The post Future of Scottish Dentistry appeared first on Appletree Dentist Glasgow.

Dr Murphy explained that as a member of the Scottish Dental Association he had studied the statistics and found the fees for NHS work paid no longer cover dentists’ costs.

The truth is, unfortunately, because dentists cannot afford to work within this system that we’ve been discussing for two and half years, the patients are not getting what they need.

The reason they’re not getting what they need is because the Scottish Government have refused to change the system or put in an interim system, which is what we requested. The Scottish Government agreed to and then reneged on that.

The article pointed out that most dental practices in Scotland provide both NHS and private care but Dr Murphy said the share of time spent on NHS activity had fallen from an average of around 75% pre-pandemic to around 50% as practices try to find a better balance to cover their overheads.

The post Why Scottish dentists cannot afford to provide NHS treatment in 2022 appeared first on Appletree Dentist Glasgow.

Our big news is the recently announced and imminent April 2022 departure of Dr Robert Kirke who plans to emigrate with his young family to his wife’s native USA. We are extremely sad to be losing the skills and wonderful humour of Rob, a very caring dentist who has been a credit to our practice these last several years.

Our sadness, however, is tempered with the realisation that he faces an amazing opportunity across the pond whilst embarking on his Masters, having passed his Board examinations.

Haste ye back Rob, whenever you get the opportunity. We look forward to hearing of your future successes.

Many of you will have now realised the huge effect that longer appointments and increased demand are having on patients and staff alike. We are working more than ever into lunch hours and evenings, receiving a much greater volume of work on referral from outlying practices. Please bear with us should you be required to wait several weeks for your next appointment.

Deposits must be taken for all treatment appointments to mitigate the effects of isolation and covid. We recommend that all bookings are sequenced at the start of your treatment plan.

The current and ongoing situation means that we will no longer be registering new NHS patients in our Glasgow practices. I plan to introduce two replacement dentists in place of Dr Kirke which will hopefully reduce the waiting times.

All of our registered NHS patients will be seen by the new arrivals from April 2022, with the exception of my own family and friends who will be seen by me at the Crystal practice.

Our new associates will offer NHS emergencies as normal. NHS treatment will be offered by each NHS dentist on two separate mornings which will not clash with the alternative associate’s sessions. This system will hopefully maximise the available days for NHS treatment.

We are putting this system in place to allow us to deal with the procrastination of the Scottish Government in regards to a New Model of Care.

Our associates continue to receive £5 for a small NHS filling. They (and the supporting staff, who receive the other £5 allocated), are better than that. Under the current system, there can be very little focus on prevention, advice and oral health.

I am aware that we have thousands of visitors to webour sites each month and would be most grateful if you might correspond with your MSP regarding this- on behalf of all NHS patients, especially children and those in deprived areas.

Finally, I would like to thank all of our patients for their continued loyalty, word of mouth referrals and kind online reviews. Have a wonderful festive season,

Kind Regards

Brendan Murphy

The post Latest COVID Update from Dr Murphy appeared first on Appletree Dentist Glasgow.

How do you see access for patients to NHS dentistry panning out?

Access is as poor as we have ever seen it – 10 per cent of Associate jobs are unfilled and the remaining GDPs, due to the constraints of SOPs, are carrying out less than half of their pre-Covid treatment levels.

In the pandemic outbreak the Scottish Government struggled with the NHS dental contract, making some effort to understand the costs and mechanics of GDS provision until the Summer COVID juncture when GDPs were least likely to add to their commitment levels and working at an overall significantly reduced level of remuneration.

Children and those in high deprivation areas will probably suffer most of all when it comes to accessing a failing service. Going forward for geriatric and child patients represents an unfathomable task for our profession, which seems to have been put to the back of a long queue.

What issues face GDPs?

We just can’t operate at anywhere near the pre-COVID treatment volumes. It’s absolutely not an option in a dental practice. The economics, however, seem to have been lost somewhere within the corridors of Holyrood. In every other walk of life when we witness the reduction of supply on a cheapened product, the demand increases and therefore no one would surely play with the demand if service/product provision were at breaking point?

The early 15 per cent reduction of treatment values and significant rise in costs has cheapened NHS dentistry. I mean to say this as an economic fact. So, NHS dentistry was always going to be economically poleaxed under the temporary systems the Government has put in place, particularly with the predictions that they will have run from 2020 to 2022 with no real progress as yet on the interim model. There can be no logical economic argument against the reality of what’s going on.

