There have been a lot of interest on the GDPUK website recently following the publication of the death rate of dentists waiting for fitness to practice hearings. This is the latest response as published in todays Times.
As an individual dentist we are vulnerable, we should have some form of united response in a similar manner to Dr's who are better organised for similar problems with the GMC. The GDC should protect us as well as the public. Read on. What are you going to do? Follow the articles on the GDPUK site.

I retired from clinical dentistry last year and spend a lot of my time thinking of how we can improve our health delivery. While there have been many advances in dentistry, when it comes to checking if our teeth are clean, disclosing still works best. Unfortunately, it's a bit too cheap to get much recognition. However, when it comes to research, there have been 3270 papers written on the subject, and a Cochrane review recent paper concluded that only one was of value.


https://www.nationalelfservice.net/dentistry/oral-health-other-health-conditions/plaque-disclosing-oral-health/


So with my simple maths, if extrapolated, it means of the two million research papers published each year, less than 700 are of value. To progress in academia, you need to get published, and there may be a conflict of interest here?


I like conspiracy theories, and I've wondered why we can only get one make of toothpaste on prescription in the UK? There are far better products and have been available for many years in different countries. I came across Clinpro 5000 in Las Vegas six years ago at a digital dentistry conference. Now we have an innovative toothpaste Biomin available in the UK, with FDA approval but only on prescription in the States.
We are still investigating rather than implementing silver diamine fluoride in the UK when we are fully aware of its benefits It is used in the USA, Canada, and has been used in Japan for over 70 years. Do we have different teeth? There is some movement on fluoridation, but it has been regularly reviewed ever four years for the last fifty years. The evidence is there, but no political will. Let's continue to traumatise the children with increasing GA sessions at a cost to the NHS, us the taxpayer, of billions of pounds, which is nothing compared to the mental trauma of the child and their parents to a potentially life-threatening procedure.
Unlike covid, we will never be vaccinated for gingivitis or caries. However, when it comes to prevention of the worlds most common diseases, why do we have these barriers?


There is a lot of discussion about the link between oral health and general health. This was more an observation.


https://www.efp.org/news-events/news/jcp-study-shows-that-periodontitis-is-linked-to-covid-19-complications-30539/ 


The pharmaceutical industry has improved since I listened to my audiobook on BadPharma. Unfortunately, even google is struggling to find the relevant paper regarding a future study on the relationship between general health and oral health I read recently. And that to avoid the three-quarters of poor outcomes which were never published, the research criteria is such that the method is issued prior to it being implemented. A recent paper I read, but even google can't help me with this morning, was on the oral and general health link. The parts that struck me were the study required irrigation of the pockets with GSK chlorhexidine, while all the other cleaning products were from Colgate. I had a "Cavimed" years ago which applied the chlorhexidine directly in the pocket. I stopped using it when new research demonstrated the results showed only a transient effect. One can only conclude that the research will show a result that using these products improve general health. We can imagine the marketing campaign that is already written.


Yeara ago, I discussed with a Professor of periodontology my idea of oxygenating the periodontal pocket with ozone using suck down splints. Even I knew it would never be possible. It must have been after the Legionnaires scare, and I asked about the safe concentration of hypochlorous acid in a pocket through a standard ultrasonic, and sodium hypochlorite. His answer was no one knew, as hypochlorite was too cheap for the research to be funded. Well, we know now. This is one of many recent obscure papers. 


https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6906904/


Now again with my simple maths, how much hypochlorite is required to irrigate the root canal? 


The most viewed TedTalk is by Sir Ken Robinson. It explains how through our training, we may stop being curious and now have a different view.


https://www.ted.com/talks/sir_ken_robinson_do_schools_kill_creativity?utm_source=tedcomshare&utm_medium=social&utm_campaign=tedspread


Many GDPs my age are relieved to retire due to the external threats that create unnecessary stress, which, as we are aware results in poor performance. My vision is to create an eHealth product Promoting Public Prevention in oral health for the public and reducing GDPs' stress. The free teeth4App could help reach the 48% of adults who don't visit a dentist regularly and give preventive advice through videos. The videos in the teeth4life App has about 60 videos based on my forty years of experience and my CPD. It would be far better if it were a collaborative effort endorsed by a professional body rather than a business whose main priority is profit for the shareholders rather than the health of public.


The App has a scoring system devised by the evidence from some of the dental health research papers already published. It is not perfect, it could be improved, it will never be 100% accurate. It does give a reasonable indication of oral health in a traffic light system, and more accurately, the risk of oral cancer and how to monitor yourself for this sixth most common cancer. Like all cancers, early diagnosis is the key.
I have had a lot of contact with AHSNs and Orcha. My App will never get a rating to be "approved" by Orcha unless I remove the traffic light system which indicates the risks above. If I remove the scoring, it will pass. It will be good enough from the criteria set indirectly by NHSx, but serve little value for the general public. I have been advised to carry out some research to justify my figures, they can reevaluate it. And they recommend I will have to make it self funding, therefore charge for it.


