NEWS NEW INDEX AIMS TO ENSURE CONSISTENT ORTHOGNATHIC CARE ACROSS THE COUNTRY An index has been developed to address the current variation in treatment for patients who require combined orthodontic treatment and orthognathic (jaw) surgery. The Index of Orthognathic Functional Treatment Need (IOFTN), developed by the British Orthodontic Society (BOS), will helps dentists and commissioners to prioritise orthognathic treatment and improve patient outcomes. This is demonstrated in a study published in the Journal of Orthodontics.1 In the UK nearly 3,000 patients in England and Wales are referred by general dental practitioners (GDPs) suffering from severe malocclusions requiring both medical and dental treatment. The IOFTN is straightforward for GDPs to use as it can be applied in a similar way to the already established Index of Orthodontic Treatment Need (IOTN).
The IOFTN now enables dentists to assess a patient’s functional need for orthognathic treatment based on a five tier criteria for treatment ranging from ‘No Need for Treatment’ such as speech difficulties to ‘Very Great Need for Treatment’ which includes defects of cleft lip and palate and other craniofacial anomalies. This provides an objective assessment of orthognathic need that all dental practitioners can follow to ensure consistent care is delivered across the country that complements the existing RCS Commissioning Guide.2 1. Ireland A J, Cunningham S J, Petrie A et al. An index of orthognathic functional treatment need (IOFTN). J Orthod 2014; 41: 77–83. 2. Royal College of Surgeons of England. Commissioning guide for orthognathic procedures. Draft available at: http:// www.rcseng.ac.uk/surgeons/surgicalstandards/docs/orthognathic-procedures-commissioning-guide (accessed February 2015).
VULCANITE DENTURE DONATED TO MUSEUM This typical example of a vulcanite denture with porcelain teeth and clasps has recently been donated to the BDA museum by Mrs Eileen Mayor and dentist Jonathan Thorpe of St Helens (Fig. 1). The denture was made for Private James Kay (Fig. 2) on his recruitment to the South Lancashire Regiment 11th battalion. Prior to this he worked as a drawer in a bottle factory in St Helens and was unable to afford dental treatment. It is clear that at a young age the majority of his upper teeth required extraction and a partial denture fitted. The darker coloured vulcanite provided additional strength and the shield shape was added for suction. He was killed in action and died of his wounds on 11 April 1918 aged 23 and this denture was returned with his personal effects. This denture and photo are part of the dentistry during the First World War Exhibition which is currently on display outside the lecture theatre at 64 Wimpole Street and continues throughout 2015. https://www.bda.org/museum
Fig. 1 A typical example of a vulcanite denture with porcelain teeth and clasps
Fig. 2 Private James Kay, the owner of the denture
WHICH? SURVEY
I
SHOULD DENTISTS CLEAN UP DENTAL COSTS?
n January there was widespread media coverage of research carried out by consumer magazine Which? into the information patients receive regarding prices for dental treatment. Their survey of 1,000 people found that: n 51% of people who visited a dentist in the past six months did not remember seeing a price list n One in five (22%) said they were not clear about exact charges ahead of receiving treatment n A quarter (26%) were still unsure about how NHS and private treatments differed n 40% were unaware that all clinically necessary treatment should be provided by the NHS. Which? also visited 25 dental practices in England and saw a price list on display in just half of practices offering both NHS and private treatment. The majority of dental clinics did not display any private prices they reported.
