Women in dentistry!

Sir, – May I congratulate Dr. Seward on her fine words in the guest leader. They are timely and purposeful.

However, one does wonder whether the decision to open the profession up to women all those years ago was balanced by the common-sense observation that they would in all likelihood only work part-time.

It would certainly seem that in examining the reasons why women are less time committed to their professional careers, general surprise has been expressed that they might like to use dentistry to empower their arguably true role, to raise a family, run the home, and invariably, be the true power behind every ambitious and successful man. Few professions can offer such fulfilment. Are we so politically correct that the obvious is no longer recognised?

C. Lister

Salisbury

Dental strategy

Sir, – It is clear from the recently released dental strategy by the Government that comprehensive NHS dentistry provided by 'family' dentists to the public, is being further undermined and threatened. It is surely time to allow the dental profession to show (via a BDA ballot) that they have 'no confidence' in Government's latest dental tragedy!

Many dentists had hoped that the delayed production of the Government's dental strategy (promised for 1998!) was for proper plans to correct the serious long-term NHS deficiencies. However, NHS dentistry continues to be blatantly discriminated against. The standard political public speeches proclaim NHS treatment being 'available to all, free at source, regardless of income, high quality treatment' etc. They fail to say 'except NHS dentistry', which continues to deceive politically on all these fronts whilst suffering the highest patient NHS charges (currently over £350 per course). Why does dentistry continue to suffer so disproportionately to the rest of the NHS?

It is indeed sad that NHS family dentists cannot now routinely practice standards that they are taught at dental school. They feel forced to seek private funding if they wish to provide quality time, recent advanced alternatives, preventative options etc. NHS family dentists can no longer compensate personally to protect patients from the Government's flawed NHS dental strategy, they are already at full stretch!¹

Dentists suffer the highest occupational stresses of all healthcare workers,² which is further compound by NHS rationing.^{3, 4} NHS family dentists have better crowns deleted from their usual choices, leaving mainly base-metal NHS molar crowns that induce allergies like cheap jewellery.⁵ Neither will the NHS fund properly preventative sealants, but we have to wait until NHS patients get decay first before sealing.⁶ Now even oral health and cancer checks every six months are under threat, as is continuous care,⁷ so we begin to realise just how 'compromised' NHS dentistry has become. Hardly 'comprehensive' or 'high quality' or 'modernising', is it? No dental school I know of in the UK promotes this unproven approach, just some third world countries and the NHS still do!

NHS dentists are doing their best within the limitations of the NHS system, but no amount of goodwill can compensate for Government's 'third world' dental planning and funding. I say it is time to stop re-inforcing Government's harmful dental policies now, by speaking out publicly. It is time to 'come out' with the truth, through a full ballot as other healthcare workers have recently done,⁸ to disassociate ourselves from this dental tragedy. The Government may still ignore the wisdom of our profession (as it has so far), but the public will be clear about who is responsible before they vote in 2001.

T. Kilcoyne

Haworth

Routine check-ups

Sir, – After reading the letter from Mr A. Sheiham (British Dental Journal2000;  189: 181) and the BDA response to it, it is clear that the sign put on the statistics has a great effect on the outcome of the argument. My own experience would lead me to believe that occasional attenders are often converted into regular attenders following a protracted period of dental neglect. This leads to an extended course of treatment that convinces the patient that regular attendance for routine treatment is a sensible way of avoiding such problems in the future.

This scenario would therefore skew the statistics for regular attenders. On average they would possibly have less teeth and more dental restorations. Also regular attenders may be the ones who have a higher rate of dental decay and greater degree of periodontal breakdown because they recognise the problem due to unpleasant symptoms and seek dental care.

A. T. Coombes

London

Oral cancer knowledge

Sir, – We have recently carried out an investigation of the oral cancer knowledge of 137 GMPs, dentists and hospital consultants working in Scotland, England and Northern Ireland. The results, that should be published shortly, indicated not surprisingly that medically trained professionals lacked basic knowledge regarding the prevention, diagnosis and management of oral cancer.

It is widely recognised that a large proportion of oral malignancy presents first to medical professionals; that elderly patients are at increased risk of oral cancer and that these elderly patients are statistically more likely to be under the care of a hospital consultant and less likely to regularly attend a dental practitioner.

Our study suggests that dentists are the professionals best suited to advise regarding prevention of oral cancer and perform examination aimed at diagnosis. In order to reduce mortality rates early diagnosis and treatment are obviously imperative. If specific oral cancer screening programmes are not put in place then the evidence suggests that our medical colleagues need additional training and education with respect to oral cancer prevention and diagnosis.

G. Anderson, H. Duncan and J. Stenhouse

Motherwell

Cartoon cover

Sir, – The figure portrayed as the dentist in a recent BDJ (189; 12) is Joseph ('Radical Joe') Chamberlain (1836–1914), a screw manufacturer who became Mayor of Birmingham and the city's Liberal MP, and then led the defection from the Liberal Party of the Liberal Unionists (those Liberals who opposed Gladstone's policy of Irish Home Rule).

