Promote Public Prevention in Health

My vision some time ago was to promote public prevention in oral health. More recently, following the experience of Covid and the opportunity and time to look into health in general, I think we drop the word oral.


We work in the health business, and health should be our priority. More and more, the emphasis is business first, and health second as applied by many dental corporates. One could argue the biggest one is the NHS system. Despite the phrase you will have heard, "I hate the dentist", the public trust us. We can utilise our circle of trust by nudging the general public into better health habits as well as interdental cleaning. The idea is for the simple App to provide preventive and specific marketing advice that promotes you, as you can customise the App yourself. It's what Stephen Covey would call a win-win. It saves us time by supporting our oral health advice the public needs and earns money by explaining your recommended services, which the public generally wants. It saves time and money for the public also.


The BPE is related to general health, and the BEWE is associated with the high volume of UPDs, the resulting obesity and type 2 diabetes epidemic, and the increase in UPFs more readily available and affordable from when I qualified in 1982. Why not include some of these details in a simple format, or include links to trustworthy sites other than the "Fake news" that has paralysed water fluoridation. We can be central to health delivery, as the NHS system is overwhelmed by the six million plus backlog of treatment. We can help.


Teeth4life also encourages the public to set reminders for screening themselves. It is not a diagnostic device but a tool to help raise public awareness and access a developing triage process. As with all cancers, early diagnosis improves outcomes. I have engaged the NHS, and specifically, help with funding to help add Teledentistry and a language option that the NHS want. We need an RCT for evidence and demonstrate a profit before they consider supporting it. The Dahl technique in orthodontics and the Hall technique in paediatrics originated from single cases. The proof came later. Clayton Christensen stated years ago regarding disruptive innovation in health delivery that you can't have historical data on innovation. The NHS framework has neglected the public and ourselves in delivering a model for prevention in health for decades. Why not promote ourselves centrally in promoting health rather than being sidelined by this overwhelmed bureaucracy?


The fixed prevention videos follow the government's evidence-based "Delivering Better Oral Health" toolkit. For the App to continue, it needs funding, as outlined elsewhere on this website, with supporting videos for all the dental team. It needs funding to maintain it as a free resource for the public and the majority of DCPs. It would take 0.25% of registered dentists paying £10 a month to keep the current version of the App, or 1% to improve it. Some contributions by peer review study groups would be more helpful to collaborate and help develop the content and functionality iteratively as with most Apps. Banking Apps have resulted in the high street changing significantly. Why not with health delivery? It would be our dental profession taking the lead in our nation's health, rather than the usual spin by the government on greedy dentists. Want to help?


In her lifelong work, Marion Nestle is looking for advocates to reduce the negative influence of the food industry on our health. We need to be able to provide a health service for the general public. The dental team have that position at zero cost on our time as we can include minor incremental changes or nudges within the video content, which we know work, as with Team GB in the 2012 Olympics. We also need to address the long-term issue where most of the population will not be able to afford our services, as outlined by Michael Sandel, and the legal system has crept into the profession, as outlined by Johnathon Sumption. We need to look outside our business to provide a fair solution for us and the public.


Don't hesitate to contact me if you are interested in a bespoke version for your dental business. Please register on care4teeth.co.uk and look at how the App can market you.
If you want us to register you or if you want to take part in a webinar for further information.

"I WILL NOT SUE THE NHS". -Kevin Lewis NEC May 13, 2022.


If you get the chance, see Kevin Lewis. He is a great speaker, and I first listened to him in the 80's explaining how we could provide prevention on the NHS by exploiting the grey areas. Like me, he is no longer worried about getting off by the GDC. Those still working in practice aren't so fortunate, but perhaps those of us retired or about to retire can at least express our opinions and help the profession.
The statement " I will not sue the NHS" was the final slide of his presentation "Outside the Box". It's safe to presume he was referring to dentistry. But ?. It's interesting how dentists working in the NHS can get sued as individuals, whereas if a hospital has a problem, the NHS gets sued. If a dentist working for a corporate gets sued................ It is a minefield out there.


