My name is Jorge Martins and I am a student of the 5th year of the Integrated Master Degree in Dental Medicine of the Universidade Católica Portuguesa (Portugal, European Union).
The aim of this study is to determine the international perception of the impact of Dental Sleep Medicine through the study of the Doctors and Dentists knowledge about Roncopathy and Obstructive Sleep Apnea Syndrome, its clinical experience, the knowledge and application of the protocols defined by the American Academy of Sleep Medicine and by the American Academy of Dental Sleep Medicine in this matter, as well as the opinions of these professionals on the multidisciplinary treatment of these pathologies. I would be grateful if you would complete the survey using the link below.
My name is Priya Chohan and I am an Oral Surgery Leadership Fellow, based at Northamptonshire NHS Foundation Trust, and I am also working in conjunction with the Central Midlands Local Dental Network. Below you will find a link to a survey which forms one aspect of a project I am undertaking, focussing on the topic of patient safety incidents in dentistry.
This survey is designed to gain an understanding of your awareness and opinions regarding patient safety incidents. It will be distributed to dentists nationally, and your responses are crucial to current research being undertaken in this field.
The survey responses will be used to contribute to the development of the new Patient Safety Incident Management System (PSIMS), which will enable all healthcare professionals, including dentists, to record patient safety incidents and promote learning from them. It will be used to optimise shared learning and ultimately drive positive change within the profession, by creating a ‘just culture’.
The survey should take approximately 10-15 minutes to complete. Once you have submitted your responses it will not be possible to withdraw consent, or retrieve the data submitted as it is completely anonymous. Responses cannot be saved before submission however, once submitted you have the option to return and edit your survey. If you wish to close the survey and return and edit it, you will have to copy the ‘edit response’ link at the end of the survey and save it somewhere to access it again.
I would like to stress that under no circumstances will the responses be traced back to the responder.
I would very much appreciate if you can spare the time to complete this survey, as it is an vital opportunity to voice your opinions on this topic.
For the latest BAOS statement on Oral Surgery Commissioning click here.
Happy New Year! I hope you had a peaceful Christmas and are all set to take on 2019. I thought this would be a good time to update you on Council activity and also remind you of up and coming events for this year.
Rita, Ruth and Shelley continue to work hard behind the scenes. Sophie is due back from maternity leave in April – a big thank you to Ruth for covering so efficiently.
Annual Conference 2018 & 2019
2018 was another greatly enjoyable Edinburgh meeting. Thank you for all your feedback – we have certainly taken this on board in the planning of our Bristol meeting this September. A lot of the feedback related to the cost of the delegate fees – it is nearly impossible to produce a high-quality conference for a low delegate fee and Council strives to maintain a reasonable balance between the two. We just broke even in 2018 so I can assure you that every penny of your delegate fee is invested in the conference. Neither do Council get free entry – everyone pays to attend except the speakers and the admin team.
As for Bristol 2019, we are planning to try and keep costs down whilst still providing an outstanding academic programme – initial details are on the website https://www.baos.org.uk/annual-conference-2019/ and the programme will be up by March.
Paul Coulthard organized a very successful second BAOS commissioning day in Manchester on Tuesday 6th November. Representatives from the English and Welsh CDO offices attended as well as MCN chairs, LDN chairs and commissioners. David Geddes appeared positive and supportive and he and Eric Rooney presented along with Rhian Jones, Vas Sivarajasingam and Victoria Taylor from Wales. Ben Squires, Tariq Drabu and Paul Coulthard presented from Manchester. The day went well with a good mix of people and lots of positive interaction.
We are still working with the BDA regarding the GDC CESR mechanism for entry onto the Specialist lists and have a meeting with the GDC later this month.
Welsh Oral Surgery is progressing well thanks to very positive communication between Adrian Thorp, Rhian Jones and Colette Bridgman, the Welsh CDO.
The Journal committee have made the difficult decision to discontinue paper copies of the Journal this year (also agreed at the 2018 AGM). I know this will come as a disappointment for many (myself included). However, I support this decision most importantly because of the carbon footprint of our Journal (printed in Singapore and shipped over with a non-recyclable cover). A digital version will not have nearly the same environmental impact (and will be consistent with 97% of the other Journals Wiley produces which are exclusively on-line). Wiley are developing an app through which Members will be able to download and read the Journal. The Journal is currently available to view online through the Members’ area – past copies are also available. The office will notify Members when each new edition is available.
