Restorative Blog: an introduction...
IT is a great pleasure to be embarking on a new chapter of my career in your region. Part of my motivation for moving to the Morecambe Bay NHS trust was the opportunity to live and work in some of the country’s most scenic landscapes.
I have undertaken Restorative and Periodontal specialist training in Scotland, prior to taking up the role as Consultant at Royal Lancaster Infirmary. My focus is essentially maxillofacial prosthodontics to work as part of the multi-disciplinary team managing hypodontia and trauma and potentially Head and Neck cancer with a focus on Implant rehabilitation, where appropriate, of these patients.
I am acutely aware of a pressing need, not only in this region but nationwide, to provide referral services for Periodontology, Endodontics, Toothwear for starters.
My ideal scenario would involve Endo/Perio/Pros NHS referral services provided in a primary care setting within no more than 30-40 minutes drive of most patients in Lancashire and south Cumbria.
My belief is that we should not label this the ‘Restorative’ MCN but emphasise 3 distinct specialties each requiring varying skills, equipment and facilities, much in the way orthodontics, oral surgery and special care do. We cannot expect our special interest or specialist practitioners to achieve the same level of expertise and perform for 3 separate networks, much as we would not expect clinicians to undertake ortho, oral surgery, and special care.
Vicky Hadden and others have pioneered an Endodontic MCN in South Cumbria which serves the regional population there fantastically well. It would seem eminently sensible to also have a service in the Morecambe-Lancaster region to complete the endo service for Morecambe Bay trust region. A Preston / Blackpool service to support West Lancs and a Blackburn / Burnley for East Lancs would make geographic sense.
The reality is of course complex and requires investment, in clinical staff and clinical facilities and equipment. In the grand scheme of the NHS budget it would be minimal. The growing body of evidence demonstrating Periodontal treatment can significantly improve Diabetes parameters may in fact lead to huge savings. Diabetes and especially its related complications cost the NHS £10 billion every year. This amounts to 10% of the entire NHS budget.
With an aging population and obesity issues this is forecast to rise to 17% of the budget. Diabetes is probably not perceived to be as serious as many other conditions, but 15% of Diabetics will suffer a lower limb amputation, and it is the leading cause of blindness in patients of working age.
D’Auitos 2018 (1) study in ‘The Lancet’ showed that intensive periodontal treatment can significantly reduce patients HBA1c score, at such levels that complications would be expected to suffer significantly fewer complications. The study showed intensive periodontally treated patients HBA1c is 0.6% lower than a control group after 1 year. A 0.4% reduction is the equivalent of a second medication so clearly this is clinically relevant.
Periodontics is a personal passion of mine, but I am interested in the breadth of Dentistry and enjoy how technology and its influence can revolutionise our practice and patients experiences in our chairs. I will be looking to communicate regularly with the regional practitioners both to listen to your needs and concerns as well as advise on referral routes, suitability and provide training for those with interest and ambitions to become part of the soon to be developed network across the region.
I believe the old-style new patient referral clinic can be improved upon, perhaps with an initial advisory video discussion between practitioner and consultant with a discussion of case plus radiographs to determine the need for patient attendance. I suspect a minority of cases would need to attend the hospital and we may save everyone time money and effort and streamline the whole services.
I will be communicating further in the near future regarding referral criteria and managed clinical networks amongst other topics.
I hope we can all look to 2021 with positivity and excitement to get back not only to where we were, but far beyond that, so we enjoy our vocation even more and our patients and communities receive world class care from our region which acts as a model for the rest of the UK.
Please contact me for any advice or with any ideas or questions.
Hope to meet all face to face not too far away.
BSc BDS MFDS MPerio FDS (Rest Dent.) RCS Ed.
University Hospitals Morecambe Bay NHS Trust