College endorses updated prevention guidance

The College of General Dentistry has endorsed the newly-published fourth edition of Delivering Better Oral Health: an evidence based toolkit for prevention.

With chapters covering behaviour change, dental caries, periodontal diseases, oral cancer, tooth wear, oral hygiene, fluoride, healthier eating, alcohol, smoking and tobacco use, the revised document gives dental teams access to the best evidence of what works for oral health improvement, all in one place, to help them provide high quality preventative care and advice to patients.

The summary guidance tables remain an invaluable resource for general dental professionals, and new content has been added on infant feeding and early detection of oral cancer, further detail given on tobacco cessation and alcohol reduction, and a new table included which focusses on accelerated tooth wear.

The fourth edition also offers case studies in supporting behaviour change, as well as greater consideration of the oral health of older people and other vulnerable groups, and a new digital format provides better accessibility on mobile devices.

Issued jointly by Public Health England and the Departments of Health in England, Wales and Northern Ireland, it is the result of a comprehensive review of published evidence on prevention involving over 100 experts, among them frontline dental teams and patient representatives.

Ian Mills FCGDent, College Ambassador and past Dean of the Faculty of General Dental Practice, was among those overseeing its development, and Yann Maidment MCGDent, Council Member and College Research Lead, is on the Delivering Better Oral Health Implementation Group.

The document is available at https://www.gov.uk/government/publications/delivering-better-oral-health-an-evidence-based-toolkit-for-prevention

Antimicrobial prescribing in dentistry – 25 November 2021

Thursday 25 November 2021, 7pm

In the first of our Talking Standards webinar series, which sets out to examine areas covered by our evidence-based standards and guidance, we will be shining the spotlight on global efforts to tackle antimicrobial resistance locally.

We will explore the ways in which dental teams can help keep patients safe from untreatable infections, consider why dental practitioners might overprescribe antibiotics and discuss the impact of COVID-19, referring to the Antimicrobial Prescribing in Dentistry Good Practice Guidelines.

Speaker:

Dr Wendy Thompson

To register for the event, please visit: https://www.prodentalcpd.com/webinars/p140-talking-standards-antimicrobial-prescribing-in-dentistry

This webinar is part of the new partnership between the College of General Dentistry (CGDent) and ProDental CPD.

It will be free to view live for all members of the dental professions. CGDent members and ProDental subscribers can claim CPD hours for free and have access to the recording after the event.  A £20 fee will apply for non-members/non-subscribers who wish to claim CPD.

Membership of the College of General Dentistry is open to all registered dental professionals. Membership for dentists is available from £94, and for other registered dental professionals from £33. The full list of CGDent membership rates is at https://cgdent.uk/membership-fees/

FGDP standards and guidance now available at cgdent.uk

The standards and guidance documents previously published by the Faculty of General Dental Practice UK (FGDP) are now available on the website of the new College of General Dentistry (CGDent), the first independent college and only professional membership body in the UK specifically for primary care dentistry. 

The FGDP recently transferred from the Royal College of Surgeons of England into CGDent, and the new College has assumed the Faculty’s function to develop and maintain evidence-based guidance and standards for the general dental professions. 

Titles now available from the College include:

  • Standards in Dentistry, a comprehensive collection of standards and guidelines for primary dental care
  • Clinical Examination & Record-Keeping, a complete reference guide to record-keeping and examination, including history-taking, consent, confidentiality, data protection and more
  • Antimicrobial Prescribing in Dentistry, which gives clear, simple and practical guidance to dentists on when to prescribe antimicrobials, what to prescribe, for how long and at what dosage
  • Selection Criteria for Dental Radiography, the leading guideline on indications for radiographic investigation, covering treatment planning and monitoring, ionising radiation regulations and best practice
  • Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment, which helps dental practices meet the standards required by the Ionising Radiation Regulations 2017 (IRR17) and Ionising Radiation (Medical Exposure) Regulations 2017 (IRMER17)
  • Training Standards in Implant Dentistry, which summarises the training that should be undertaken to carry out implant dentistry safely, and the standards which should be met by training courses
  • Dementia-Friendly Dentistry, which enables dental professionals to understand dementia and its implications for dental practice, and adapt their patient management and clinical decisions accordingly
  • An Introduction to Research for Primary Dental Care Clinicians, which introduces the principles of research methodology, discusses the relevance of research to primary dental care, and provides an overview of the different stages in a research project

These publications join the College’s COVID-19 guidance documents, which were developed with the FGDP last year:

  • Implications of COVID-19 for the safe management of general dental practice: a practical guide, which supports dental professionals to take a risk-based and evidence-based approach to providing safe general dental care, whatever the national threat level
  • Dentistry during COVID-19: Psychological advice for dental teams, policy makers, and communicators, which offers straightforward suggestions to address common challenges arising from the COVID-19 pandemic in dental practices, and lists resources and organisations which can support dental professionals’ mental wellbeing.

Digital copies are available free of charge at https://cgdent.uk/standards-guidance, and print editions will soon be available.

A programme of webinars exploring each of the publications, and how they can be put into practice, will begin soon. Co-hosted by the College of General Dentistry and ProDental, the UK’s largest independent provider of online dental CPD, many of the events will be free for all dental professionals to watch live, with access to the recordings and CPD certification also free for CGDent members.

Events to discuss Selection Criteria for Dental Radiography, Standards in Dentistry and Clinical Examination & Record-Keeping are expected between October and December 2021, with Dementia-Friendly Dentistry, Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment, Training Standards in Implant Dentistry and An Introduction to Research for Primary Dental Care Clinicians among those anticipated next year.