RESPONSES TO THE WHICH? SURVEY Mick Armstrong, Chair of the BDA’s Principal Executive Committee (PEC): ‘In the narrow window available in a time-pressed NHS, a dentist must explain not just the technical details of clinical treatment options, but also the workings of the payment system and where the NHS and private treatment cross over. With such a muddled set of arrangements, the system almost sets up the dentists working in it to fail. ‘The BDA supports recommendations about clear published price lists as this helps to ensure both the patient and the dentist share a common understanding. NHS posters [http://bit.ly/1v4lleD] are not exactly eye-catching, so we are not really surprised that a minority of patients don’t remember seeing them long after their visit – but that doesn’t necessarily mean that they weren’t there. Indeed, the CQC investigates pricing information as part of its inspection process. Nearly all 10,000 practices in England have been inspected by the CQC and 95% have met their overall inspection standard. ‘Evidence continues to show that the public consistently value their visits to the dentist. New data from NHS England [http://bit.ly/1CMwLou] suggests that 84% of recent patients viewed their experience as positive.’ Kevin Lewis, Director at Dental Protection: ‘It is always disappointing to discover that patients have experienced communication problems like those described in this report. But just as disappointing is the
214
BRITISH DENTAL JOURNAL VOLUME 218 NO. 4 FEB 27 2015 © 2015 Macmillan Publishers Limited. All rights reserved
NEWS
degree to which this report – just like many others that have preceded it – oversimplifies what is a very complex and highly individual range of care and treatment options. It makes for a populist consumer story but it is ultimately unhelpful because it undermines the trust that the overwhelming majority of patients have in their dentist. ‘General practitioners and their staff are responsible for explaining the complexities of the current three-band system to their patients, as well as dealing with any queries or complaints that result as a consequence. Patients, not surprisingly, find it difficult to understand and accept that you can have less treatment and still be expected to pay the same.’ Dr Trevor Ferguson, Dean of the FGDP(UK): ‘Confusion about treatment options, or about the costs of those options, should never be a barrier which stops patients from obtaining the dental advice and care that they need. We hope that the Which? investigation will draw attention to the complexity of providing mixed NHS and private care in the hope that these processes may be reviewed and simplified in future.’
The World Health Organisation (WHO) recommends a reduced intake of free sugars throughout life for both adults and children in their new guideline. Following a consultation that ended in March 2014, the guideline Sugars intake for adults and children recommends that both adults and children reduce their intake of free sugars to less than 10% of total energy intake. Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. The recommendations are based on evidence reviewed regarding the relationship between free sugars intake and body weight and dental caries. Increasing or decreasing dietary sugars is associated with parallel changes in body weight. The recommendation to limit free sugars intake to less than 10% of total energy intake is based on evidence from observational studies of caries. The WHO also suggests a further reduction of the intake of free sugars to below 5% of total energy intake, in recognition that the negative health effects of caries are cumulative from childhood to adulthood – therefore even a small reduction in the risk of dental caries in childhood will be of significance in later life. A publication date for the guideline has not yet been announced. Seeing red The London Eye is now sponsored by Coca-Cola. On the opening day of the rebranded visitor attraction, the Children’s Food Campaign handed out 500 toothbrushes to visitors: 500 being the number of children admitted to hospitals in the UK each week for extractions. Lydia Harris wrote the following letter to the BDJ Editor-inChief in response to the news.