Dr Helen Petersen, Editor-in-Chief, has planned a special ‘pain’ edition of the Oral Surgery Journal for later this year which is being guest-edited by Professor Justin Durham. Application to Medline will go ahead in 2020.
Eligibility to sit MOral Surg
We wrote to the Tri Collegiate Board in November 2018 regarding eligibility to sit the MOral Surg exam (the mechanism that allowed candidates to sit the exam by portfolio application was unaccountably removed in 2012, making it difficult for SAS grades to objectively demonstrate appropriate knowledge via a nationally accredited examination). Unfortunately, the reply was not what was hoped for and the Board declined to change the current criteria. We have written again requesting clarification with regard to their decision and will keep you informed of the outcome. The letters are available on our website: https://www.baos.org.uk/for-professionals/.
E-learning and training
Greg Gerrard and Adrian Thorp are collaborating with the DDU with regards to a joint e-learning module (similar to this https://www.theddu.com/learn-and-develop/free-cpd-modules-from-the-bsp-and-the-ddu) which should be a great tool for practitioners as well as giving guidance on preventing and managing nerve injuries.
Greg Gerrard, Tara Renton, Nikolas Palmer and Noha Seoudi have written a series of antimicrobial e-learning modules https://www.baos.org.uk/elearning/ which give interactive accredited CPD along with links to the latest evidence for gold standard antimicrobial prescribing. These have been hugely successful and have not only been highlighted in the FGDP’s response to the draft Northern Irish AMR 5 year action plan but also referenced by the GDC in their update for anti-microbial prescribing. BAOS, FGDP and ACOM were the three named Dental organisations who supported World Antibiotic Awareness Week and the modules were also referenced in the press release for this. Greg is in communication with some Spanish colleagues who are keen to adapt them for Spain. This is terrific for BAOS – many thanks to all the authors.
Our website is constantly refreshed, and updated versions of our patient information leaflets will soon be available. Members can also access the BAOS King’s College surgical teaching videos – a great training resource (please see the Members’ area to access these).
We also have a Core CPD course planned for May in Leeds (free to the Regional Reps to thank them very much for all their hard work – details out soon), a joint meeting with RCSI, ABAOMS and IAOS in November in Belfast, Regional Study Days planned for the next three months https://www.baos.org.uk/events/, another ‘Training the Trainers’ course planned for November and, of course, our 2019 Annual Conference in Bristol – no shortage of great CPD and networking opportunities!
I would like to thank Council so much for all their hard work for the Association – I am extremely proud to be working with such an active, engaged and dynamic group. A special thank you to Pete Brotherton, and Mark Gormley, stalwart members of Council who left us at the end of 2018 and a very warm welcome to Judith Jones and Sarah Ali who join us at the start of 2019.
A very happy, healthy and prosperous New Year to you all!
With very best wishes
BAOS Council Member
Look at how oral surgery is developing in its own right! Our most recent list of consultants in the specialty now numbers over 100 and the numbers are rising. NHS Trusts are finally realising the benefits of employing consultants in terms of service improvement, clinical governance, training of junior staff and waiting list management, and of course primarily in order to improve patient care. It is encouraging to see that many district general hospitals are now appointing consultants – these were previously the preserve of only OMFS consultants.
Teamwork – none of us work in isolation and developing and maintaining close working relationships with our professional colleagues is vital. Oral surgeons bring a unique set of skills, which are a valuable asset to any team. The BAOS CAST (Consultant and Senior Trainers’ Group) aims to support both consultants and senior trainers throughout their careers. We acknowledge the history of oral surgery and the difficulties that senior colleagues have and indeed do still face in gaining recognition of their skills and in securing consultant posts. Our meeting at the Conference in September 2018 was well attended and several issues were discussed, this group will link directly to Council and we have links with the BDA.
With increasing consultant numbers we have greater opportunities to have our voices heard and to drive the agenda for the benefit of both our patients and our working lives. In an ever-changing NHS and healthcare landscape, this has never been more important.
BAOS Council Member
Oral Surgery on the Move
Within my locality there appears to be a growing demand for the provision of oral surgery within private practice undertaken by oral surgeons. The obvious benefits are the treatment of patients within their own practice setting, assisted by familiar faces, which helps to relive patient anxiety. It also generates practice income and avoids delays in patients receiving treatment. What are the benefits for us?
