Rachel Evans

We all sufferer failure occasionally with our local anaesthetic, especially with the so called “hot pulp” but do you know why and the how to overcome this? At the BAOS annual conference we had an excellent lecture from Professor Ken Hargreaves, Professor and Chair of the Department of Endodontics at the University of Texas in San Antonio.  He provided the scientific explanation as to why this occurs and the solution.

Only 20-70% of IDB procedures are successful when treating inflamed mandibular molar pulps. The inflamed tissues within the pulp release prostaglandins that lead to hyperalgesia. The prescription of NSAID’S prior to undertaking potentially painful procedures will help by reducing the effects of the inflammatory markers, reducing patient pain and improving the effectiveness of local anaesthetic.

By supplementing a lignocaine IDB with an articaine buccal infiltration, you will achieve effective anaesthesia 3.6 times better than in combination with a lignocaine infiltration. When treating symptomatic irreversible pulpitis, articaine IDB provided no additional benefit to lignocaine IDB, so there is no advantage in utilising articaine as an IDN block, but there is a significant advantage to using it as a localised buccal infiltrate in order to achieve more predictable effective local anaesthesia.

Rebecca Hierons

President

Dear Members

In the midst of all this beautiful Summer sunshine and almost a year into my Presidency (though it feels like a month), I thought it would be good to update you all as to exactly what Council and the BAOS office have been doing for the past 8 months.

First and most importantly, BAOS would not exist without all our stalwart members – please do share any news, comments or feedback with us. We have a Twitter feed and Facebook page now so sharing has never been easier. It is always good for Council to hear from any members – if you think we can help with something (be it job advertisements, career advice or publications), please do ask.

Admin Team
Firstly, big thanks are due to Rita, Ruth & Shelley who have been working hard behind the scenes. They have had to contend with an office move as well as Sophie being off on maternity – (I was lucky enough to meet gorgeous baby Johnny in May). They all continue to do stalwart work with the co-ordination of all the Regional Rep Days, organisation of the Teaching and Learning Course as well as all the membership work and finances – not to mention the Annual Conference which fast approaches.

Website
Thanks to Pete Brotherton and Andrew Clark (Nextnorth web design), BAOS now has a smart new website with our new logo and specially designed image (from my friend Amar Naru, a dentist and a superb medical illustrator) – please do check it out if you haven’t already and try and spot all the pathology!

Meetings
Council representatives have had two positive and productive meetings with David Geddes, Head of Commissioning for NHSE, the upshot of which is that BAOS and NHSE are planning a joint second commissioning day in early November this year.

We also had a very productive meeting with the MDU and DDU last month. We plan to collaborate on some e-learning material on risk management in Oral Surgery for the new website which Greg Gerrard is kindly leading on.

We are also due to meet with Colette Bridgeman, Welsh CDO in September.

Specialist List and CESR
Pippa Blacklock and I wrote to the BDA on behalf of BAOS to ask them to address the issue with the GDC of lack of access for dentally qualified SAS grades to the Specialist List via the CESR route (medically qualified SAS grades all have a mechanism to apply to their lists via the GMC and CESR). We have been invited to attend a meeting in September arranged by the BDA for all Stakeholders to discuss this important issue and hope to make some progress.

Regional Reps
Divya Keshani and our invaluable network of Regional Reps continue to do an outstanding job with organising study days across the country. Yorkshire and the West Midlands held great meetings last month with Scotland and the South East following in October and November of this year. The BAOS Regional Reps day will be held in London in December this year which allows us to thank the Regional Reps for all their hard work. There are some vacancies coming up so if you would like to apply, please keep an eye out – it is a great way to get involved with BAOS.

We also have a Core CPD Course planned for next year in Sheffield, a joint meeting with RCSI, ABAOMS and IAOS in November 2019 in Dublin and of course our 2019 Annual Conference in Bristol – lots of opportunity for great CPD and networking.

