APEX Solutions


Daily Mail Investigate Whitening Toothpastes

Posted by Robert Pilcher

It should be fairly obvious what I normally think of The Daily Mail. Well this time in the edition on 21 Jan 2013, they had a really balanced article on Whitening Toothpastes.


I have always told my patients, that whitening toothpastes can remove surface stain, but will not change the base colour of the teeth. Although not very scientifically done, the DM's little study showed the same. These toothpastes also make a lot of cash for toothpaste manufacturers - By 2008, sales were worth £63 Million. A tube of whitening toothpaste costs 4 - 9 1/2 times the cost of a standard toothpaste. The DM looked at 6 brands:

Arm & Hammer Advanced Whitening Toothpaste (£2.60, 75ml) - claims to 'remove stains... and buff the teeth into a brighter, whiter smile'. 3 shades whiter clinically proven - 3 shades of what? - grey. 3 shades means nothing unless you know what the shade guide is. The difference between them may only be discernable using a spectrophotometer.

SwissDent Xtreme Whitening Toothpaste (£9.70, 50ml) - says it 'penetrates even the tiniest fissures to produce perfect bleaching results'. That's a tenner, and it's only 50 ml!

Oral B 3D White Enamel Protect (£3.49, 75ml) - claims to 'whiten the front, back and visible surfaces between teeth'.

Beverly Hills Natural Whitening Expert (£3.49, 75ml) - makes the incredible claim that it can 'remove stains in just one minute'. No good here as extenxive studies show that the 'average' person in the UK cleans for 45 seconds!

BlanX Intense Stain Removal (£6.50, 75ml) - says it 'restores teeth to their original natural whiteness'.

Rembrandt Complete Whitening Mint (£8.31, 50ml) - claims to be 'clinically proven to whiten teeth beyond surface stains with daily brushing'.

The DM conclude that Whitening Toothpastes are not the answer to whiter teeth:-

So if whitening toothpastes aren't the answer, and a top of the range dentist's treatment is out of your price range, what can you do?

Don't be tempted to bypass the professionals by buying any of the products available online. Research by consumer group Which? found that about ten per cent of people who had bought tooth whitening products online to self-administer ended up with chemical burns on their lips.

A similar number reported brown stains on their teeth, suggesting that their enamel had been irreparably damaged.

So if you're serious about getting whiter teeth - safely - the most economic, and legal, way is to ditch your whitening toothpaste habit, and visit a dentist. They'll show you how to use the bleach gel to minimise burns, avoid discolouration, and get the whiter teeth you want.

After all, better to spend a couple of hundred pounds on a treatment that will work than on 20 tubes of ineffective toothpaste.'

How sensible!

Are you ready for Thorrablot?

Posted by Robert Pilcher

Many, many moons ago (1998), I was posted to Bosnia as Senior Dental Officer with 16 Armoured Field Ambulance Group, for the 7 month winter tour (now they have snow up in the Bosnia hill). This was one small part of the NATO peace keeping forces in Bosnia. Now Iceland does not have an Army, Air Force or Navy (only a small Fisheries protection fleet), but is part of NATO. Until recently, they had a huge US Air Force base (Keflavik), whose purpose was to monitor the Soviet Northern Fleet moving in and out of Archangel - the only route to the Atlantic being between Iceland and Scotland. At that time Iceland's contribution consisted of 2 civilian Doctors, and 2 civilian Nurses. I got to know this group very well, especially Ingi Thor Agustsson.

My first experience of Thorrablot was my first visit the Iceland in 2000. Thorrablot is a mid-winter festival starting the first Friday after Jan 19th (the 13th week of winter), the start of the old Norse month of Thorrin, and this year starts on 25th January - Today. It is marked by lots of entertaining - eating and drinking 'traditional' Icelandic 'food'. I put inverted commers around 'food' as having eaten some of this, it is not what I call food. If you take into account in the past, that the fishing fleet could not set sail in the winter, excess livestock is slaughtered before winter - as there is little fodder, and nothing grows at all during the winter and freezers have not been invented, then by this time the only thing left is rotten, or the unpalatable bits, then this would explain the 'food'. Singed Sheep's head, Hakarl - pronounced How-cuttle - which is rotten shark meat (I have eaten this), blood cooked in a sheep's stomach - quite nice as a bit like black pudding, and also nicer bits like smoked lamb, skyr - a totally fat free yoghurt which is yummy, all washed down with Brennivin (an Icelandic spirit with the properties and taste of pure alcohol) which is not so nice. I was subjected to this and also dried cod - like a piece of old leather. It is odd to go out, and when your friend's 4 year old says 'Daddy, I'm hungry' is bought a piece of dried cod to gnaw on.