this rebrand, London’s most iconic landmark has been illuminated red, the pods decorated with logos and staff uniform emblazoned with the Coca-Cola motif. Not surprisingly, this move has prompted some controversy within the health community. On the opening day, the Children’s Food Campaign handed out toothbrushes to some of the first visitors, in an attempt to relay the message that sponsorship of such a tourist attraction by a sugary drinks manufacturer is wholly inappropriate. Guidance from the World Health Organisation, issued in 2003, states that free sugars should make up less than 10% of total energy consumed.1 A new draft guideline in fact suggests that this should be around 5%,2 which equates to approximately 25 grams of sugar (with an average intake of 2,000 calories per day). With one 500 ml bottle of CocaCola containing approximately 53 g of sugar and one 330 ml can containing 35 g, it is not surprising that sugar intake in all age groups exceeds current recommendations, with one of the key sources of sugar being soft drinks, particularly among teenagers.3 The following questions could then be posed: Does this type of advertising need more strict regulation, given the health consequences that increased consumption of this product could lead to? Would stopping this kind of sponsorship/advertising make a discernible difference to public health? Research suggests a link between sugary drinks marketing and sugar consumption,4,5 and in 2010 the World Health Organisation set out guidelines to ‘ensure that children everywhere are protected against the impact of such marketing’.6 Given Public Health England’s best efforts to get people to ‘Change4Life’ (a campaign aimed to encourage swapping sugary drinks for sugarfree), it seems inappropriate for an iconic London landmark such as the (Coca-Cola) London Eye to be sponsored by, and indeed, advertising for, a corporate, sugary drinks giant, whose increased sales may worsen our public health and the costs to our NHS. L. HARRIS, BRISTOL 1. World Health Organisation/Food and Agriculture Organization. Diet, nutrition and the prevention of chronic diseases. Report of the Joint WHO/FAO Expert Consultation. Technical Report Series no. 916. Geneva 2003. 2. World Health Organisation. Draft Guideline: Sugars intake for adults and children. 2014. 3. Public Health England. Sugar reduction: responding to the challenge. Available at: https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/324043/Sugar_Reduction_Responding_to_the_ Challenge_26_June.pdf (accessed 11 February 2015). 4. Chandon P, Wansink B. Does food marketing need to make us fat? A review and solutions. Nutr Rev 2012; 70: 571–593. 5. World Health Organisation. Reducing consumption of sugarsweetened beverages to reduce the risk of childhood overweight and obesity. Biological, behavioural and contextual rationale. Available at: http://www.who.int/elena/bbc/ssbs_childhood_obesity/en/ (accessed 28 January 2015). 6. World Health Organisation. A framework for implementing the set of recommendations on the marketing of foods and non-alcoholic beverages to children. 2012.
©Hemera/Thinkstock
©iStock/Thinkstock
SUGAR CONSUMPTION MUST BE REDUCED THROUGHOUT LIFE
Sir, on 17 January of this year the London Eye was rebranded the ‘Coca-Cola London Eye’. With
BRITISH DENTAL JOURNAL VOLUME 218 NO. 4 FEB 27 2015
215 © 2015 Macmillan Publishers Limited. All rights reserved
The IOFTN now enables dentists to assess a patient’s functional need for orthognathic treatment based on a five tier criteria for treatment ranging from ‘No Need for Treatment’ such as speech difficulties to ‘Very Great Need for Treatment’ which includes defects of cleft lip and palate and other craniofacial anomalies. This provides an objective assessment of orthognathic need that all dental practitioners can follow to ensure consistent care is delivered across the country that complements the existing RCS Commissioning Guide.2 1. Ireland A J, Cunningham S J, Petrie A et al. An index of orthognathic functional treatment need (IOFTN). J Orthod 2014; 41: 77–83. 2. Royal College of Surgeons of England. Commissioning guide for orthognathic procedures. Draft available at: http:// www.rcseng.ac.uk/surgeons/surgicalstandards/docs/orthognathic-procedures-commissioning-guide (accessed February 2015).
VULCANITE DENTURE DONATED TO MUSEUM This typical example of a vulcanite denture with porcelain teeth and clasps has recently been donated to the BDA museum by Mrs Eileen Mayor and dentist Jonathan Thorpe of St Helens (Fig. 1). The denture was made for Private James Kay (Fig. 2) on his recruitment to the South Lancashire Regiment 11th battalion. Prior to this he worked as a drawer in a bottle factory in St Helens and was unable to afford dental treatment. It is clear that at a young age the majority of his upper teeth required extraction and a partial denture fitted. The darker coloured vulcanite provided additional strength and the shield shape was added for suction. He was killed in action and died of his wounds on 11 April 1918 aged 23 and this denture was returned with his personal effects. This denture and photo are part of the dentistry during the First World War Exhibition which is currently on display outside the lecture theatre at 64 Wimpole Street and continues throughout 2015. https://www.bda.org/museum
Fig. 1 A typical example of a vulcanite denture with porcelain teeth and clasps
Fig. 2 Private James Kay, the owner of the denture
WHICH? SURVEY
I
SHOULD DENTISTS CLEAN UP DENTAL COSTS?