Annual Conference Edinburgh 2018
The annual conference this year is to be held in a new venue for us – the wonderfully appointed Edinburgh International Conference Centre (EICC). This is a bigger venue than the Royal College, which means we do not have to restrict delegate numbers. The outstanding academic programme and exceptional evening entertainment promise to make it a tremendous meeting. We have accepted 27 open papers and 80 posters for presentation.

The larger venue inevitably means costs have risen and Council are all aware of trying to contain costs for delegates whilst trying to provide a really high quality meeting which can be difficult, but we hope we have struck the right balance this year. I personally love attending the Conference, which is definitely the annual highlight for the Association. I have been to all bar one since the inaugural NCCG Nottingham meeting in 1998 and I have always found it a fantastic way to get my Oral Surgery CPD whilst catching up with old friends as well as making new ones. I really hope to see as many of you there as can make it. Roll on September!

With very best wishes to you all.

Rebecca Hierons
BAOS President

Greg Gerrard

BAOS Council Member

Risk Reduction in Oral Surgery

Visiting the excellent ‘Teeth’ exhibition at the Wellcome Collection was a good reminder of just how much the profession of dentistry has changed. Removing teeth remains the mainstay of our work but the way we treat our patients with respect for their autonomy has completely transformed from the paternalistic approach of the past. The demands of treating today’s patients bring some challenges – chiefly a rising tide of litigation and a regulatory system that the GDC themselves recognise needs urgent reform1.

Representatives of Council and our President recently met with senior leaders at the Medical Defence Union to discuss issues of mutual concern. We are keen to find ways in which we can support our members to provide safe, effective care that leaves patients satisfied and avoid complaints and litigation. We practice in a risky area of dentistry, performing procedures that come with the certainty of unpleasant side effects and the possibility of complications that can affect patients for the rest of their lives. Much can be achieved by remembering the basics – be friendly, listen well, think of consent as a process (not an event) and write good notes.

Some hazards are harder to mitigate. For those members seeing the bulk of their patients on referral, there is the obvious immediate risk that we are meeting them for the first time. We have not had the opportunity to build up a reserve of goodwill over the years that many general dental practitioners can rely upon if problems with treatment arise. Since the ruling of Montgomery v Lanarkshire2, there is a greater expectation that we understand our patients as individuals and consider which risks they might attach particular significance to. This poses a significant challenge when we may have only 15 minutes with the patient and means we need some additional help from primary care colleagues in the detail of their referral to convey some of their knowledge of the patient.

Whilst there are many areas of our practice where the standard of care is easily established, there are some areas that attract more controversy and for many surgeons, uncertainty about which options to present to patients and how the risks and benefits should be framed. These include the role of coronectomy, the early management of nerve injuries and the necessity of cone beam imaging of high risk wisdom teeth (especially for colleagues without easy access to CBCT equipment).

We plan to create a joint e-learning package with the MDU on risk management in Oral Surgery which will hopefully prove as successful as the module that they have co-authored with the British Society of Periodontology. Council will also consider whether BAOS should provide best practice consensus guidelines in specific areas that are not covered by other guidance.

One specific area of concern from the MDU relates to their difficulty in defending cases where a nerve injury has been identified following wisdom tooth removal but no referral to a specialist nerve injury centre has been made. Many of these cases have been settled due to the lack of referral rather than the occurrence of the injury. This is certainly an area in which BAOS may be able to help by signposting members to centres providing these services along with a treatment algorithm depending on the nature of the injury.

In addition to these projects, there are already some great resources on our newly relaunched website about patient safety and LocSSIPs which should now be in use across dentistry to prevent wrong tooth extractions. We have also published revised patient outcome and experience measures that can help drive quality improvement for oral surgery providers in both primary and secondary care3.