By coincidence, today is Burns night, and I have to admit that I am a bit partial to Haggis (Minced sheep's heart, liver, lungs, oatmeal, onions, suet and spices!).

Iceland has changed a lot since I first went, there is a low-cost airline (called - Wow) flying from London to Keflavik, and some fantastic restaurants in Reykjavik, as well as Akureyri - the second city. Hotels are much more plentiful - but why not rent a summer house - we did for our last visit. There are some great long week-end deals,and it is actually only 2 hours 45 minutes flight - and in the winter -The Northern Lights.

So any Icelanders out there, have a wonderful festival and watch out, I'm coming back soon!


UN agrees to reduce mercury emissions - 140 countries reach deal

Posted by Robert Pilcher

Is this going to be another hollow agreement from the UN? I was always a great advocate of the United Nations. Whilst on a UN peace mission in Bosnia, as part of a former life, I took time to read 'Shake hands with the devil, by Lieutenant-General Romeo Dallaire. It covers the period when he was force commander of the UN Assistance Mission for Rwanda 1993-94. The overall mission was still commanded by civilian personnel from the UN. It is not a read for the faint-hearted. It details the genocide in Rwanda - 800 000 killed in 100 days. It showed that the Arusha Peace Agreement could not be enforced by the UN as the military component did not have the resources or authority from the Security Council to intervene.

Perhaps not quite the same as reducing mercury emissions, but really, how big are the UN's teeth. Will the biggest polluters actually want to reduce emissions, it is part of their thriving economy. SE Asia produces 50% of the world's mercury emissions. It is not difficult, to see how. Burning coal accounts for 24% of mercury emissions into the environment. China's Carbon dioxide emissions GROW by the entire UK's annual emissions every 9 months - due to coal burning power stations, so their mercury emissions are growing at the same rate. Unless you can get China (and India) on board, it will be like trying to put out the Cupola fire with a thimble to carry the water. It will grow faster than you can put it out.

So what is in the agreement - by 2020 it will regulate a range of areas including:

    Supply of and trade in mercury.

    The use of mercury in products and industrial processes

    The measures to be taken to reduce emissions from artisanal and small-scale gold mining - (There is a discovery channel programme called 'Jungle Gold', shows how the gold is extracted from the last bits after panning - it reacts with the gold, and is then the resultant compound is heated to drive off the remaining mercury as vapour)

    The measures to be taken to reduce emissions from power plants and metal production facilities.

So how does this affect Dentistry - well the agreement also states that measures to phase down the use of dental amalgam 'shall take into account the Party's domestic circumstances and relevant international guidance'. They shall include 2 or more of the following list

    1. Setting national objectives aiming at dental caries prevention and health promotion, thereby minimising the need for dental restoration;

    2. Setting national objectives aiming at minimising its use;

    3. Promoting the use of cost-effective and clinically effective mercury-free alternatives for dental restoration;

    4. Promoting research and development of quality mercury-free materials for dental restoration;

    5. Encouraging representative professional organisations and dental schools to educate and train dental professionals and students on the use of mercury-free dental restoration alternatives and on promoting best management practices;

    6. Discouraging insurance policies, and programmes that favour dental amalgam use over mercury-free dental restoration;

    7. Encouraging insurance policies and programmes that favour the use of quality alternatives to dental amalgam for dental restoration;

    8. Restricting the use of dental amalgam to its encapsulated form;

    9. Promoting the use of best environmental practices in dental facilities to reduce releases of mercury and mercury compounds to water and land.


Well we already do 4, 5, 8 and 9. We have use encapsulated amalgam at AbbeyDental Practice for nearly 10 years. UK dental practices have been required to have amalgam sererators fitted to waste water outlets for 8 years. The resultant waste is sent for reprocessing.

1, 2 and 3 are the resonsibility of government. However we have been waiting forever for these.





At what age should I bring my child to the dentist?