And talking of mines, the NHS was set up by a miner. Nye Bevan, who left school aged 14 to work in a coal mine. It would be interesting to speculate on what he thinks of our NHS now. One principle was the NHS is free at the point of delivery, so the principle of the NHS has not applied to dentistry for some time. I remember my first boss telling me dentistry was doomed as the fees went up to just over £10, covering all treatment in a system that paid on the item of service. He also advised that I buy added years for the excellent NHS pension. It's why like doctors, I could retire early. It was a long time ago. Back in the 70's our NHS started to be questioned, as in this audiobook.

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Accidents do happen, or in legal speak, poor outcomes. As you will know we need to point out that we learn from mistakes, as shown by the airline industry and the black box. If an error occurs, it's a learning process. While immediately after a plane crash, human error is deemed responsible, just as with the Boing 737 Max. The company tries to blame the pilot. Humans don't have a black box, and often the maintenance of the body isn't great, and we all respond differently to different assaults to our fuselage, which is why some procedures have poor outcomes. But it isn't always a mistake. Few sue a good outcome following a poor procedure. If we kept having excessive poor outcomes in the past, an RDO could intervene, ideally before the lawyers and the GDC. As outlined in "The Design of Everday Things" by Don Norman, humans often make mistakes and errors due to the working environment, materials, training, and equipment. We aren't brain surgeons, but we try to "Do no Harm", as discussed by Henry Marsh. 


An interesting observation of the air industry development was that the Wright brothers started it with limited resources and education, unlike Samuel Pierpont Langley, who had both. The plane got off the ground by trial and error from a passionate, enthusiastic group, not by the top academics with massive funding. 


Many dentists went down the private route around 2006 with a negative misleading media spin. Most dentists I know went private years ago to provide a better service for their patients. Often for less money. The high earners that everybody heard about were working mainly in the NHS at the time. We could get the media on our side by using existing technology to deliver prevention through our Dental Health Service, provided by general dentists from a bottom-up business model rather than a beurocratic top-down one. We can deliver some basic oral health advice using the technology the public carry with them 24/7. 

If we collaborate, we can distribute a free trustworthy resource for the general public. It will cost us buttons as a group. Raising the bar, however slightly, will positively influence the public's general health. That will help reduce the burden on the resources of our NHS. It will also help change the usual hostile media we used to get, which finally seems to be landing with the politicians, not the profession.
No matter which practice you work at good oral hygiene is the basis of good outcomes. The teeth4life App has a traffic light system to engage the user to take ownership of their health. It also help highlight oral and skin cancer awareness. We don't have to work in the NHS system, but we can all support it.


General dentists are nervous about carrying out relatively straightforward procedures because of the potential poor outcomes. As dentistry has "progressed" it has become more specialised so that certain incremental changes in treatment produce minor improvement in outcomes at a much greater cost. Does this serve the general good of the nation? Can we change the perception?


As general dentists working to provide an excellent service, we should not be stressed by the worry of litigation. Invariably there will be occasions when things do not go as either the dentist or the patient would like. If there was a ceiling in the cost of litigation dependent on the service provided. The more you pay for a procedure, the greater the compensation in the rare instance you get a poor outcome. If you are seen on the NHS, that bar should start as low as Kevin suggests. 
All evidence shows you get better outcomes when none of you are stressed; this applies to the dentist and the patient. Spending five minutes talking to your patients, rather than ten, writing up the notes will reduce litigation. There was a case recently where a patient complained six times to the dentist about a persistent ulcer. She mentioned it to the hygienist, who referred her to the hospital. After treatment of the SCC, the upset patient complained. No action was taken against the dentist, as he hadn't written up the notes. 
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This video I made before I retired, it was a bit controversial, so I used the software to change the language to Spanish using the AI in the software. A future version of a teeth4life App could be available in multiple languages utilising pre-existing AI, or even with your authentic, trusted voice in the videos.