The flip side is that the contralateral ‘private’ supply inevitably and markedly increased with a correlative rise in demand for that service- so many mixed and solely private GDPs had no choice but to increase their private fees at the earliest stages of the pandemic, to balance the 15 per cent NHS ‘tax’ on pre-COVID treatment values. This was paralleled by a 7.5 month NHS dental lockdown period prolonged by a government who were slow to react. Almost all general dentists consequently now do more private treatments. That’s unlikely to flip back.

What impact will free dentistry have?

It’s a nice idea but in terms of making a difference it will be minimal for the next couple of years. It’s likely that fewer people, not more, will access NHS dentistry – partly due to delays in the New Model of Care. Appointments are longer and waiting times up. For many, the dalliance with free NHS dentistry should be tempered with the realisation that the NHS dental service haemorrhages both patients and practitioners at an alarming rate.

For those few patients who currently stand to benefit, they should be considered in the context of the average pre-COVID NHS treatment costs – approximately £19 per adult per annum. So they’ve taken something that was almost free to the average Scottish adult and inadvertently made it more difficult to access through various measures.

What are the alternatives?

There are several practices already converting to monthly plans and the majority are carrying out significantly higher levels of private dental care than the pre-COVID 25 per cent national average. The main point to make is that it’s now often the patient’s choice.

From our perspective, dentistry has become considerably more expensive since COVID. That’s an issue that Government has not properly investigated since the Scotland Act in 1998. Yet they have chosen this period with fixed reduced NHS treatment fees to make Scotland the world’s only developed country to provide all adults with free dentistry. That seems strange, given the lack of evidence or consultation on its requirement.

To be fair, they have admitted that there was no consultation. The timing, given what our staff were going through, was convenient for the Government but poor for patients and dental staff in my opinion. When you consider the minimal access levels for those patients it might help, the summary message from the Government might have been: “It’s not about you (the profession) or the average Scottish patient, it’s about the election.”

How do you think it will tackle the problems you and your colleagues are facing?

They could start by opening up the conversations with GDPs, dealing with correspondence as promised and in earnest – i.e. immediately asking the profession about the expenses and freeing the shackles placed on the job market by COVID support. This means forcing PSD [Practitioner Services Division] to highlight exactly what basis upon which each line 7 COVID support figure is calculated and how it may be affected by an associate moving for example. We were told by the CDO and David Notman that they’d consult with the whole profession. This isn’t happening.

We have been stating unequivocally that NHS dentistry under the current contract is doomed. In all but name, the old SDR is in the bin. We won’t accept a return to those conditions. Some GDPs are fearful for what lies ahead – e.g. the occasionally mooted suggestion that they may be obliged to provide posterior composites within the confines of the NHS or hit high targets. These suggestions require us to remove ourselves from the realities of providing dental treatment under enhanced PPE, with fallow and increased administration which are here to stay according to ‘best practice’, whilst acknowledging the limits of a modern NHS and an ever increasing demand.

In summary, the Government needs to embrace the concept that NHS and private systems can run symbiotically, within each practice, to the betterment of the vast majority of patients.

Have there been discussions on a way forward?

Not with the “whole profession.” They haven’t answered emails sent months ago. I’m unsure as to whether they’re hoping we’ll fade away. That’s unlikely for the next generation. My son’s a third year dental student in Bristol. They’re more likely to go away permanently. I’d say my kids generation are more entitled, they wouldn’t put up with a lack of negotiation for 22 years.

Does that upset you and your colleagues?

It upsets our majority very much but these views are my own. We need young dental professionals to feel that the NHS is a good place to be. It’s the repeated but as yet undelivered promise of consultation with the “whole profession.” I wouldn’t want my colleagues to think we have given up, far from it, but it leaves you feeling you’re banging heads off walls. We ‘get’ the behemoth that’s the NHS, and the more critical areas within it such as cancer therapies and surgical wards, but engagement now is essential whilst there’s a chance of salvaging something reasonable.

What are the effects ‘on the ground’?

The vast majority of GDPs are seriously concerned by the semi-permanent nature of reduced treatment fees. Given how lowly they (GDPs) regarded the pre-COVID SDR payments it’s a significant blow and they will therefore be more inclined to repair than replace, contradicting any suggestions of ‘normal service.’ We are securing the short term prognosis but not always making a full restorative plan. These are based upon concerns regarding a system that’s long been broken.