If we make a viable version and engages the public and is financed by some of the profession, then the profession should take the credit. I think we can make prevention work, but we have to engage with those outside academia and those with a skillset outside dentistry and ask simple questions for simple answers to help improve all our wellbeing. The biggest dental corporate had hindered rather than helped oral health over the last twenty years. There is a better alternative, we just haven't thought of it yet. Please help.






















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Tony Smith
Dental Entrepreneur promoting prevention for both the public and the profession through FREE eHealth product
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hashtag#preventionisbetterthancure hashtag#healthawareness hashtag#dentalhygienist hashtag#dentalbusiness hashtag#buisnessideas hashtag#innovation hashtag#appdevelopment hashtag#dentistry hashtag#videomarketing hashtag#marketingcontent

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I was asked by a dental Magazine to write an article about the App, in the format of answering their questions. This is it:-

What is Teeth4life? 


Teeth4life is an eHealth product. It's a free resource available now to download on the App Store and Google Play. It protects us with the data stored on our dental software, and promotes our services with a customised profile. It has a scoring system to monitor oral hygiene and has a notification centre which ideally, following your advice, supports them in creating and maintaining good oral health.  It encourages the user to take ownership of their health through gamification. The default advice should recommend a monthly reminder for oral cancer and get in the general habit of self-monitoring their health. Never have we been more aware of the poor outcomes if our general health is poor. As general health is directly linked to oral health, why not also use this opportunity to educate them on preventing the world's most common disease?


You can customise the App for free via the supporting website care4teeth.co.uk. Please read the section on marketing and the blogs on support. The public can select your details from the MY DENTIST section and personalise it for themselves and their family in the MY TEETH section. 


Please give us your background, how did you come to creating this app? 


I was lucky as I moved to Anglesey when I was six and went to a comprehensive school. None of my 26 cousins did, and I was the first to take A levels, partly because I was too young to leave. I'm the only one to go to university where I could have studied science, which was my strength, but instead studied dentistry, as I remember my Dad stating, “But dentistry is a profession” and back then, I wanted a job. I liked the idea of being my own boss, helping people, and never having to be on call or open a book after qualifying, unlike doctors. It was a long time ago!


As a profession, we have ethical and moral obligations and need to warrant the public's trust at large. I am concerned that, like many professions are we are being hijacked by big business. The purpose of a business is to create and keep a customer. Until I sold my practice to a corporate, the patient was the customer. In effect, I became the customer and "my patients" become a commodity for the accountants that run these businesses. Just as the government can complain about Vodaphone and Amazon's tax dodges, we struggle with large dental corporates and AI-driven orthodontic groups  who take the income but no responsibility for the outcome. Sadly, after nearly forty years as a GDP I don't trust the government to promote dental prevention. When I have approached the NHS with the App, they have asked me how it will generate money for the NHS. The bureaucracy is so big it has lost its founding principles of "universal, equitable, comprehensive, high quality, free at the point of delivery, centrally funded". As a profession, we are obliged to do it ourselves.
 
I sold my practice around the time of my Dad's declining health which resulted in his care for over a year in a dementia ward, where oral hygiene was difficult. Many of my patients were carers, and I asked them about their experience and subsequently made a website care4teeth.org to support them with a variety of resources, including video links I thought useful on YouTube.
Technology changes, and while the now redundant iPod carried 10,000 songs in your pocket, any smartphone can have you in your patient's pocket, well, at least your advice, and while they are in the bathroom cleaning their teeth and gums. 
I approached a few dental App companies, but they used basic retail templates. Many large companies have Apps, but in the main as a vehicle to sell only their products. There wasn’t an impartial one that covered most aspects of preventive dentistry and so eventually, I thought I'd make my own. It has taken a while as the first App company I was going to have joint venture with wanted to charge the public, and would be a hurdle for the public I was trying to engage.
I eventually designed the App that as a dentist I would find useful, and eventually used a small company to produce it, while I gradually taught myself to make videos, via YouTube.

This weekend I've been thinking of the problems FDs and their trainer have due to covid. The Fds will have less experience coming out of dental school than ever, which adds to the pressure on both the Fd, and their trainer. then at the end of their FD year, they will still be relatively inexperienced compared to the past. This was an idea, that could work with collaboration. DO you want to help? CLICK HERE for the page link.

I've written the outline on this site. It's for FDs, but also there could be another section as a resource for dentists wishing to upskill. The idea that we don't get lost viewing poor videos, and spend our time more effectively viewing a good resource selected by our peers, on our phone in work. Use the saved time, restoring our work/life balance at home.

​Covid has impacted all aspects of dentistry, and the impact on training is probably most significant. What can we do to support those embarking on their career? The burden on trainers is greater than ever, and we need to support them as much as the young dentists. The financial rewards are not sufficient to warrant training, and it's often a vocation. But let's hope everyone is getting the support they deserve or highlighting it to those who have influence.

click on images for further articles.