I saw Elvis yesterday, and it was well worth seeing. This isn't a spoiler, but at the end it shows the last performance Elvis carried out a week before he died. The current view is addiction to drugs, one of which is Amphetamines which were given in the 60's for weight loss. While product placement occurs in many movies, I'm not sure if this is one Coca-Cola would have liked highlighted in this film. Perhaps as advocated for health we should?

This is the full video.
https://youtu.be/4svkR46CesI
​ He never lost his voice.

How can the teenagers BEWE be linked to our taxation.
An individual's tooth erosion and how to treat it is more prevalent now than in the 1980s when I qualified. It's a gift that keeps on giving for our income stream. But if they become diabetic or obese with a reduced working lifespan which may affect their taxable income, and take up more NHS resources care in our old age?
While our grandchildren may ask, "why did you ruin our planet?", it will be more devastating to both of us when they ask why did you not promote healthy eating? We know UPFs( Ultra processed foods), and UPDs (Ultra Processed drinks)  cause increases in obesity, type 2 diabetes, and many other health problems. 
We are in a prime position to promote health. Long lectures on sugar's evils have rarely worked in the surgery environment. We need to give consistent nudges to support general health advice. We can influence our patients who trust us by using modern technology to support our messages, promote specific information, and allow the user to make their choices for the sake of their health and the health of our national economy. 
The food industry learnt from big tobacco how, when, and where to intervene to maintain their profits. For example, Save the Children withdrew its concerns about sodas following a $ 10 million payout for local Bangladesh funding. Multi-national food companies don't have to pay for the long-term health consequences. It made commercial sense to help maintain their $47 billion worldwide revenues ( from Soda Politics around 2010).
Is it different in the UK? Have we just backtracked on UPFs? Is the consumption of UPDs going down? Is history repeating itself? Can we do anything?

As the highest growth in obesity is in the teenage group, should we be concerned for their health, our pension, or both?
To help us all get better, why not help one another, similar to how Team GB won so many cycling medals in 2012. It wasn't one person. It was a team effort of coaches and diverse experts in their field, collaborating outside their specific areas with other professions and making many minor improvements. As we are in the sphere of influence and trusted health professionals, can't we suggest a few simple nudges to encourage the public to consider the consequences of their actions for themselves and their families?

More recently, due to global warming, governments worldwide have intervened and introduced policies that have promoted disruptive innovations such as electric cars and bikes.
Why not for health? With life expectancy decreasing, increasing the pensionable age does not seem like a great solution, although it will help balance the books. Many of us are retiring while we can. We could help those who may never make it? We can market healthy living at every opportunity using advanced digital media and digital sensors that weren't available in the 80s. 

It needs collaboration to agree on essential health advice that a consensus can decide on concerning oral health and general health.
We can deliver it for free with some focussed videos on oral health, as well as dietary advice with some reference to the evidence and how to self-monitor for other diseases such as Oral Cancer.
We don't need to be experts in all fields, but we can share our experiences and expertise to help improve our general health even if the government no longer has the funding to support dentistry, or mental health, or social care. It's worth a try. Do you want to help?
Perhaps our collective action on libertarian paternalism will prompt a government into prevention rather than cure. Governments worldwide have been brave enough to take on the motoring industry, promoting disruptive transport innovation ($2.7 trillion global market value 2021). Why not the food industry ($ 8.7 trillion global market value 2021).

Alternatively, could DLP focus their energy on bigger fish such as Coca-Cola and Pepsi, who inflict far more damage on our nation's smiles than any stressed-out individual dentist. The Tobacco companies settled for a minimum of $206 billion in 1998 in the USA.