To be clear, we are not turning our backs on patients but will inevitably reduce the vast majority of restorative works based upon a treatment value of circa £9 for a small filling, of which associates receive 45-50 per cent. Does the public think that the majority of dental professionals should be pressed into working for £4.50 in the age of fallow periods, lengthened appointments and enhanced PPE? If you put 10 such similar AGPs together – a full day’s work – you’ll get less than the average call-out fee for a plumber or joiner.

Our profession – most at risk from COVID and the next pandemic – has already said ‘no’ to the possibility of normal practitioner profiles, whilst the Government is no further forward on a New Model of Care.

And the biggest challenge, as a practice owner?

It’s not the practicality of clinical dentistry I’d say any more, it has to be the pressure of no diary white space for emergencies, but also the ball and chain created by COVID Support for associates. We are powerless to affect it going forward and often it’s completely unexplained to associates and practice owners. Whilst they now appear to fix the future financial penalties forced upon those dentists who may yet be ill or absent through injury, the Government has not fixed historical anomalies with the ‘test period.’

The assessment period is brutally punitive for those who were absent from work in the year before COVID. GDPs taking time off for pregnancy, injury, illness or mental health before COVID, are therefore still beholden to financially crippling Covid Support – on a semi-permanent basis because their assessment is founded upon that period of absence.

As if all of the above were not enough, this continues to force evermore GDPs away from NHS dentistry and by proxy, countless dental nurses, hygienists, therapists and dental technicians then follow. Naturally, there’s more pressure on those who remain. This is the most damning NHS dental legacy of the pandemic.

After 18 months there are people who’s COVID Support is still based on a time when they moved practice or were off through sickness, injury and/or mental health. It’s heartbreaking for those dentists affected.

You were involved in a proposal submitted to the Scottish Government for the New Model of Care.

What’s the thinking behind it?

The initial thinking was about the NHS commitment, as it’s been historically perceived and how dentistry has changed radically in our working lifetime. The existing system cannot work- it’s so difficult to mix NHS/private diaries and keep track of administration whilst operating efficiently to a busy diary.

A young dentist nowadays might be more likely to commit to doing three NHS days per week (in much the same way as most of my GP friends do) and freeing up a couple of private days. They would expect, however, to be remunerated similarly to GPs, particularly given the available rewards within the private sector, which so many more are enjoying right now- sufficient appointment lengths and nice labwork etc.

Furthermore, it’s wrong for the private sector to be stacking up the NHS deficiencies and staff deserve similar rewards to those working in hospitals and community.

The idea of forcing all dentists within a mixed practice to operate within the NHS – as seen within the threatened 2024 ventilation grant claw-backs – is a non-starter. The Government is taking the wrong line here by creating that division. Each dentist has earned the right to their own clinical freedom and each NHS patient and Scottish citizen/employee deserves the same fresh air, whether they’re NHS or private.

My response to that was to not apply for some practices and redouble my efforts to make our practices less reliant on those income streams, whilst ensuring all NHS patients are not disadvantaged in any way. So the proposal is about proper clinical freedom within NHS dentistry, mixing that with the ability to provide patients with the preferred aspects of modern dentistry.

Do you think that there’s still hope for a strong NHS dental service going forward?

Yes, but it’s been dealt two hammer blows following decades of neglect which predates the first Holyrood Government. Brexit and Covid have yielded poor returns on recruitment and consequently hindered maintenance and development of NHS treatment providers. It might not be the NHS dental services that the Scottish Government wants or hopes for. They’ll need to arrest the abnormal haemorrhage quickly and they’ve put themselves under tremendous pressure through a commitment to increase provision of a service when everything else pointed to a shrinkage of that service through the economic pressures discussed.

Any left of centre government will want to avoid the accusation of privatisation through the back door but there is a risk of that, through a shrinking core service – at least partially. It would be nice to think that we could go back to offering patients almost “all of the options, all of the risks” within the NHS but that might now be an unrealistic prospect as we are running out of time. It’s the one commodity we don’t have unfortunately, and GDPs will make decisions based on saving jobs and paying bills, whilst providing qualitative patient care.

The last 18 months have been a reminder of those priorities and the NHS versus private conversation must be number four on that list. If the government might act swiftly regarding proper consultation, a strong NHS dental service becomes more probable than remote.

The post NHS Dentistry in Scotland: Dr Murphy Interview in Scottish Dental Magazine appeared first on Appletree Dentist Glasgow.

This postcard image is of Downie Place – which is what this part of Dumbarton Road was formerly known as – with the shops below our surgery clearly seen beside a road which had yet to be cobbled.