Posted by Robert Pilcher

So many times you hear about children going to the dentist for the first time only when they have pain. Probably not a good experience for the child who will now associate a visit to the dentist with toothache and invasive treatment. This is often at about age 4. Treating a 4 year old, trying to do a filling or worse extraction is stressful for all concerned. General Anaesthetics for dental treatment are now only available in Hospital Environments, so no dental GA in the chair, your child will have to wait weeks for a referral.

So what age is best to start? As a general rule of thumb, for the average child, I would think that about 2 is a good time to start bringing for the first time. If there are older brothers and sisters, then perhaps 18 months. Quite often, the young child will want to copy what big brother/sister is doing and want to have their teeth looked at as well. At the very least he/she will want a ride in the chair.

For the single/first child, it may not be possible to carry out a full examination at the first or second visit, but it is important that visiting the dentist becomes something routine. It is now normal with my families, for the children to want to be seen first.

However there are always cases where even 2 is too late. There was a recent case in the Daily Mail (Yes them again), where a 3 year old had to have 13 TEETH EXTRACTED. The mother took him for the first time at age 18 months, when he 'was unable to eat solid food at all and wouldn't even touch sweets'. By this time, it is too late.

So 2 years old or maybe 18 mths, especially if older brothers or sisters.

It was well worth braving the Ice and Snow

Posted by Robert Pilcher

Heather and I got back from the footy. That was one hairy journey. We intended to drive in to Tower Hill and get the tube in for the Chelsea V Arsenal game. We started off down the A10. A14 then M11 (we live north of Cambridge) starting about 9am. The roads were pretty clear, until we got past Duxford into Essex. Suddenly there was snow and slush all over the motorway, so that the outside lane was unusable. Everyone was on the inside lane doing 40 - 50 mph. Does that sound familiar to anyone who had to drive on the A14 in Suffolk last Monday. 67 accidents in Suffolk on Monday morning. Is it something about East Anglia? I know it's a rural area, but it does seem to miss out - especially on road salt!

Anyway, by the time we got level with Stansted, it was quite unnerving. Time to change the plan. Divert to Epping and get the tube in from there. Now here was the strange thing. The M11 was getting clogged down with snow, even with the amount of traffic that was using it, but the B1393 from the M11 into Epping was as clear as a bell, even though the paths had 3-4 inches of snow, and there were hardly any vehicles in sight.

Braving the ice and snow in the name of football

Posted by Robert Pilcher

Well its early on Sunday, and today Heather and I are off to Stamford Bridge for the game against Arsenal. Anyone who has been in my surgery will understand my passion for Chelsea Football Club. Today looks as if it could be a cold one. The forecast is -1C and heavy snow for the 13:30 kick off. The snow is the worrying bit. The pitch will be OK, but the last time a game was postponed due to snow, was 2 winters ago when the surrounding streets were compacted snow, and the police called off the game due to safety issues for the fans.

 I don't like Sunday games. I like a quiet day on a Sunday before work on Monday, but at least it's not a 4pm kick-off. We usually get in at around 9pm.  Televised football has put a lot of money into the game, and allows the arm-chair football fan to watch almost continuous football on Sky, but for fans that attend games there is no routine anymore. I like the routine of a 3pm game. We have enough time to go shopping in the morning, set off for London. We go the same route, eat at the same cafe, chat to the same stewards in the ground, sit with the same people. As it says in the 1997 Suggs and Co featuring the Chelsea Team song (The year we won the FA Cup, our first major Domestic Trophy since 1970 - I was 8), the only place to be every other Saturday, is strolling down the Fulham Road. Later today I will be strolling down the Fulham Road, from Fulham Broadway Underground Station to the Shed.



How was it for you? Care Quality Commision visit August 2012

Posted by Robert Pilcher

There has been a large amount of criticism of the CQC in the Press, but our experience of contact with them has been not unpleasant. Having a stranger come into the Practice, with the brief of examining the whole business, including all our procedures and practices, is a daunting prospect, but one which Abbey Dental Practice actually welcomed.

