The age old question of what is the correct recall interval for a periodontal patient has had the magic systematic review treatment and the answer is.....wait for it.......further evidence is required. What a shocker. How many systematic reviewers does it take to change a light bulb? Further evidence required. So there is no evidence that 3/12 recalls for maintenance work for everyone. Anyone who has periodontal recall patients would agree.
What was interesting about this review published in December 2015 in the journal of evidence based dental practice was part of the conclusion which, as well as saying we need more research, mentions "The merits of risk-based recommendations over fixed recall interval regimens should be explored."
And this makes total sense to me. Why have a one size fits all approach. Patient centred care is the way to go, and CQC and NICE say so too.
It points to the need for regular risk assessment and modification of care plans as needs change. We should be completing a risk assessment of a patient every time we see them. But how best to do this?
One worry I have around this published lack of evidence is that the stretching of intervals between Oral Health Assessment and Oral health reviews by NICE were met with some concern. There is potential for supervised failing in both caries and periodontal prevention. A very real issue of achieving health for the patient then stretching the recall sessions until the scores go up again. That is not maintenance, that is supported failure and re-infection.
And when we have a growing body of evidence linking chronic inflammation associated with uncontrolled periodontal disease and systemic illness, is there such a thing as over reviewing when it comes to obtaining and maintaining periodontal and gingival health?
This is another topic for a staff meeting discussion and I suggest at least an annual review of risk assessment protocols in your practice.
One system that I have supported in its implementation is the oral heath review being carried out to a certain stage by a trained dental nurse, reducing time in chair with both hygienist and dentist. This working in triage method is incredibly rewarding for the team, efficient in time and economics, and allows a high standard of maintenance of health for patients.
GSK and Corsodyl have packaged a gum care risk assessment pack which you can receive for free and is a good place to start.
Another great tool out there for risk assessment is Previser
PreViser gives dental clinicians a way to objectively analyse their patients' oral disease risk and severity. These analyses are delivered as personalised reports that improve care planning accuracy and patient acceptance and compliance.
A comprehensive assessment includes assessments for perio, caries, oral cancer and tooth wear. Alternatively individual reports can be generated for perio, caries and oral cancer.
To save time, the patient can be given access on a tablet or computer in reception to complete the non-clinical elements of the assessment.
However you choose to implement risk assessment for recall length, the key thing is to ensure you are attaining and maintaining stability in the patients oral health. And you tend to find those patients who have achieved health are just as keen as you to keep those recall review sessions and maintain the health you helped them achieve.
Tuesday, 2 February 2016
Thursday, 14 January 2016
NICE to see you - to see you delivering Oral Health Promotion - are you ready to change?
NICE have brought out fresh guidelines for oral health promotion and patient centered behaviour change and prevention care in December 2015. These will focus the practice on assessment, advice, behaviour change and prevention.
They sit right along Outcome 1 and 4 from CQC.
The guidance is for the whole dental team, clinical and non clinical and they are quite clear there are no exceptions. There will be an expectation for the team to base your advise and recommendation on the Delivering better oral health toolkit while tailoring it to the patients individual needs and using NICE Guidelines on behaviour change - recommendation 8 to be precise. This should involve someone who is trained as a behaviour change practitioner.
The NICE team recognise that not only will this guideline need patient behaviour change but that there will also be a challenge in motivating the motivators who will drive the change in practice to prevention led.
Those who were part of the pilots for the NHS will have a head start. Those who have already worked out that putting prevention and oral care at the core of the practice is the way to go will be thinking what took them so long?!
But for the rest of us, can we honestly say the whole team is delivering patient centered oral health education and behaviour change? And are we able to show this in our protocols, ways of working and notes?
I see this as an opportunity to really rethink how your practice works. Are you still fixing the problems as your first priority? Is oral health education delivered while you wait for the block to work, or over the patient while you work, or as a monologue at the end of the appointment as you herd them out the door? Have you just given up because they never listen anyway? Have you got a practice or company protocol for training, delivery and auditing of oral health advice?
Maybe you have just found your No. 1 item on the agenda of your next practice meeting. And that can be a good thing.
