The Crisis at Christmas Dental Service: a review of an annual volunteer-led dental service for homeless and vulnerably housed people in London.

Background The UK charity Crisis originated in 1967 as a response to the increasing numbers of homeless people in London, and the first Crisis at Christmas event for rough sleepers was established in 1971. Since then, Crisis has provided numerous services over the Christmas period to the most vulnerable members of society. One of these is the Crisis at Christmas Dental Service (CCDS) which provides emergency and routine dental care from 23-29 of December each year. The charity is entirely dependent on voluntary staffing and industry donations including materials and facilities. This paper aims to assess the impact of the service over the last six years of clinical activity from 2011-2016.Method Anonymised data were collected from the annual CCDS delivered over the last six consecutive years. Services included: dental consultations; oral hygiene instruction; scale and polishes; permanent fillings; extractions; and fluoride varnish applications. In addition, anonymised patient feedback was collected after each dental attendance.Results On average, 80-85% of the patients were male and the majority were between 21 and 60 years of age. The most common nationality was British (46%). Over the six-year data collection period intervention treatments (restorations and extractions) remained fairly consistent, while the number of fluoride varnish applications and oral hygiene instruction have increased. The majority of patients reported positive satisfaction with their treatment and would have recommended the service to others. Approximately 75% of patients did not regularly attend a dentist outside of Crisis and a similar proportion were given information on where to access year round dental services for homeless people in London. The majority of dental volunteers felt that they enjoyed the experience and would consider volunteering again for Crisis in the future.Conclusion The Crisis at Christmas Dental Service has emerged as a valuable asset to the portfolio of resources accessible to vulnerable, marginalised people over the Christmas period and exposes the high dental need of the homeless population of London.

Can UK undergraduate dental programmes provide training in non-surgical facial aesthetics?

Aim Recently, more and more dentists have found themselves engaging in the delivery of non-surgical facial aesthetics (NSFA) as part of their regular practice routine. NSFA is a growing field in aesthetic medicine that is practised by a range of clinicians including doctors, dentists and registered prescriber nurses and is an industry estimated to be worth over £3 billion in the UK alone. In the past few years, several public scandals in aesthetic medicine have prompted reactions by several bodies including the Government and Royal Colleges. With Health Education England (HEE) having recently released standards in education, it is clear that a shift in attitude towards training is imminent. With a large volume of dentists making up this NSFA workforce it is reasonable to consider the stance of undergraduate training and the relevance of the existing knowledge within dentistry in the context of the HEE standards.Method All dental schools in the UK were contacted to establish the range of subjects taught within the curriculum, with particular reference to those relevant to NSFA. The two largest aesthetic pharmacies were contacted regarding numbers of registered dentists they serve.Results Twelve out of 16 dental schools responded. Two-thirds of responding dental schools do not cover NSFA in their curricula. However, many dental schools cover related subjects including: facial anatomy/material science/neuromuscular junction physiology (100%), anatomy of the aging face (66%), pharmacology of botulinum toxin (25%) and ethical-legal implications of aesthetic dentistry/NSFA (50%/42% respectively).Conclusion Dentists are well placed to deliver NSFA given their background in relevant subjects and surgical training. With the emergence and growth of such a large multi-disciplinary field it is crucial that dentistry is not left behind. Just as most dental schools have embraced the evolution of cosmetic dentistry and implantology, it would be prudent to consider that training standards around NSFA are reflected in both undergraduate curricula and appropriate post-graduate clinical training for dentistry.

Awareness of medication related osteonecrosis of the jaws (MRONJ) amongst general dental practitioners.

Background Recent evidence suggests that medication-related osteonecrosis of the jaw (MRONJ) can be caused by a number of anti-resorptive and anti-angiongenic agents not limited to bisphosphonates. A working knowledge of these medications is important for dental practitioners.Methods A total of 129 general dental practitioners (GDPs) were surveyed regarding their awareness of MRONJ and its causes.Results More than 90% of the GDPs sampled were unaware of anti-resorptive and anti-angiogenic medications other than bisphosphonates that had the potential to cause MRONJ. Just over 40% of the sampled GDPs were confident to treat patients on oral bisphosphonates in primary care. Much of the reluctance to manage these patients was due to lack of accessible guidelines and unclear protocols.Conclusions The results demonstrate GDP attitudes to patients taking bisphosphonates and highlight how further education is needed to increase confidence to perform simple exodontia amongst this cohort of patients in a primary care setting. As there continues to be a shift to providing dentoalveolar services in primary care, we must ensure that those performing the treatments have a greater understanding of potential MRONJ risks and have guidance as to when to refer.

Brexit and dentistry.

On 23 June 2016, eligible UK voters will be asked to decide whether to vote in the EU referendum. The EU impacts on our daily lives in more ways than many people realise. Dentistry is affected by EU legislation. Examples include the movement of dental professionals, the import of dental equipment and materials, as well as health and safety legislation. Many more EU dentists and DCPs come to the UK to work than vice versa. These numbers have increased markedly since 2004. The result of the vote may affect how dentistry operates in the UK in future years. In addition, a vote to stay would not necessarily prevent change. There are attempts underway to increase the ease by which professionals can work in other member states, especially on a temporary basis. This too is likely affect dentistry at some point. Workforce planners and policy makers should factor in the impact of the EU in future dental policy.