https://en.wikipedia.org/wiki/Tobacco_Master_Settlement_Agreement

Is todays evidence, tomorrows poor advice? It’s difficult to keep track on what is not necessarily the optimum way to live your life, but a way that is feasible with achievable goals.
I am old enough to have been told to “go to work on an egg”, then told to avoid due to cholesterol, but now eggs are OK, and anyway I have the miracle statin to avoid a stroke that the drug protects 1 in 286 of us. I take it to ward off dementia. I take it to ward off dementia.
I know we are all time poor, it’s why I made the App to save time supporting my oral advice health advice, and market my dental services. But why stop there? We can point anyone who follows our oral health advice, to more current basic health advice. Every little helps, but not always when it comes to BOGOF, there is a massive long term problem not dissimilar to Tobacco or OxyContin.
Sugar produces far worse diseases than caries, lets engage with the public and help them enjoy better health with simple messages, as with UPFs Ultra Processed Foods. 
Marion Nestle, the former Professor of Nutrition, Food Studies and Public Health at New York University fifteen minutes into this podcast talks about how we are poisoning children, and how we are paying for it. 


https://www.bbc.co.uk/sounds/play/p0c98rrz


The simple message for all of us as advised by Micheal Pollan in his book In Defence of Food,
"Eat food. Not too much. Mostly plants."
And avoid UPDs ( carbonated drinks), which is where explaining the BEWE is of further value.
This is recent evidence on UPFs and weight gain and the start of the disease process.
 And if you like reading, the link is below.

https://www.cell.com/cell-metabolism/pdfExtended/S1550-4131(19)30248-7


If you prefer watching, try this for Diabetes from a doctors view on living with Obesity.
https://youtu.be/da1vvigy5tQ 
There is more with our time do talking to patients and leading them to useful information that may help improve their quality of life than writing masses of needless notes which are of little value to you, your patient, and ultimately your defence organisation.
Another explanation with the general simple advice below.
https://youtu.be/tic7X3ET4gE​

Why restrict our advice to teeth and gums?
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We can take a central role in delivering better health, nudging the public who trust us to give health advice. Such as options as outlined here using the research on the effect of Ultra processed foods (UPFs), which Britain consume in higher quantities than any other European country. The increase in availability of this food packaging has a clear correlation with the increase in childhood obesity, with multiple alarming research and evidence ignored for many years. Just as many of todays youth may blame us about the world climate change, they will complain about their individual poor health.
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Is todays evidence, tomorrows poor advice? It’s difficult to keep track on what is not necessarily the optimum way to live your life, but it is feasible with achievable goals.
I am old enough to have been told to “go to work on an egg”, then told to avoid due to cholesterol, but now eggs are OK, and anyway I take 10mg daily of the miracle statin to avoid a stroke that the drug protects 1 in 286 of those who are on the medication. I take it to ward off dementia, I'd rather not wait for the evidence. Although there is now evidence that taking the statin, omega 3, and a mini aspirin helps our immunity which therefore may help my gum health, and all three are relatively cheap.
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We are all time poor, it’s why I made the App to save time supporting my oral advice health advice, and market my dental services. But why stop there? We can point anyone who follows our oral health advice, to more current basic health advice.

Earlier this year the government made a U turn on BOGOF deals at supermarkets on the basis of inflation, but more likely following intense lobbying from the multinational food suppliers. These UPFs, generally have created a massive long term problem not dissimilar to Tobacco or OxyContin.

Sugar produces far worse diseases than caries, lets engage with the public and help them enjoy better health with simple messages, as with UPFs Ultra Processed Foods. 

Marion Nestle, the former Professor of Nutrition, Food Studies and Public Health at New York University has multiple YouTube talks about how we are poisoning children, and how we are paying for it. The books on Food Politics & Soda Politics are long, and deeply depressing. For more info this is her website . 
Her Nobel Talk has the repeated theme of ADVOCACY where we as a profession have a potential huge role to play in helping improve our nations health from explaining the BPE, NEWS, and signposting trustworthy resources for our society to "take back control" of our health.


The simple message for all of us as advised by Micheal Pollan in his book In Defence of Food,
 
"Eat food. Not too much. Mostly plants."