Change can be hard, and implementing a new way of working in a busy practice a struggle, but the end benefits will outweigh the pain. Motivated patients are more receptive, grateful and switched on to the value of the treatment you provide. Good communication reduces the risk of litigation. And a team that can see their actions producing a result will stay motivated and work well for the practice they are in.
It is good to revisit your protocols regularly, things change. Here is an article I wrote about this a few years back which still rings true and might help you plan that meeting.
They sit right along Outcome 1 and 4 from CQC.
The guidance is for the whole dental team, clinical and non clinical and they are quite clear there are no exceptions. There will be an expectation for the team to base your advise and recommendation on the Delivering better oral health toolkit while tailoring it to the patients individual needs and using NICE Guidelines on behaviour change - recommendation 8 to be precise. This should involve someone who is trained as a behaviour change practitioner.
The NICE team recognise that not only will this guideline need patient behaviour change but that there will also be a challenge in motivating the motivators who will drive the change in practice to prevention led.
Those who were part of the pilots for the NHS will have a head start. Those who have already worked out that putting prevention and oral care at the core of the practice is the way to go will be thinking what took them so long?!
But for the rest of us, can we honestly say the whole team is delivering patient centered oral health education and behaviour change? And are we able to show this in our protocols, ways of working and notes?
I see this as an opportunity to really rethink how your practice works. Are you still fixing the problems as your first priority? Is oral health education delivered while you wait for the block to work, or over the patient while you work, or as a monologue at the end of the appointment as you herd them out the door? Have you just given up because they never listen anyway? Have you got a practice or company protocol for training, delivery and auditing of oral health advice?
Maybe you have just found your No. 1 item on the agenda of your next practice meeting. And that can be a good thing.
Change can be hard, and implementing a new way of working in a busy practice a struggle, but the end benefits will outweigh the pain. Motivated patients are more receptive, grateful and switched on to the value of the treatment you provide. Good communication reduces the risk of litigation. And a team that can see their actions producing a result will stay motivated and work well for the practice they are in.
It is good to revisit your protocols regularly, things change. Here is an article I wrote about this a few years back which still rings true and might help you plan that meeting.
Friday, 8 January 2016
Uncomfortable and unreasonable. Those are my strengths.
I guess it was the focus on one portfolio and brand, and the constrictions that come with that.
I had no idea what I was getting into in 2011. For starters, the company officially announced the Discus acquisition weeks after I started. And so I grew by learning about chemical interactions with the tooth structure and whitening products.
Then I grew my knowledge of governing and legislation in 2012 when the EU 6% law came in to affect. That period was uncomfortable and Safetoothwhitening.org is the product of that growth and I am proud of what it has achieved. Being unreasonable, and working with a team who were also unreasonable, delivered a new product in record time.
2013 and the growth here was a painful lesson that sometimes businesses have to make hard cuts to grow and we lost all of our education funding for our student programmes. As a manger the growth this year was not an easy one. From that pain came the decision to be unreasonable and not give up our website and this has now grown to having over 11000 dental members.
2014 saw my growth as a marketeer, owning the running of the business, it's budget, forecasts and strategy, resetting from the painful cuts to start to regrow in a healthier way. My growth was learning how working in an unhealthy way can impact your family. Not my finest hour. No one needs to be on 24 hours. And it makes you a boring person too.
2015 saw me grow in my understanding of a business on a European and Global level, the painful growth of running Europerio 8 as a Global activity has been valuable. Being unreasonable and working outside my remit with our research team brought valuable insight and allowed us to launch a new product in the most successful way yet. Breaking my arm in August has taught me growth is required in all areas to maintain a balance as a person, and also not to take my health for granted.
And my whole experience at Philips, which is a positive one, taught me you need to be unreasonable to drive change. And that comfortable people do not like you doing it. But I believe there is a way to do it to achieve results when you need others to support your change. It took time and a lot of one to one conversations and interpretations. And that was almost always uncomfortable for me.
And so back to 2016. And a blank page for me. It is daunting to say the least. But I am reminded that painful growth and the discomfort I am experiencing at not knowing my future just yet are exactly what I need.