A piece of research from Qatar was on Twitter at the beginning of the month. Click on the picture for the link.

​This follows up the research carried out in Birmingham by Professor Iain Chapple and his team published in January. I have seen him lecture twice on the subject, and still, I couldn't quite understand the exact mechanism of the link but grasped the method. He used some excellent video animations to explain the process.

​I made an animation over a year ago to present it to my patients so they may understand. I'm not sure if my explanation is accurate following Qatar's research, but the outcome is the same. I think it is called a "Plato's truth". While my information is not 100% accurate, the message is for the benefit of the recipient. It also may be funny, and laughter is the best medicine.

New Year has brought in some further clever advances in software. I used this software a few months ago while I was still working in Practice. My GDC registration was not updated, and so I assume I am able to voice my opinion without losing my livelihood.
Our dexterity will always be required, but we will find it easier to communicate with our patients in a targeted fashion. 
This was made in September, and it's still in Spanish. I added one image, the rest were chosen by AI, as was the language. I struggle with English. Its my best language, I have no idea if this is Spanish, let me know if it isn't.
​

This is the software it was made on with the text used translated into Spanish. The software choses an appropriate image, and the language using the text which may have been via speech recognition.

If you can't read the text, then this was my first attempt. I have heard my voice is too monotonous and dull, so using AI I had a sex change.
​Click for the animation, in English.

There have been some further developments with all software, but teeth and gums are the same. Please download the teeth4life App. Customise it for yourself to help promote and protect yourself. Let's make 2021 a year when we were able to promote prevention in health, and take back control of our own work life balance.
​This is a link explaining how the teeth4life App can promote and protect you.

In the USA a 1951 policy on water fluoridation enabled 74% of the USA to access fluoridated water by the time when I qualified in the early 1980's. The prediction was that by the year 2000 decay in children would be irradicated. This never happened. Instead, as in the UK, where currently water fluoridation is only 11%, and despite the increased explosion of marketing of toothbrushes, toothpaste, and mouthwashes, it didn't work. How come? Why won't it work in the future? What can we do?

As you can see around 1990, the decay rate plateaued. It explains why with our 11% of fluoridated teeth, the decay rate in the uk is worse, and from the last review in 2019 increasing. The graph is taken from the dentist below who qualified ten years before myself, and voicing an opinion similar to my own, and a lot of GDPs. Click on the picture for her enlightening presentation.

We need to integrate our health delivery to the public in a different way. It is so disappointing to retire when our knowledge is greater than ever, but by any standards our results are so poor.
We have failed because we work in isolation, and as everyone knows you need to get in a helicopter and take time out from dealing with indervidaul decay, and see we are a small aspect of health. The governments green paper states the following regarding the savings for prevention for the under fives. For the general population the average is now a £14 saving.

This is all the evidence we need, I don't think anything has changed. Why procrastinate?

​When I moved to Anglesey in 1996, water was fluoridated, but a bit late for me to have the maximum benefit. In 1992 Welsh Water unilaterally withdrew the water's fluoridation, and the dmf rate more than doubles in a five year period. The public, and the profession were not informed. The evidence is there. Just Google it.
​https://journals.sagepub.com/doi/full/10.1177/0022034519843495

​A BHAG I remember from years ago in the early 1990's, before I had a computer at work. It's a Big Hairy Audacious Goal devised by Jim Collins. I didn't know it was attributed to him then, but  I googled it. More recently I came across OKR on a Ted Talk. Objectives, and Key Results. The objective or goal in my lifetime has never changed, its prevention in oral health. I always found it depressing having to restore childrens teeth, listening to parents telling me their children ate too many sweets. Occasionaly, when brave, I asked where they got the money. My results were satisfactory, but nationally my gut feeling is we are worse. A lot worse, as outlined in the excellent presentation by Marielle Pariseau, with some insight in how to overcome it.
A famous quote attributed to Eintein was " the definition of insanity is doing the same thing over and over expecting different results". 
Governments regularly publish results, such as childhood GA extractions and obesity.  Similar for adults, but at this age, our prevention focus should be on their "gums". Let's try something different.

​The government paper on "Advancing our health: prevention in the 2020s" from July 2019. prevention mentions targetting the under 5's only with OHI, and water fluoridation (page 51 gov paper prevention). 
In the PHE report on water fluoridation from 2018 on page 8 

Water Fluoridation: Health monitoring report for England 2018 
Conclusion 
The findings of this report agree with the view that water fluoridation is an effective and safe public health measure to reduce the frequency and severity of dental decay, and narrow differences in dental health between more and less deprived children and young people. 

and then on page 14 of the 135 page document.

"PHE continues to keep the wider evidence under review and will consult with local authorities prior to publication of a further report within the next 4 years. "