My own background prior to joining Abbey Dental Practice, is, I served as a Dentist in the Army for 17 years up to January 2000. In the services, there is an established hierarchy.  Everyone has a boss that you report to. Even as a Lieutenant Colonel, I was used to receiving a Confidential Report every year (and an insert after each emergency tour e.g. Bosnia, Falklands), much like an Appraisal, and my Practice was also inspected EVERY year by a more senior Dentist (who inspected patients and record cards for quality of care and dental fitness levels of patients), and by his Admin Warrant Officer who inspected everything relating to Practice Management. This was normal, and was used as an opportunity to ensure that everything was 'Ship-shape and Bristol Fashion'.

Heather, the Practice Manager, and I, used this opportunity to ensure that everything was up to date. Registration with the CQC started for Dental Practices Apr 2011.  We paid our £1600 registration fee. Ensured all our policies were up to date, and started providing training for staff members. We were keeping an eye on the CQC website for where dental practices were being inspected. Not a lot was happening to start with. It seemed like inspectors were being constantly diverted to concerted efforts on specific sectors in response to the latest headline in the Daily Mail. Then reports started to appear in Norwich. Ipswich, Cambridge and Colchester (and most were failing on protecting vulnerable adults), and started moving towards Bury St Edmunds. It was like 4 military columns of an expeditionary force heading for Bury St Edmunds. They approached as far as Thetford, Kentford, Sudbury and Stowmarket, then the approaching forces halted and nothing happened. It was like the campaign season was over for that year. The wagons and horses were unable to make it through the mud of the winter, and the advance was suspended until the weather would improve in the spring.

Well 2012 WAS very wet, so obviously the roads were still impassable past the normal start of the campaign season. Then suddenly, the forces were spotted again, there were e-mails. One from the PCT, and one from the CQC. The campaign season had started again.

PCT? Oops,  Forgot about them. Wanted to come and inspect the Practice. Really! You cease to exist from April Fools Day 2013, and you want to come in Jul 2012. OK. We'll use that as a dry run for the CQC. More on that another day.

So, we all asked ourselves, who else is being done in Bury St Edmunds? No-one! Mmmmmm! Why no-one else? 5 months later, still no-one else.


 Do I feel persecuted? Actaully I'm pleased, as we've been through it once, so now have an idea what to expect in future.

The Inspector who came from the CQC was actually really pleasant. Efficient. Looked at Everything - every Practice Policy, Training Record, Registration record, CRB check record, Child and vulnerable adult training, absolutely everything. Questioned Me, Practice Manager, Staff Members, went through Infection control and processing instruments with Noami. Watched Reception at work dealing with patients face-to-face and on the phone, even spoke to patients about their experiences. Very thorough, very pleasant - took 5 hours.

How did we do? Passed - see link here.


Hopefully can now maintain this level, doing some training each month so all done again before next visit (After everyone else in Bury St Edmunds of course!)





7 Things you didn't know about TEETH WHITENING

Posted by Robert Pilcher

TOOTH WHITENING. Not that old chestnut again! Every man and his dog seems to be doing these days. Beauticians, Hairdressers, buy it off the internet. Well the law changed last November as to who can do what to whom.

This latest information has been released by the British Dental Association (www.bda.org/whitening).

1. Whitening is safe. If carried out by a trained dental professional, whitening is perfectly safe. Based on their knowledge of your oral health your dentist will discuss with you the options available, decide if tooth whitening is appropriate for you and develop an overall treatment plan that gives the desired result. (At Abbey Dental Practice, your Dentist will carry out a cancer examination, a gum disease examination, and a decay/filling/crown examination to ensure that there are no underlying problems. Do you know what infection control procedures are in place at the Beautician's etc. There are very strict and monitored procedures for Dental Practices, with severe consequences for breach by Dental Practices - GDC, CQC, and the Department of Health publication - HTM 01-05)

2. Only Trained Dental Professionals Can Whiten Teeth. It is illegal for anyone other than dentists or their teams to carry out teeth whitening. Anyone else offering teeth whitening (e.g. beauticians, hairdressers, and salon staff) won't have the right training and knowledge, could permanently damage your teeth and gums and can't help when something goes wrong.

3. The Preferred Option. Whitening won't remove the surface of your teeth or change their shape. It's often a better option than alternatives, such as veneers, because it doesn't involve permanently altering the tooth's structure and is easy to look after.