This is recent evidence on UPFs and weight gain and the start of the disease process.
The link to Kevin Halls research is here.

https://www.cell.com/cell-metabolism/pdfExtended/S1550-4131(19)30248-7

Which includes this text
Interestingly, the appetite-suppressing hormone PYY in- creased during the unprocessed diet as compared with both the ultra-processed diet and baseline. Also, the hunger hormone ghrelin was decreased during the unprocessed diet compared to baseline.


In conclusion, our data suggest that eliminating ultra-pro- cessed foods from the diet decreases energy intake and results in weight loss, whereas a diet with a large proportion of ultra-pro- cessed food increases energy intake and leads to weight gain.

This podcast from the excellent BBC podcast " A thorough examination" with the Van Tullekem doctors is easier to follow, with a brief explanation by Kevin Hall. 

Listen to the whole series, or their YouTube video on UPFs, as well as excellent videos which also explain erosion for children.




If you prefer watching, try this for Diabetes from a doctors view on living with Obesity.
The screenshot is from the final advice. Its passionate.

There is more value using our time do talking to patients and leading them to useful resources that may help improve their quality of life than writing masses of needless notes which are of little value to you, your patient, and ultimately your defence organisation.
We should work differently and collaboratively. We have the technology to make a cloud based diet history that not only noted the sugar intake and frequency, but the general quality of the diet. Tesco made the club card, and it helped improve their profits. The same data could help give advice on your health, but there is a clear conflict between your health, and their profits. Perhaps we could have access to our shopping habits via an NHS club card? When it comes to our health, Every little helps.

Another explanation with the general advice on sugar and diabetes.
Ted talks are a great source of learning from people working in their field of interest with evidence of their experience.

More references. 
https://www.theguardian.com/business/2023/mar/12/revealed-experts-who-praised-new-skinny-jab-received-payments-from-drug-maker?CMP=Share_iOSApp_Other
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My calculations based on
In some cases, adults with a BMI of 30 or above will be eligible for the drug, for example individuals with a lower BMI but still qualify as obese. It is important to remember that even though up to a quarter of all UK adults have a BMI greater than 30, not all of them will need this drug.
-53million adults, approx 13.25 million obese.

Annual potential cost for NHS 13.25 million adults BMI >30 = £25 billion
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As it can be bought over the counter, once the NHS no longer funds the drug, the public will. And while many with a BMI over 30 will not be eligible on the NHS, many below 30 will self medicate. Just like botox, once you have started you may find it difficult to  stop and it's the reason the share price has grown exponentially over the last few years. It is not a cure, that is not in their commercial interest.
When a company with a commercial value greater than the GPD of a country the size of Pakistan advertises their product, we need to market alternative health options constructively and collectively in a manner that benefits society as a whole.
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To help improve the teeth4life App, I have had the support from Design for Growth. I need to ask the public and the profession what they want. It's not as easy as it sounds, but a couple of articles I came across this weekend. One from 2004
A pilot study of patients' views of an oral health scoring system
And this comment

Of respondents, 97% considered that the OHS gave them a better understanding of the condition of their mouth and 98% considered that the OHS was a good method for communication between dentist and patient.

As it was before we had smart phones, so perhaps a free App could help?
The other much larger article was eighteen years later, this is the LINK and this 
is part of the conclusion.....

Of these, psychological and emotional factors such as control, shame and trust are very important.

Our patients trust us, and we have to encourage them to keep themselves healthy, and so recommending your App by sending an email, as well as physically handing over a card specifically about the good and poor aspects of their teeth has a minimal cost, but a big benefit saving both you and your patient time, and improving both your financial wellbeing. 

Getting support for the App has been an interesting experience, and why would you "trust" the App and its contents? Well it could be if it was endorsed by the NHS, which was my approach last year. It failed like many health innovations, and the reason is below. But if it was endorsed by the profession, or part of it. All these like the App, BDA, BSDHT, BSDT, FGDP, BADN. but will any of you endorse it? If there is an element that you don't approve of, please add in the feedback section on this website, or DM.