In 1895, he joined Lord Salisbury's Conservative government as Colonial Secretary. Chamberlain's belief in the need for closer imperial union led him to argue for 'imperial preference' in tariffs (i.e. protectionism). However, his proposal to abandon Britain's traditional free trade policy met with strong opposition, and in 1903 he resigned from office to spend three years attempting, through the Tariff Reform League, to win the country over. In so doing, he split the Liberal Unionist–Conservative bloc and contributed to its landslide defeat in the election of 1906.

The cartoon is obviously in support of the Liberals and their policy of Free Trade – making the point that adopting protectionism would be tantamount to pulling out the teeth of Britain (represented by John Bull).

D. Turner

Education and Science Department, British Dental Association

Tooth notations

Sir, – Thank you for your note in the British Dental Journal (British Dental Journal2000;  189: 349), concerning recording of tooth notation. As you say, we are familiar with the Palmer system in the UK but less familiar with the confusing FDI notation.

The use of the new shorthand notation is now becoming more commonly accepted but I was interested in your examples. For instance 54/ are written separately as UR5 and UR4 rather than UR54. You also mention /2345 will be written as UL2 to UL5 when surely UL2345 would be clearer. We need to take into account mixed dentition notations where it would be more helpful to write, for example, 6E4C21/ as UR6E4C21. If you cross the midline we can always, again for example, say U6E/E6, indicating both right and left upper quadrants. This is the terminology I currently use in my letters.

I also wonder, do foreign language publications use a similar notation as not all have U and L as the first letter of the 'upper and lower' nor R and L for 'right and left'? Some languages have an equivalent letter the same as one of the five deciduous tooth notation.

Incidentally, how would the FDI notation of 6E4C21/ be recorded? I evaluate this to be 16 55 14 53 12 11. If this is correct it is certainly longer and more prone to error in reading.

Finally, although you sensibly use capitals for notation deciduous teeth in the BDJ, it would be helpful to put in a plea for the use of capitals in patient's handwritten notes. It has been known for 'c' and 'e' to be confused and has lead to the wrong tooth being extracted. Perhaps this whole subject might be further discussed.

A. M. Hall

Chichester

Special care dentistry

Sir, – I applaud P. Erridge who feels so strongly about the recognition of special care dentistry as a specialty that he has written about this after his retirement (British Dental Journal 189: 526). I support his comment about recognized specialists showing little enthusiasm or insight into the management of people in need of special care. This is born out by the fact that even such specialists seek the advice and guidance of experts in special care dentistry in the treatment of some of their patients.

The division of Community Dentistry, Sedation and Special Care Dentistry of GKT Dental Institute is committed to the provision of the highest standard of care to people with disabilities. In addition, it is committed to the training of qualified dentists who have an interest in the provision of care to this group of people and as a first step the Community Dentistry Department within this division has developed a vocational training post followed by an opportunity to obtain MFDS.

We have been able to recruit a high caliber of newly qualified dentists all of whom have had a keen interest in pursuing a career in Special Care Dentistry. However, once they have attained their MFDS we have to turn them away because there is no recognized specialty and it would be unjust to offer them training without a CCST, unlike their counterparts who choose a career within a recognized pathway.

While this continues, those who suffer are people in need of special care within the UK, who surely deserve a standard of care just as high as any other group. If this specialty is not established as Dr. Erridge suggests, we are in serious danger of having no one to care for people with severe disabilities once the present cohort of enthusiasts has retired. The profession should unite to establish this specialty which will, at the end of the day, benefit the quality of care for our patients!

Liana Zoitopoulos

King's Dental Institute, London

Oral temazepam

Sir, – Dr Visavadia (British Dental Journal2000;  189: 238) highlighted an important issue concerning the prescription of oral temazepam for special needs patients. The case he mentioned was a needle phobic. Oral temazepam should not be the first option in the management of needle phobic patients. Psychological management is a more appropriate tool. Oral temazepam can be used as an adjunct to psychological therapy in certain cases. The dosage of temazepam should be monitored and reduced if the patient is getting less anxious and the patient should eventually be weaned off. One should always bear in mind that this type of patients may be unreliable in appointment keeping. The best practice is to prescribe the medication for one visit at a time, thus avoiding multiple doses and any possible misuse of the drug.

D. Wong

Southampton

Antibiotic cover

Sir, – The recent article (British Dental Journal2000;  189: 610) on reducing the recommendation for antibiotic cover gives me concern for the future safety of our patients. The statistics are interesting but if we do not prescribe antibiotic cover we could then be faced with the possibility of having caused a patient to suffer infective endocarditis.

This is not a pleasant experience for the dentist and is life-threatening to the patient. The lawyers would have a field day. I have a personal interest in this matter as my own grandfather was a guinea-pig in the original research and he eventually died as a result of uncontrolled infective endocarditis. I hope that our profession can retain its concern for the individual patient and be guided by prudence rather than by raw scientific data which ignores the individual.

C. Marks

Southampton

Dentists register on the Internet

Sir, – I would be most grateful if you could inform your readers that the Dentists Register is published in full on the Internet. This means that your home address is accessible to anyone with a PC with net access. Conversely, a General Medical Practitioner cannot have their address accessed directly by the Internet at the GMC site.

I have written to the GDC about this, and they suggest changing the address to your work address if you are unhappy with this.

N. Martin

Northampton