n January there was widespread media coverage of research carried out by consumer magazine Which? into the information patients receive regarding prices for dental treatment. Their survey of 1,000 people found that: n 51% of people who visited a dentist in the past six months did not remember seeing a price list n One in five (22%) said they were not clear about exact charges ahead of receiving treatment n A quarter (26%) were still unsure about how NHS and private treatments differed n 40% were unaware that all clinically necessary treatment should be provided by the NHS. Which? also visited 25 dental practices in England and saw a price list on display in just half of practices offering both NHS and private treatment. The majority of dental clinics did not display any private prices they reported.
RESPONSES TO THE WHICH? SURVEY Mick Armstrong, Chair of the BDA’s Principal Executive Committee (PEC): ‘In the narrow window available in a time-pressed NHS, a dentist must explain not just the technical details of clinical treatment options, but also the workings of the payment system and where the NHS and private treatment cross over. With such a muddled set of arrangements, the system almost sets up the dentists working in it to fail. ‘The BDA supports recommendations about clear published price lists as this helps to ensure both the patient and the dentist share a common understanding. NHS posters [http://bit.ly/1v4lleD] are not exactly eye-catching, so we are not really surprised that a minority of patients don’t remember seeing them long after their visit – but that doesn’t necessarily mean that they weren’t there. Indeed, the CQC investigates pricing information as part of its inspection process. Nearly all 10,000 practices in England have been inspected by the CQC and 95% have met their overall inspection standard. ‘Evidence continues to show that the public consistently value their visits to the dentist. New data from NHS England [http://bit.ly/1CMwLou] suggests that 84% of recent patients viewed their experience as positive.’ Kevin Lewis, Director at Dental Protection: ‘It is always disappointing to discover that patients have experienced communication problems like those described in this report. But just as disappointing is the
214
BRITISH DENTAL JOURNAL VOLUME 218 NO. 4 FEB 27 2015 © 2015 Macmillan Publishers Limited. All rights reserved
NEWS
degree to which this report – just like many others that have preceded it – oversimplifies what is a very complex and highly individual range of care and treatment options. It makes for a populist consumer story but it is ultimately unhelpful because it undermines the trust that the overwhelming majority of patients have in their dentist. ‘General practitioners and their staff are responsible for explaining the complexities of the current three-band system to their patients, as well as dealing with any queries or complaints that result as a consequence. Patients, not surprisingly, find it difficult to understand and accept that you can have less treatment and still be expected to pay the same.’ Dr Trevor Ferguson, Dean of the FGDP(UK): ‘Confusion about treatment options, or about the costs of those options, should never be a barrier which stops patients from obtaining the dental advice and care that they need. We hope that the Which? investigation will draw attention to the complexity of providing mixed NHS and private care in the hope that these processes may be reviewed and simplified in future.’
The World Health Organisation (WHO) recommends a reduced intake of free sugars throughout life for both adults and children in their new guideline. Following a consultation that ended in March 2014, the guideline Sugars intake for adults and children recommends that both adults and children reduce their intake of free sugars to less than 10% of total energy intake. Free sugars include monosaccharides and disaccharides added to foods and beverages by the manufacturer, cook or consumer, and sugars naturally present in honey, syrups, fruit juices and fruit juice concentrates. The recommendations are based on evidence reviewed regarding the relationship between free sugars intake and body weight and dental caries. Increasing or decreasing dietary sugars is associated with parallel changes in body weight. The recommendation to limit free sugars intake to less than 10% of total energy intake is based on evidence from observational studies of caries. The WHO also suggests a further reduction of the intake of free sugars to below 5% of total energy intake, in recognition that the negative health effects of caries are cumulative from childhood to adulthood – therefore even a small reduction in the risk of dental caries in childhood will be of significance in later life. A publication date for the guideline has not yet been announced. Seeing red The London Eye is now sponsored by Coca-Cola. On the opening day of the rebranded visitor attraction, the Children’s Food Campaign handed out 500 toothbrushes to visitors: 500 being the number of children admitted to hospitals in the UK each week for extractions. Lydia Harris wrote the following letter to the BDJ Editor-inChief in response to the news.