I got too comfortable, too safe and too set in my mindset. Too willing to settle. A great quote a good friend used today - "The reasonable man adapts himself to the world; the unreasonable one persists in trying to adapt the world to himself. Therefore all progress depends on the unreasonable man." - George Bernard Shaw.
And so I will play to my strengths and embrace the discomfort, and be the unreasonable voice and see what it to come.
Monday, 3 October 2011
An exciting new challenge
So finally,I can share the secret I have been bursting to tell everyone. Today was my first day in an exciting new role for me as Senior Professional Relations Manager to Philips Oral-health Care in the UK.
This unique role has been created to assist the already well established team in developing relationships with the dental world in the UK to encourage scientific and technological development; supporting the British Dental Profession in keeping our rightful place among the leading countries in the dental world.
I will work alongside the already robust and quality education programme put in place by Tricia Rawsthorne and will have input into the best way we can support all of the dental team in their quest for best practice.
I will still work in clinic and will also continue lecturing but will not be consulting in practice any more.
This amazing role allows me to grow and develop some of my favourite elements of my professional life with the strong support of a very capable team. I am so pumped by the possibilities I could just pop!
Watch this space for updates of all the great subsidised and sometimes free CPD programmes and development plans that Philips have available for the whole team.
Wish me luck!
Keep on keeping on
Mhari
This unique role has been created to assist the already well established team in developing relationships with the dental world in the UK to encourage scientific and technological development; supporting the British Dental Profession in keeping our rightful place among the leading countries in the dental world.
I will work alongside the already robust and quality education programme put in place by Tricia Rawsthorne and will have input into the best way we can support all of the dental team in their quest for best practice.
I will still work in clinic and will also continue lecturing but will not be consulting in practice any more.
This amazing role allows me to grow and develop some of my favourite elements of my professional life with the strong support of a very capable team. I am so pumped by the possibilities I could just pop!
Watch this space for updates of all the great subsidised and sometimes free CPD programmes and development plans that Philips have available for the whole team.
Wish me luck!
Keep on keeping on
Mhari
Sunday, 18 September 2011
All the leaves are brown (well a lot of them) and the sky is grey....
It happened last week. I swear it comes earlier every year. No, not Christmas decorations being sold in Harrods (that started in August for those that want to be appalled) but my desire to stick the heating on. You see, I am the early bird of the house, rising at 5.45am most weekdays. I am also very un-Scottish and really do like to be warm. And I have to say that last week it was decidedly nippy in the bathroom first thing. I am trying to hold out until October but can't make any promises. Work wise, I am only just getting back up to speed after my August break and September seems to be disappearing fast.
And the heating going on, leaves turning brown, and skies becoming grey (more so than in summer) all point to one thing....that this is the start of dental conference season here in the UK. And there are so many to look forward to. I will be attending:
Dental Showcase - 20-22 October - Birmingham - FREE for all GDC registrants with some FREE CPD there too http://www.eventdata.co.uk/Forms/BDTA0Visitor.aspx?FormRef=BDTA1Visitor
BACD Conference - 10-12 November - London - minimally invasive techniques is the future of all dental treatment including cosmetic solutions - will be a good one https://www.bacd.com/dental-professionals/dentists.html
Pan Dental Society Meeting - 11-12 November - Liverpool - trauma is the main theme at this meeting with an amazing line up of international speakers http://www.pandental.co.uk/
BSDHT Annual Conference - 18-19 November - Bournemouth - A wealth of international speakers, and some cutting edge workshops, one of the best prevention led trade exhibitions - plus an exciting announcement from Dental Health, the societies journal - http://www.bsdht.org.uk/welcome1.html
Phew! A busy but fantastic start back to work for me. I love to learn and develop in these environments and invariably meet some fascinating people too. I also love the social aspect of these things, a chance to develop friendships and practice my mum dancing too.
So I hope to see some of you at these meetings and will do my up most to blog the best bits of each meeting.