With records of there being a dental practice here in the 1880s, we can realistically lay claim to being one of the oldest if not the oldest continuously run dental practice in Glasgow.

The University of Glasgow issued the first Licence in Dental Surgery in 1879 which must surely mean that there can have been very few if any others around Glasgow before the 1880s.

We are celebrating other images of Partick within our Glasgow dental practices just now. The waiting room wall showcases images from circa 1930 – including our surgery ‘close’ entrance – to the 1950s.

The shops and tenements within the larger central image were knocked down to accommodate access to the then new Clydeside Expressway – all in the name of progress. Bring back the clean cobblestoned streets of Glasgow!

The post Appletree Dental: The Oldest Dental Practice in Glasgow? appeared first on Appletree Dentist Glasgow.

Better to look and call us for advice than to leave something unchecked for an indeterminate amount of time.

Our colleague Sarah Falconer, dentist at EnVisage in Falkirk and Cumbernauld has shared this handy poster from the Let’s Talk About Mouth Cancer charity, a very worthwhile resource.

The post Checking Your Own Teeth and Mouth appeared first on Appletree Dentist Glasgow.

Since my year of graduation in 1992, I’ve witnessed some fantastic developments which have vastly improved the way that we treat patients. These very often either improve the treatments themselves, prevent the development of future problems or alternatively assist the patient in both achieving and understanding the issues/options which face them.

1. White fillings – although these were available years ago, the quality wasn’t quite as it is now. Additionally, patients were then very often choosing to have metal fillings because they simply couldn’t afford the early prices. Now, in our practices, we rarely place mercury amalgam fillings as patients choose white fillings. I’ve made this number one because it’s our most common request and all dentists are capable of providing these restorations.
2. Implants – before graduating, we received very little formal education on implant dentistry. This was very much a rapidly developing phenomenon. The idea that we might be replacing patient’s teeth routinely in practice seemed like fantasy at that time. We are now inundated by patients seeking to eliminate an unwanted denture, to improve various cosmetic aspects of their smile through dental implants and most importantly to deliver best function through their new, fixed porcelain teeth. We place hundreds of dental implants at Appletree Dental Care every year, thanks to our many referring dentists.
3. Cosmetic or Clear Braces – in February 2009 I ventured down to Birmingham for a CPD conference. There were no dentists offering Six Month Smiles at that time in Scotland. It was genuinely a career changing moment and we returned a few days later, enthused by the idea of using ceramic brackets instead of metal, on adult patients who were hitherto deprived of the cosmetic braces options. Now there are many more systems such as Invisalign and Inman Aligners although bracketed orthodontic options are still very much the gold standards.
4. Dental software – our practices allow us to be much more organised, giving you the patient so much better service than we could 28 years ago. Computerised reminders, appointments, treatment notes enable us to give far more time to your treatment.
5. Electric toothbrush – a recent 11year long study by Pitchika et al demonstrates the benefits: 22% less gum shrinkage and 18% less decay. Patients are inclined to scrub less and get into areas which may otherwise be inaccessible. Further, patients with motor control issues e.g. frail, elderly, those with challenges to dexterity, all fare much better with electric brushes.
6. Preventive Dentistry – represents the cornerstone of every consultation. We focus on dietary, fluoride and hygiene advice on a day to day basis. Most of our patients return every six months and no matter how complex their journey to and with us, they usually require very little maintenance or treatment ongoing. This is on the back of our preventative focus.
7. Teeth whitening – the limit on Hydrogen Peroxide legal concentration was set at 6% by the UK Cosmetic Product Regulations in 2012. There were significant issues in regards to earlier, higher concentrations, although we have chosen never to administer these: safety first. Tooth whitening is often the first treatment stage considered in a cosmetic dentistry process with porcelain veneer or crown-work matched to the resulting shade. With gum shields custom made, it can provide excellent results through a very safe technique.
8. Financial Agreements –  in the beginning, there were mostly NHS patients. Private treatment was sporadic in Scotland with the occasional patient choosing white fillings or a single veneer or bridge which may not have otherwise been available on the NHS. Now, patients are referred to us by other dentists or through our websites for all kinds of smile makeovers and cosmetic dentistry options. These are regularly paid for by our patients, through dental finance agreements made via Finance4Patients.
9. Digital Dentistry – many of the porcelain and implant related restorations such as crowns, bridges and supporting titanium bars or frameworks, are fabricated using CAD/CAM technology. Information is exchanged online between our technicians and laboratories around the world. We use milling centres in Spain, Belgium and Qatar. Digital photographs of before, during and after are exchanged on a daily basis. None of these options were available to us in the early years.
10. Communication – there were no text or email reminders in 1992. Now patients can check websites, Facebook pages and other social media forums to look at the services or treatments we offer. We often email patients with complex Cosmetic or Implant treatment plans to explain all the options and confirm their preferred plan.