4. Selecting the Right Product for YOU. Your dentist is trained to know what whitening products will be safe for you teeth and gums. Products provided by non-dentists often do not have enough safety data and evidence to support their use; this can result in burned gums and/or blistered lips or even more serious consequences. Using products that are not appropriate for you will produce poor results.

5. How it works. A carefully-controlled concentration of bleach is applied to your teeth using specially made trays that fit in your mouth. Your Dentist will be able to discuss with you the level of whitening you want and give you an idea of how many treatments you may need to achieve the shade you're after.

6. What to expect. You may experience some sensitivity for a short time during your treatment but this is normal and will soon fade away after completion.

7. Over the counter kits may not be safe. The products you can buy online or from high street shops often fail to declare the precise chemicals used so it's very difficult to assess their safety. Because of this they should not be considered safe. These products won't produce the same good results you can expect by visiting your Dentist.




Why are newly qualified dentists being prevented from ever working in the NHS?

Posted by Robert Pilcher

Surely this cannot be true! It hasn't been in the Daily Mail. But yes this is in fact the case. After 5 years at University (at an estimated cost to the tax payer of £250 000 and student debt of about £70 000), Dentists, who are at this stage fully registerable with the General Dental Council, are required to undergo a year long Foundation Training, in an approved NHS Training Practice. A bit like a doctor doing a year of house jobs in hospital. If you do not do this Foundation Training, you can never provide NHS treatment to a patient EVER. Dentists have 18 months to start this training after qualifying. However, this only applies to dentists from UK Universities. If you are a newly qualified dentist from the EU (any of the 27 countries), you are exempt from this requirement and can work in the NHS straight away after graduating. These training places are funded by the Department of Health (Tax Payer).

Last year was the first year of centralised recruiting for this training requirement and 35 English and Welsh Dental Graduates failed to obtain a training place, and had to re-apply this year. In the mean-time, they may not be working as a dentist, so will be becoming deskilled. If they do not get into a Training Practice this time, they will NEVER EVER be able to work in the NHS - it is known that some have failed to secure a place this time round and are now excluded from the NHS.

Now here comes the problem. There are not enough training places for all the dentists who have to do it. Although EU dentists are not required to do Foundation Training, to work in the NHS, it is a good opportunity to gain experience of the NHS system, improve their english, whilst earning a salary (yes Foundation Dentists are on a salary), so a significant number apply. The Department of Health funds 953 places (England and Wales). This year there were 1150 applicants, so 200 are without a place. We do not know how many of these 200 unsuccessful are England/Wales graduates. Now some dental students either fail/defer finals, so some of these 200 will be allocated places after June 2013. Going on last years figures as a guide, this will probably result in about 130 England/Wales graduates not gaining a training place, and will have to reapply next year (swelling the number of applicants even further for the 953 places).

So why should dentists be special and guaranteed a job after University? Well it's not guaranteeing them a job, it is part of their required training to work within the NHS. If the government does not provide the places, they are reducing the size of the workforce available to work for the NHS. These dentists will either give up dentistry (a personal disaster), move abroad or never work in the NHS. Does this matter? Well as a taxpayer, you have contributed to the cost of the training of these dentists - an estimate of the costs is £250 000 per dentist. This would be in the region of £30 Million for 130 dentists. The Department of Health has said it will not increase funding and places for Foundation Training for Dentists, however only on Monday in Parliament, the Secretary of State for Health was asked about training places for medical students:

From Hansard

Nic Dakin: To ask the Secretary of State for Health what estimate he has made of the over-supply of UK graduate medical students to the Foundation Programme in 2013. [134208]

Dr Poulter: The UK Foundation Programme Office, that manages recruitment to the Foundation Programme, has alerted the four UK Health Departments and Health Education England that it is likely the programmes available for August 2013 will be over-subscribed.

We are committed to ensuring that all graduates in the United Kingdom receive a place on a foundation training programme in 2013.

Nic Dakin: To ask the Secretary of State for Health what steps he plans to take to manage any over-supply of UK graduate medical students to the Foundation Programme. [134209]

Dr Poulter: The four UK Health Departments and Health Education England are considering urgently how to manage any over-supply in advance of the receipt of accurate information on the numbers involved.

We are committed to ensuring that all graduates in the United Kingdom receive a place on a foundation training programme in 2013.

So there we are. A committment by the government to ensure that all newly qualified Doctors receive Foundation Training, but nothing for Dentists.