this rebrand, London’s most iconic landmark has been illuminated red, the pods decorated with logos and staff uniform emblazoned with the Coca-Cola motif. Not surprisingly, this move has prompted some controversy within the health community. On the opening day, the Children’s Food Campaign handed out toothbrushes to some of the first visitors, in an attempt to relay the message that sponsorship of such a tourist attraction by a sugary drinks manufacturer is wholly inappropriate. Guidance from the World Health Organisation, issued in 2003, states that free sugars should make up less than 10% of total energy consumed.1 A new draft guideline in fact suggests that this should be around 5%,2 which equates to approximately 25 grams of sugar (with an average intake of 2,000 calories per day). With one 500 ml bottle of CocaCola containing approximately 53 g of sugar and one 330 ml can containing 35 g, it is not surprising that sugar intake in all age groups exceeds current recommendations, with one of the key sources of sugar being soft drinks, particularly among teenagers.3 The following questions could then be posed: Does this type of advertising need more strict regulation, given the health consequences that increased consumption of this product could lead to? Would stopping this kind of sponsorship/advertising make a discernible difference to public health? Research suggests a link between sugary drinks marketing and sugar consumption,4,5 and in 2010 the World Health Organisation set out guidelines to ‘ensure that children everywhere are protected against the impact of such marketing’.6 Given Public Health England’s best efforts to get people to ‘Change4Life’ (a campaign aimed to encourage swapping sugary drinks for sugarfree), it seems inappropriate for an iconic London landmark such as the (Coca-Cola) London Eye to be sponsored by, and indeed, advertising for, a corporate, sugary drinks giant, whose increased sales may worsen our public health and the costs to our NHS. L. HARRIS, BRISTOL 1. World Health Organisation/Food and Agriculture Organization. Diet, nutrition and the prevention of chronic diseases. Report of the Joint WHO/FAO Expert Consultation. Technical Report Series no. 916. Geneva 2003. 2. World Health Organisation. Draft Guideline: Sugars intake for adults and children. 2014. 3. Public Health England. Sugar reduction: responding to the challenge. Available at: https://www.gov.uk/government/uploads/system/uploads/ attachment_data/file/324043/Sugar_Reduction_Responding_to_the_ Challenge_26_June.pdf (accessed 11 February 2015). 4. Chandon P, Wansink B. Does food marketing need to make us fat? A review and solutions. Nutr Rev 2012; 70: 571–593. 5. World Health Organisation. Reducing consumption of sugarsweetened beverages to reduce the risk of childhood overweight and obesity. Biological, behavioural and contextual rationale. Available at: http://www.who.int/elena/bbc/ssbs_childhood_obesity/en/ (accessed 28 January 2015). 6. World Health Organisation. A framework for implementing the set of recommendations on the marketing of foods and non-alcoholic beverages to children. 2012.
©Hemera/Thinkstock
©iStock/Thinkstock
SUGAR CONSUMPTION MUST BE REDUCED THROUGHOUT LIFE
Sir, on 17 January of this year the London Eye was rebranded the ‘Coca-Cola London Eye’. With
BRITISH DENTAL JOURNAL VOLUME 218 NO. 4 FEB 27 2015
215 © 2015 Macmillan Publishers Limited. All rights reserved
![[Dentists' Knowledge of Ethical Questions Regarding Dental Medicine - A Survey of Dentists from Saxony, Saxony-Anhalt and Thuringia (Germany)].](/assets/img/hold.png)