1. General Dental Council. Shifting the balance: a better, fairer system of dental regulation. Updated 9 March 2017. Available at: https://www.gdc-uk.org/about/what-we-do/regulatory-reform (accessed May 2018).
2. Montgomery v Lanarkshire Health Board [2015] SC 11 [2015] 1 AC 1430.
3. Gerrard G, Jones R, Hierons RJ. How did we do? An investigation into the suitability of patient questionnaires (PREMs and PROMs) in three primary care oral surgery practices. British dental journal. 2017 Jul;223(1):27.

Rebecca Hierons

President

BAOS Spotlight article June 2018

CESR – Veni, vidi, vici?

The BAOS Council have been aware for some time now of the problem facing a large proportion of our Staff Grade, Associate Specialist and Speciality Dentists (SAS) members with regard to specialist list entry. As many will know, a large number of SAS missed being grandfathered onto the specialist list and despite providing high level Oral Surgery (OS) services in secondary care have no mechanism to apply for entry.

This is at odds with our medical SAS colleagues who do have a way to apply for specialist status via the GMC Certificate of Eligibility for Specialist Registration (CESR) route which has been functioning successfully for some years. In all other aspects of the grade there is no contractual distinction and national terms and conditions are exactly the same.

There will soon be a widening workforce gap in Oral Surgery as the older generation of specialists retire as there are not enough new specialists being generated at present to fill this gap. We currently have 41 specialist training posts generating around 13-14 new OS specialists a year – not nearly enough to deliver the service, teaching and training essential for good patient care.

This gap could potentially be filled by the large number of experienced Oral Surgery practitioners via a robust CESR route. To this end, BAOS have written to the BDA to ask for a review of the current systems in place for entry onto specialist lists. We very much hope that, in collaboration with the BDA, CCHDS and other Stakeholders, we can find a way forward via CESR that would benefit our speciality and ensure gold standard OS treatment for all. Unlike the hapless Julius, there may yet be a happy ending!

Rebecca Hierons

President

Tara Renton

Past President

‘Getting it Right first time’ (GIRFT)

Introduction

The first ‘Getting it right first time’ (GIRFT) report,¹ published in 2012 and led by Tim Briggs (Orthopaedic surgeon), considered the current state of England’s orthopaedic surgery provision suggesting that changes could be made to improve pathways of care, patient experience, and outcomes. The report took the view that this approach had the potential to deliver a timely and cost-effective improvement in the standard of orthopaedic care across England, whilst maintaining timely and effective care for patients, as demand increased due to a population that was living longer.

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Pete Brotherton

Council Member

Website Launch

The BAOS council are proud and thrilled to announce the launch of its new look website.

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Martin Curran

Council Member

“If you don’t change you will never progress”

Oh, how dentistry has change since I entered dental school in the late seventies.  I must admit that I “swanned” my way through dentistry, doing what I had to do but not overdoing it.  Mark Twain said, “Never let your schooling get in the way of your education” and I took his advice to heart.  Well, I did make it, mainly because I turned up to lectures and I did a bit of work on the side.  Could have been more but a pass is a pass.

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Pippa Blacklock

Blog Post

The BAOS Annual Scientific conferences continue to go from strength to strength as demonstrated by the recent conference held in Belfast, Northern Ireland on the 27 to 29^th of September 2017.  The event was held in the iconic Europa Hotel in the city centre.

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Rachel Evans

Blog Post

My Dad was the type of man whom held the attention of a room full of people with his charismatic chat and charm. He was significantly slowed by a massive stroke 20 years ago, but he was still a conversationalist and social individual. He was surrounded by family and friends celebrating his 80^th year, when not three months later he was poorly in hospital with very limited communication skills and suffering episodes of acute confusion and states of paranoid delusions.

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Tara Renton – Outgoing President

It has been an amazing privilege to represent BAOS and Council over the last two years. I cannot thank the Council members enough for their extra-ordinary commitment and energy – unfunded and on top of busy professional and personal lives. Our past lead Administrator Roger developed sound foundations in the infrastructure of the Association, further built on by our new admin team Sophie with Rita…my sincere thanks.

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