I enjoy providing a peripatetic oral surgery service to my local region. I have a box of essential equipment including my surgical motor and a few favoured luxators, which I transport from place to place. I provide a kit list to the practice to ensure that my basic surgical instruments and consumable items are all available when needed, although you’d be surprised how many times I am handed a clip to suture with! I work on a fixed rolling rota every 2 weeks, so my diary is set and organised many months in advance. I am able to review my diary beforehand, so I avoid any inappropriate referrals and I can divert referrals as necessary.
I find that patients are more confident and relaxed within their own familiar dental environment and are well supported due to the existing report with staff. Treatment plans can be discussed directly with the clinicians and modified accordingly. I enjoy the variety of my job plan and find it very rewarding, although Christmas party time can be more complex when negotiating dates between 7 practices!
BAOS Council Member
How and why we got to Montgomery
A breach of duty in negligence is found to exist where the defendant fails to meet the standard of care required by law. The objective test, which is also known as the reasonable man test was set out in Blyth v Birmingham Waterworks Company (1856) 11 Ex Ch 781, where the defendant is expected to meet the standard of a reasonable prudent person.
There are though many opportunities in law where the level of this standard of care can be raised (or lower) as the individuals have represented themselves as having more (or less) than average skills or abilities. For example a learner driver is expected to meet the same standards as a reasonable competent driver Nettleship v Weston  2 QB 691 even though not fully qualified. In comparison as in medicine or dentistry, the standard of care of the individual is increased compared with that of a reasonable person.
The initial test that became enshrined in law as the benchmark for medical negligence was ‘The Bolam Test’ Bolam v Friern Hospital Management Committee  1 WLR 582. It was used to disclose all risks including any treatment, and a test for breach, was therefore, whether a responsible body of medical opinion would have supported the doctor’s conduct.
The drawback was that it gave legal sanctions to self-regulation for the medical profession not the courts that decided what is ‘reasonable’. It seems therefore that the medical profession was above the law.
Bolitho v. City and Hackney Health Authority  4 All ER 771 turned Bolam on its axis and it was the courts that became the final arbitrator of a medical breach. It was established that a doctor could be liable for negligence despite a body or professional opinion sanctioning their conduct when the judge was not satisfied that the opinion relied on was reasonable or responsible.
It was determined by Lord Browne-Wilkinson that the assessment of professional negligence within the court setting must always consider expert medical opinions but these must not outweigh legal principles.
Although there has been a plethora of case law on negligence, moving forward to Montgomery v Lanarkshire Health Board  UKSC 11. This case gives uncertainty concerning whether the ruling has really clarified the position for both the medical profession and potential claimants.
The Courts initially rejected Montgomery’s case as evidence provided that a responsible body of medical opinion would have acted as the doctor and would not have warned of the risks. However the Supreme Court reversed the decision.
Montgomery means there is now a lengthy and meaningful discussion between doctor and patient of what amounts to ‘material risks’ including proposed treatment and alternatives giving the risks of both. The focus of material risk is determined by whether a reasonable person in the patient’s position would likely to attach significance to the risk.
Montgomery indicates what is being asked of the medical profession, is now clearly time-consuming; it is though deemed professional good practice.
There are reservations whether Montgomery has provided a new position or whether it merely confirms how the case law has progressed incrementally since Bolam. There is certainly a move towards the ‘reasonable patient’ being at the heart of the standards to apply rather than the standard being that of the reasonable doctor.
There are areas for discussion in Montgomery, as Lords Kerr and Reed during their judgment stated that material risks couldn’t be reduced to percentages as the significance of risk was determined by other variables as well as the magnitude of risk and would be different to all patients. Percentages though do form an integral part of risk assessment in medicine and therefore consideration must be given to these when talking to patient about inherent risks.
Clearly though, the judgment in Montgomery does reinforce that doctors should participate in a meaningful dialogue with each patient, and the their duty goes beyond mere provision of information.
Recent Blog Posts
- Faculty of Dentistry, RCSI and British Society of Dental and Maxillofacial Radiology CBCT Training course for Dentists on September 20, 2019 8:15 am
- Annual Conference 2019 on September 25, 2019
- The Annual Scientific Meeting (ASM) of the Faculty of Dentistry RCSI on November 1, 2019