Watch this space, and see the government quietly go back on their committment.



NHS changes April Fools Day 2013 and Dentistry

Posted by Robert Pilcher

Well there was nothing in the newspapers about 'Naughty' Dentists, or anything about dentistry at all. I couldn't even rely on The Daily Mail. Have you seen this 'vid' on You Tube - http://www.youtube.com/watch?v=5eBT6OSr1TI . So since there is nothing to discuss in the newspapers, I'll have to write about something non-comical happening in the very near future.

 As I am sure we are all aware, as of April 1st (why do they always choose April Fools Day to launch changes to the NHS) Suffolk Primary Care Trust (Suffolk PCT) will cease to exist as it is. Most of its present functions will be carried out by Clinical Commisioning Groups (GP Consortia). This will see General Practitioners controlling the majority of the £110 Billion (£110 000 000 000) NHS budget. Since 2006, NHS Dental budgets have been controlled locally by the PCT. After April 1st, dental budgets (and contracts) will be held centrally by the Business Service Authority (formally the Dental Practice Board) in Eastbourne. This was the case prior to 2006 (so we have come full circle in 7 years).

How will this affect Our practice past April 1st? The vast majority of our patients will notice no difference at all - either Private, Denplan or NHS children. The vast majority of dentistry for our patients is carried out in practice. However, for some, we have to refer to Hospital or specialists for wisdom teeth or difficult extractions, or investigation of suspicious 'lumps and bumps' or for orthodontics. This will continue, of course, but as of yet we don't know the mechanism for referral, or from whose budget this will come - will we be referring direct to the hospital or specialist, or Clinical Commisioning Group, or as at present, a referral management centre in Ipswich, who control the flow of work to the hospitals and specialists in Primary Care. We have a small group of Surgical Dentistry Specialists in Suffolk, (one in Bury St. Edmunds), who work in General Practice. It has only been for the last couple of years that we have been able to refer to this small group for wisdom teeth or difficult extractions. They give a very quick service, usually less than 6 weeks (if the patient is available). We do not know if this service is to continue after April 1st. I'll get Heather the Practice Manager to do some more digging.

So the majority of our patients will see a seamless transition to the new system. I hope this is true for the service previously arranged by the PCT from the surgical specialists and orthodontists.

I am sometimes asked why there are not more NHS dentists in Bury St. Edmunds, and why someone doesn't open a new practice. This is quite simple. Prior to 2006, any dentist could open a new dental practice, wherever he or she wanted. They did the research, decided where a good place was, prepared a business plan for a Bank, found premises, borrowed a 'shed-load' of money, converted the the premises, opened the doors and waited for patients to come in.

This however meant that the Government and in particular the Department of Health, had no control over the budget spent on NHS dental treatment, or control over the dental workforce. This was unacceptable, so in 2006 (yes April Fools Day again), this all changed. Dentists, and therefore PCTs, were given fixed value contracts to provide a fixed amount of NHS dentistry, based on a 12 month period from Oct 2004 to Sep 2005.  This meant that practices like ours, with a small NHS childrens' contract, were only allowed to see children on the NHS, and we couldn't see any more than we were already. This was true throughout the whole of England and Wales (don't ask about Scotland - they didn't change).

As time goes on, Dentists retire, or move out of the NHS, converting to private, and the NHS allocation can disappear into the ether, or for some reason a Dentist may not reach their target set for NHS dentistry (illness, accident, pregnancy), do this twice and your allocation of NHS dentistry can be cut, so even less NHS Dentistry available.  As described earlier, new Dental Practices were decided by market forces, but after 2006, they were decided by the PCT (possibly under pressure from above). Not in an area where they are likely to survive and thrive, but where the PCT had decided. This is proceeded by a bidding war by interested parties - look what happened to National express running train services in East Anglia, or the bidding fiasco for the West Coast Mainline.

So the reason we don't have more NHS Dentists in Bury St. Edmunds, is because in order to control the amount of money spent on NHS dentistry, the Department of Health (and Treasury) have rendered it impossible to open a dental practice anywhere, unless they could bid for one of the very few new contracts, and the dentist did not decide where it was, the PCT did.

The next blog will be about - I don't know - how about the cost to tax-payers for training dentists, who the Department of Health prevent from ever working in the NHS.