I was sad to hear from Pam Swain that the BADN has cancelled their meeting this year due to lack of sponsorship and support. Times are hard no doubt. But it seem crazy that some companies are short sighted and are not investing in the Dental Nurses; the hub of the practice. So we at CPDforDCP will be giving away one hour of FREE CPD from now until Christmas to help the dental nurses out. Septembers will be with you this week if we can sort out our small computer problems!! http://www.cpdfordcp.co.uk/freecpd1.html
Keep on keeping on
Mhari
Thursday, 4 August 2011
Two more of the Catalyst team
Wow it is really raining here today. But I am so excited about these brilliant days that it is not dampening my mood one bit.
Revealing another two experts on tap for you and your team to brain drain. Michael will be with us on November 4 in Birmingham only.
Michael Cahill - aka - The Pheonix
Michael is the owner of the awaard-winning Cahill Dental Care Centre in Bolton. He has been married to Fiona for almost 25 years and has 2 teenage sons. Since converting the practice to fully private over 12 years ago he has worked with some of the world's best coaches and trainers, and has been recognised with both national and local awards for Best Employer and Best Team. Michael will be sharing his ideas and methods on how to develop your very own A-Team, that will be able to deliver world-class service and build life long relationships with your patients.
Patricia Rawsthorne - aka - The Mentor
Patricia Rawsthorne is Professional Education Manager for Philips Oral Healthcare and has been with Philips for nine years. She is solely responsible for the implementation of dental education programmes for students and qualified dental professionals and has underpinned the Philips Transitional Support Programme for dental hygienists and therapists. She is a qualified Dental Nurse and Oral Health Educator and recently qualified from Surrey University in Level Three Mentorship
Book your place now and take a team member for FREE
Wednesday, 3 August 2011
Catalyst days - the plan of action - and another superhero for your practice
I am winding down for summer now. Yesterday was my last clinical day and today my last office day until September 1. Quality family time was one priority when I built my business plan for the last 3 years.
It might be one of the things you want to look at in your development and vision for your practice.
With our unique Catalyst days, each delegate has a detailed form to fill out before the day to help them focus on what they want to achieve. These detailed appraisals will help us to help you. They will be confidential but we do want to use the small group of like minded people to your advantage so we will ask you to share. The environment will be relaxed an open to encourage honesty and development as a group.
"Sharing knowledge is not about giving people something, or getting something from them. That is only valid for information sharing. Sharing knowledge occurs when people are genuinely interested in helping one another develop new capacities for action; it is about creating learning processes." Peter Senge
Introducing another superhero of the dental world here to save the day:
Sarah Fiddaman - aka - The Baking Implementer
Working as an Independent Practice Manager Sarah brings a spark to the business (as well as cakes!) Dentistry continues to evolve as an industry and Sarah helps teams, and principals work to their strengths. Having worked outside of the industry (predominately in Hospitality) she brings a wide range of skills with her including Project management, Excel spreadsheets and a determination to make Exact support business decisions. You always know where Sarah is – either by her laugh, or the smell of freshly baked goodies – providing Practical Practice Support so that Principals can do what they do best – Teeth not paperwork.
It might be one of the things you want to look at in your development and vision for your practice.
With our unique Catalyst days, each delegate has a detailed form to fill out before the day to help them focus on what they want to achieve. These detailed appraisals will help us to help you. They will be confidential but we do want to use the small group of like minded people to your advantage so we will ask you to share. The environment will be relaxed an open to encourage honesty and development as a group.
"Sharing knowledge is not about giving people something, or getting something from them. That is only valid for information sharing. Sharing knowledge occurs when people are genuinely interested in helping one another develop new capacities for action; it is about creating learning processes." Peter Senge
Introducing another superhero of the dental world here to save the day:
Working as an Independent Practice Manager Sarah brings a spark to the business (as well as cakes!) Dentistry continues to evolve as an industry and Sarah helps teams, and principals work to their strengths. Having worked outside of the industry (predominately in Hospitality) she brings a wide range of skills with her including Project management, Excel spreadsheets and a determination to make Exact support business decisions. You always know where Sarah is – either by her laugh, or the smell of freshly baked goodies – providing Practical Practice Support so that Principals can do what they do best – Teeth not paperwork.
More superheroes to be revealed this week. Places are filling up so book early and take advantage of the FREE team member place.
Keep on keeping on
Mhari
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