital. He returned after an OPT, and was about to lose half his mandible. He was really annoyed with me.

Many years later, a regular patient missed her appointment and came in overdue by a few months, it transpired she was undergoing radiotherapy for her SCC. A dentist from the new practice inside Sainsburies, where she worked, had asked for volunteers to try out the new surgery. When I apologised and said I must have missed it, she refused my apology and stated I always checked her tongue. I never diagnosed it. One of my friends and a family member have since developed oral cancers, and we arranged for a Peer review session by the local oral surgeon who's team had treated my friend. During the discussion, I came to appreciate how rapidly an SCC can develop. While we need to check patients ourselves, they need to be made aware and check themselves monthly for this deadly disease which is increasing in prevalence, especially in younger patients, due mainly to the HPV virus. I was never any good at feeling lumps and bumps. I asked my patients if they had noticed any swellings recently. My relative noticed their swelling a few months before I could feel it. Fortunately, it was a benign salivary tumour.
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I made a few videos for my App, and I'll add them to this as one is about 20 minutes long and explains how we can fast-track diagnosis using these innovations for the iPhone. I'll include the spreadsheet I made, which is the "scoring" behind the early tooth loss and oral cancer risk. There is no consensus on the scoring, as some say a heavy drinker and smoker is 30 times more likely to get oral cancer, and some say 36. The scoring is not a diagnostic tool, it's a traffic light system as an indication for the user.

In the conversations I have had with a different NHS innovation company on secure encrypted images being sent to a triage centre, I had a typical setback. Their concern was the public may think the App is a medical device, and therefore there was a potential of getting sued. They wouldn't be interested because of the potential risk, and the 100s of people who could quickly be reassured would lose out. As stated elsewhere and in Jonathon Sumptions Reith's lecture, lawyers have encroached on medicine. In 1911 there was 1 lawyer for every 3000 people. Now it's 1 to every 400. They need to do something, and our litigation rates are twice as high as the USA's when I qualified. The unfortunate outcome is we become risk averse, deskill or specialise and charge more, but general dentistry is beyond the reach of the public, and they don't attend regularly. I did a survey and asked if people would prefer to check themselves once a month or get checked yearly by a dentist. 
Once a year was the overwhelming response.
If the system is wrong, we need to fix it. It would seem we need to pay a better lawyer than the ones lurking at DLP.

If we extend our recall periods, we can signpost the public to take ownership of their health. It will cost us nothing if it's on their mobile phone with a reminder for signs of all cancers.

Poster link
https://www.dropbox.com/s/9vywphajsfg889n/Oral%20Cancer%20Poster.pdf?dl=0
Scoring Link
​https://www.dropbox.com/t/yAtMNhJxba7QYZp0

​ I worked for two corporates, I had letters from both of their  solicitors  when I highlighted problems I had providing an adequate service. They were concerned of their corporate image, not our duty of care. If you don’t have the correct materials, the equipment is broken, the support staff are changing frequently, it all adds to stress. And stress creates poor performance, which creates problems, complaints, and more stress. As our values were not aligned, and I was over 60, I retired because I could. And I had  developed a hobby that I thought could help support the profession. I'd waited too long for support from any government of the day.


There is a constant legal issue over if there is a complaint, is it the dentists fault? Should it not be the companies?
The conventional blame culture and pathway is as outlined in Don Norman’s book.
As we become more reliant on AI, shouldn’t the equipment, materials, and other external factors be taken into account?


The worst corporate is the NHS. It's not the dentist who is at fault. It’s the system. In any other business, if there is a problem you look at the cause. And in the past for a large corporate the CEO would resign. Our health ministers are not in post long enough to resign any more. Matt Hancock resigned not because he failed to address a long term prevention plan for dentistry, but an inappropriate fumble with his staff.


Are these quotes from Don Norman’s book applicable to dentistry? Is the NHS system, the corporate environment, or the individual at fault,?

I was in Las Vegas in 2015 Sirona brought out their latest chair unit with the scanner and cone beam unit attached at over $120,000 from behind one of the round screens with dry ice, lasers and pumping music, and 1,000s of American dentists clapping and whooping. It was sold within minutes as with this kit AI could design the template to locate your implants on a 3D printer.

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Which was just as well as the dentist who bought it was aged 82. So if the implant failed, who was responsible, or is there a shared responsibility. Not least with patient who didn’t maintain adequate oral hygiene, and persisted in smoking.

​I did a year long distance learning course for orthodontics around 1990. I learned that the diagnosis was full of difficulties, and ultimately referred everything apart from moving a tooth over the bite. However, now it’s a huge industry, and a great source of income for adults who never had braces in their youth, and those cases who have relapsed. A few on-line course seems to be enough, and leave the diagnosis to the AI. Who is responsible?

Finally, with restorations. These scanners continue to improve exponentially, and the requirement to change parameters is minimal. Just like the patient needing to be in the green before commencing treatment, the computer will give a green or a red depending on your scan and its ability to produce a proposal. If the scan is an amber, and you fit the inlay, only, crown, veneer, laminate, or any new named restoration design. Who is responsible? It was clear back in 2015 that the main cause of  failures of the Volkscrown were due to dentists not following the correct cementation procedures. And that is a learning process, with human error of slips and mistakes. Many years ago I had failures with Dicor crowns. The same material is now used successfully when milled. It was reassuring to know after about 20 years, that the failures were not a human error, but bad design.

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