RÓISÍN TREACY and PAUL O’GRADY report from the Association’s Annual Conference in Kilkenny in May where dentists had the chance to experience a wide range of CPD.
Dr Nick Armstrong got the jam-packed team programme underway on Friday morning with his presentation on infection control and washer disinfectors. In a short presentation, Nick talked delegates through the importance of correct instrument washing and disinfection. The most important message he had for the audience was to always read the manufacturer’s instructions when it comes to cleaning equipment.
If anyone was still feeling lethargic by 9.30am, Dr Conor McAlister was not making allowances for it. During his interactive presentation on Irish dental project in Africa ‘Cheka’, he challenged delegates to get involved and answer questions. Their efforts did not go unrewarded, as Conor provided prize bracelets for those who answered correctly.
The Cheka project is run in the town of Embulbul, located 20km outside Nairobi in Kenya. The project began in 2002, and Cheka opened a dental surgery in Embulbul in 2003. Since its foundation, 14 teams of volunteers have visited Nairobi as part of the project. Delegates passing by outside the conference hall could be forgiven for thinking there was some kind of celebration going on inside, as the presentation concluded with a slideshow of photographs, to the music of Bob McFerrin’s ‘Don’t worry, be happy’.
Director of Dental Protection, Dr Kevin Lewis was the third speaker of the morning, giving an address on simple steps members of the dental profession can take to reduce the risk of litigation. In an entertaining presentation, Kevin referenced statistics that show that New Zealand is the least litigious country for dentists, because the government compensates patients for any harm they might suffer during the dental process. However, in Ireland, claims are much bigger, and Dental Protection saw a massive rise in litigation when the recession hit.
Kevin adopted Edward de Bono’s ‘six thinking hats’ tool as a method of helping the dental team avoid litigation. The group-thinking tool allows the dentist to look at a situation from six different angles – facts, emotions, threats, opportunities, innovation, rational – in order to determine the risk, and solve it before it becomes an issue.
Healthy tips for patient and dental team
Following the morning break, hygienist Kellie O’Shaughnessy took to the podium to discuss oral health promotion. Kellie’s presentation emphasised the importance of communication with patients: “The moment the patient walks through the door, communication is key. Not just verbal contact, but also body language and eye contact.”
Kellie went on to discuss how approaching a patient in a positive way about oral health can make all the difference. To prove this point, delegates were shown two different videos of the same scenario – discussing the issue of smoking with patients. The first video – the wrong approach – showed a doctor bullying a patient into giving up smoking, with the patient becoming agitated and upset during the conversation. While the second video showed the same doctor explaining to the patient in a calm and understanding manner how important it is that she quit smoking, and describing different aids to help her do this.
Physiotherapist Stephanie Tarrant presented a hugely beneficial talk on the causes and prevention of muscle injury in the dental practice. The dental profession holds an 80% incidence report compared to other health care groups. The factors that lead to muscle injury include: prolonged repetitive forceful or awkward movements; poor posture; ill-fitting chairs and equipment; and, a fast-paced workplace. Stephanie gave a number of helpful tips to reduce the risk of muscle injury.
During the presentation, Stephanie highlighted the need for a survey of current members to determine the extent of musculoskeletal injury within the industry. She explained: “Unless we know where we are, we can’t move forward, we can’t make things better.”
After lunch, delegates were given the opportunity to earn more CPD points during Stanley Malamed’s ‘Emergency medicine: back to basics’ presentation. Healthcare providers have both a legal and moral obligation in emergency management – they must keep the victim alive until he or she either recovers, or help arrives to take over management. Stanley explained that the dental team must have a predetermined plan for managing medical emergencies, and this team is made up of three members. The first member is the first person on the scene of an emergency, their responsibility is to shout for help, stay with the victim and perform basic life support if necessary. The second member responds to the call for help and gets the necessary equipment (defibrillator, etc.), while the third member is everyone else on the dental team, and they are responsible for calling emergency services. The presentation went on to include advice on what to do in the case of seizures, asthma, allergies, and chest pain.
Paddy McCann’s address on mouth cancer was certainly not one for the faint hearted. The picture-heavy presentation showed an array of different oral cancer cysts and tumours, in the pre-operative, operative, and post-operative stage. Paddy stressed the importance of taking an extensive patient history when it comes to patients with oral cancer, in order to determine how fit they will be for the journey, and whether they have the support required to get them through it.
High-achieving endurance athlete Gerry Duffy gave a highly entertaining and motivating speech about his journey from a humdrum, unhappy lifestyle in his mid-twenties to achieving many goals in his life. Interestingly, he noted that perhaps the single biggest challenge he faced was not completing something as extreme as the Deca Iron Man Challenge (which he won), but giving speeches. It has taken him most of his life to get to the stage where he is not filled with fear and dread ahead of a speech. It was only as recently as 2011 that Gerry reached a point where he felt confident that he could deliver a speech.
Gerry described his seven key habits for success, which are: 1) give yourself time to think; 2) improve your physical fitness; 3) surround yourself with great people; 4) be enthusiastic; 5) be different in your approach; 6) commit to continuous improvement; 7) constantly check your mindset. His favourite saying is: “It’s not what happens to you, it’s what you do about it.”
There were two contrasting presentations on orthodontics on the Saturday. The first was from Dr Michael Ormonde of the Kylemore Clinic in Kilkenny who addressed the theme of “The changing face of orthodontics”. He acknowledged that digital technology had brought a lot to orthodontics but, he said, you need to know what to do with it. Michael reviewed many of the techniques currently being offered to general dental practitioners, pointing out their strengths and their weaknesses, and cautioned that taking on an orthodontic case that doesn’t work can be enormously stressful. “I have had referrals and I’ve finished cases that prove that the dream that is being sold does not always work.”
Dr Tif Qureshi, on the other hand, is a part-owner of the Inman company. He addressed the topic ‘Truly minimally-invasive dentistry for every dentist’. He stated that the golden rule for any dentist taking on cosmetic work was “Do unto others as to yourself” and that sometimes referral to a specialist orthodontist is the best treatment for the patient. The big question, he said, is: should GDPs be doing orthodontic work? The answer, he stated, is given by the answer to a question that every dentist has to ask themselves: is it within your capability? His view is that simple orthodontic work is well within the scope of the GDP and that showing the correct planning and getting the proper, informed patient consent will result in professional respect for that work. The benefits he stated as: high patient acceptance; appropriate and low-risk work; progressive smile design (which he described as align, bleach, contour); de-radicalised preps; and far less stress.
Quality in dentistry
Professor Martin Tickle of the University of Manchester addressed the topic of quality in dentistry. Surprisingly, he revealed that quality in dentistry has tended, up to now, to be equated with complex restorative work. However, work is now underway to measure quality at the micro (individual dentist); meso (practice); and, macro (policy) levels. Improving quality, he said, requires shifting the performance of the entire system. Therefore, intervention and implementation are required. The acknowledged intervention methodology is: agree goals; agree how goals are measured; identify changes needed to achieve goals; test those changes; sustain and spread change.