​The teeth4life App has a traffic light scoring system, and to help promote the App for the public and the profession, I wanted it to be endorsed by the NHS. I paid for an Orcha review and the necessary changes in the App structure to get it on the NHS App library. At a later discussion, they advised that it was in a tier 3 status because of the traffic light scoring, and I needed to carry out an RCT. I couldn't use any current evidence-based research; I had to do my own. I couldn't afford the RCT, and their suggestion was to remove the scoring, and it would get approval as a tier 2 App, like Brush DJ. 
However, it will be of less value for the user and not encourage them to take ownership of their health. It would be a mobile webpage, not an App. 
How did the scoring system work in the pilot studies? If the scoring system is the same as the pilot scheme, the App may get NHS approval, as all the videos on prevention in the App follow the government's guidelines on delivering better oral health. 

Please get in touch, and we could discuss how your experience could be used to improve the content of the current App,  and for a future premium version of the App. All AHSNs I have spoken to like the App, but say it needs funding- but not by them. When it is self-funding, the NHS may be interested. But if the profession funds it, we should take the credit.

I came across this Instagram site via Linkedin today.
​The Brain Doctor, so much useful support and advice for ourselves and our patients. Click on the pictures to her site with excellent advice, as well as enthusiasm for her work. Click on the picture for a link to her site.

I was a trainer for twenty years, and really enjoyed the training, but was aware that our VTs, VDPs, then FDs were fully aware of the real stresses in running a practice committed to the NHS. Our patients trust us, but the NHS doesn't. To provide the best treatment you should not work stressed. Click on image for engaging talk from 12 years ago. The post below is from a discussion on GDPUK forum, and may help our way forward. 

Re: Time to stand up and be counted
 30 Dec 2021, 11:39 
There were a number of reasons for my post:
1. To try to get senior dentists to look in the mirror and admit that, by and large, THEY have caused/allowed the system to continue because THEY prop it up. I first converted one of my practices in 1991. Back then the system abused dentists but, as Keith alluded to, dentists abused it back. The Area Teams knew this but also knew it was the only way to keep the system going. Nowadays the Area Teams/NHSE are out to get anyone who "tries to play the system". Senior dentists sit in a comfort zone and, by and large, are blissfully unaware of how younger dentists are suffering.
2. I have done it before and I am doing it again. I paid over £1,000,000 for an NHS practice + property 3 years ago. The loan is personally guaranteed. But I am giving the contract back. Not selling it. I am doing the right thing for my patients and staff and sending a strong message to others.
3. In the last 30 years, I do not know one single practice that has ever transitioned from NHS to private that has regretted it. As has happened, in some posts, I want more people who have done it to come out encourage others to do it. Perhaps the BDA should start to create a database of all those that have done it as an example for others.
4. I want to introduce the concept of an abusive relationship which needs to be called out. I want dentists to sit back and actually analyse what kind of relationship they are in with NHSE/the Treasury.
5. I wanted to call out everybody who works in an admin role supporting NHS Dentistry to ask themselves whether they are supporting an abusive relationship. This includes the OCDO, LDCs, Deaneries, DF Trainers......

I remain furious with the profession that rather than disengaging from NHS Dentistry, by continuing to engage, they are supporting the abuse of younger colleagues and patients. Patients think, "It's the NHS, it must be good". It is not and under the current system, it never will be.

Tinkering and trying to "make it work" will never work. NHS General Dental Practice needs to be chucked on a bonfire so that a new fit-for-purpose system is designed from the bottom up but will probably only be an emergency and/or children-only service.

Happy New Year.
Dr Simon Gallier BDS

Future Health Partnership

http://www.futurehealthpartnership.co.uk

Biomin is a more recent product. If you like Science I've added the links after the following video on Erosion. This is a rather longer version of the video I have put in the App for the public. You can hear the audio joins, and some repetition of previous videos.
This one has a potential solution at the end of the video. It's a bit different. I placed about ten. I used Lava Ultimate. I had a fracture of one, but it still covered the dentine, and so I left if. I only placed one Emax and that fractured, and I repaired it with composite.

There are a lot more details via the Biomin website.