The post Top 10 Developments in Modern Dentistry in Glasgow appeared first on Appletree Dentist Glasgow.

Examination revealed that there were old stained composite fillings on the front teeth without veneers.

Additional feedback given at her free consultation revealed that she didn’t like spaces at the side and the two front incisors were comparatively large next to her lateral incisors.

Emax Pressed Porcelain Crowns

After deliberation of the merits regarding porcelain veneers versus crowns, Eva decided to have six ceramic crowns in Emax pressed porcelain.

This process to replace old porcelain veneers and their filling materials took up a one and a half hour appointment, which also included taking impressions for the final veneers.

Additional composite resin build ups were used to eliminate the space on the premolars at the side.

Temporary crowns were fitted and the porcelain was turned around in one week.

Alex Adair, the dental technician, was present to make sure that both the patient and dentist were happy with the final selection of porcelain shading and translucency.

The treatment to replace old porcelain veneers cost £2520 and involved eight teeth – six in porcelain, two in composite bonded resin.

Eva commented that she was much more confident with her new smile. She realised how much her teeth had affected her sense of well-being only after she had them fixed.

Great feedback.

The post Replace Old Porcelain Veneers with New Ceramic Crowns appeared first on Appletree Dentist Glasgow.

Dr Murphy discussed this and other options with Terri who was clear on two things: she didn’t want to accept things as they were and she couldn’t put up with metal braces for so long.

“Is there anything more cosmetic and faster than train tracks?”

Dr Murphy went through other clear braces options. This case was too complex and the crowding too severe, to consider aligners like Inman or Invisalign.

He proposed a custom Six Month Smiles treatment with clear brackets and tooth coloured wires to suit Terri’s requirements.

Custom Clear Braces Work

The process involved placing each bracket by hand. Six Month Smiles involves sending impressions to a laboratory and asking a technician to make gum shields with cosmetic brackets inside.

Instead Dr Murphy placed the brackets directly himself in the ideal position to generate quick and accurate movement of front teeth.

By polishing in between teeth and expanding upper and lower arches slightly the crowding was slowly alleviated.

He predicted initially that treatment time would be up to one year although ultimately it took 13 months. There were challenges relating to night time tooth grinding and occasional brackets coming off.

Due to the level of difficulty in the upper jaw, it was agreed that both a bonded wire retainer and a removable plastic retainer would be preferred.

Terri was 100% happy with the final outcome of her custom Six Months Smile treatment.

“It’s turned out better than I had expected. There were a few extra visits but Brendan always made out like it was no trouble, even when it clearly was!”

Terri paid £2935 for cosmetic orthodontics, tooth whitening, two removable retainers and one bonded retainer. This included a free consultation as well as photos and impressions and £30 for X-rays.

The post Custom Six Month Smiles Treatment Alternative to Metal Braces appeared first on Appletree Dentist Glasgow.

Donald came to us from his regular NHS dentist in Helensburgh who referred him for dental implant treatment.

He had tired of the bulk on his upper denture, having had all top teeth removed many years ago.

There was insufficient bone to place implants of sufficient size and number initially but following sinus grafts and a long period of graft integration, we were able to place five implants into the upper jaw.

The second stage involved fitting a fixed titanium bar with five small screws into the implants.

This fixture is extremely rigid and allows patients to chew steak, bite apples and enjoy full function without movement of teeth. It also allows excellent hygiene around the implants.

You can see from the photos that four of the implants are placed at the back of the upper jaw, entirely within the new sinus bone.

The final structure is made of high impact acrylic, very cosmetically designed gum, with clip attachments locking it onto the fixed titanium bar.

Donald paid £2200 for sinus grafting, £5000 for 5 implants, £4500 for the fixed titanium bar and final cosmetic denture.

Had there been sufficient bone initially, treatment would have been completed using four dental implants at a total cost of £8500, including prosthesis.

The post Fixed Titanium Bar on Dental Implants: When There is Insufficient Bone appeared first on Appletree Dentist Glasgow.