To keep informed about these events as dates and times are confirmed, sign up to the monthly CGDent newsletter at cgdent.uk/college-newsletter

To find out more about the benefits of joining the College of General Dentistry, visit cgdent.uk/benefits.

College of General Dentistry endorses FGDP(UK) and PHE revised guidance on radiation protection

The College of General Dentistry is endorsing revised guidance on radiation protection in dental practice, published by the Faculty of General Dental Practice (FGDP[UK]) and Public Health England (PHE).

The second edition of Guidance Notes for Dental Practitioners on the Safe use of X-ray Equipment sets standards of good practice for the safe use of X-ray equipment in dental practice.

The guidance is freely available on the FGDP website, where hard copies are also available to purchase from the online shop, and FGDP members based in the UK will shortly be receiving a complimentary hard copy.

Presenting definitive, detailed and comprehensive recommendations in a logically ordered and intelligible format, Guidance Notes for Dental Practitioners on the Safe use of X-ray Equipment, 2nd Edition is designed as a reference for the whole primary care dental team.

The guidance covers both administrative and practical matters, taking into account developments in dental X-ray equipment, imaging technology and legislation since the first edition, which was published in 2001 by the National Radiological Protection Board (now part of PHE’s Centre for Radiation, Chemical and Environmental Hazards).

It was produced by a working party led by Public Health England and consisting of regulatory bodies, professional bodies representing dentistry and radiation protection, consultant dental radiologists and general dental practitioners.

The new publication includes:

  • Existing guidance on dental cone-beam CT (CBCT), hand-held dental X-ray equipment and digital imaging systems
  • Updated guidance on:
    • Radiation controlled areas
    • The training of referrers, practitioners and operators with respect to dental CBCT
    • Acceptance, commissioning and routine radiation safety tests for all dental X-ray equipment and the recommended intervals (extended to every three years for most dental CBCT equipment) between routine tests
    • A simplified system for image quality rating and analysis
    • A simplified approach to quality assurance of digital imaging systems and viewing screens
  • New guidance with respect to the requirements:
    • For dental practices to register with the HSE (or HSENI)
    • To investigate the circumstances when contingency plans are activated, and on the need to rehearse contingency plans
    • To monitor radiation levels at the boundaries of controlled areas
    • To assess doses to persons who need to enter controlled areas
    • For employers to co-operate when employees work with dental X-ray equipment on another employer’s premises, including arrangements for the formal handover of responsibility
    • Regarding what should be expected of service engineers who undertake the installation, testing and servicing of dental X-ray equipment
    • When disposing of or selling-on X-ray equipment
    • For record retention
  • Detailed practical guidance on how to achieve the optimisation of patient dose
  • Template documents, including a radiation risk assessment and the employer’s procedures relevant to dentistry

The guidance supports compliance with the Ionising Radiations Regulations 2017 (IRR17) and the Ionising Radiation (Medical Exposure) Regulations 2017 (IRMER17), but does not impose any requirements on employers beyond those required by legislation.

Ian Mills, Dean of FGDP(UK) and Trustee of the College of General Dentistry, said:

“The core function of the FGDP is to raise the standards of care delivered to patients through education of the dental profession and the provision of evidence-based guidance, and we have been delighted to work with Public Health England to publish a second edition of the Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment. For almost two decades, this has been an important text in setting standards for the safe use of X-ray equipment in dental practices, and this updated edition will undoubtedly continue to be a key reference document for the whole primary care dental team.

“We are grateful to PHE and the many contributors who have spent considerable time and effort ensuring that it is informative, accessible and highly relevant, and are indebted in particular to Dr Keith Horner FFGDP(UK)(Hon.), whose analysis of the revised regulations three years ago was the catalyst for this project, and who has been involved throughout as the Faculty’s representative on the working group.”

Dental Fallow Time Calculator launched

A new free-to-use Fallow Time Calculator has been launched to enable dental professionals to determine, justify and record the fallow period necessary following dental procedures carrying a higher risk of exposure to potentially-infectious aerosols.

Built by digital consent platform Flynotes, supported by Practice Plan and Wesleyan, and endorsed by the Chief Dental Officer for England, the new tool complements the COVID-19 guidance published by the the College of General Dentistry (CGDent) and the Faculty of General Dental Practice UK (FGDP), the recent update of which incorporates the Scottish Dental Clinical Effectiveness Programme (SDCEP) recommendations on fallow time.

Public Health England guidance currently recommends a fallow period of 60 minutes in a treatment room with less than 10 air changes per hour from the point that an aerosol-generating procedure is completed. The CGDent-FGDP guidance recommends that practitioners justify any decision to stray from this, record factors which allow reduction of the time, and include details in the clinical record for each patient.

The Fallow Time Calculator is designed to facilitate this process, and is based on SDCEP’s multifactorial approach to determining fallow time. Set out in its recent publication, Mitigation of Aerosol Generating Procedures in Dentistry – A Rapid Review, this sets a ‘benchmark’ time of 15-30 minutes, which will vary dependent on the type and length of procedure, the employment of procedural mitigations such as high-volume suction and rubber dam, and the availability of environmental mitigations such as air ventilation.

Available at https://myftc.co.uk, the Fallow Time Calculator also offers a full audit trail, updated regularly in accordance with the guidelines, which practices can use to aid diary planning, allowing efficient patient treatment flows whilst ensuring necessary fallow periods are implemented. Register at https://myftc.co.uk/register.

Ian Mills FFGDP(UK), Dean of FGDP(UK) and a Trustee of CGDent, said:

“I’m proud and delighted to launch the new Fallow Time Calculator, which is the result of a fantastic collaborative effort. I particularly want to thank two fellow members of our guidance task group for their work in developing it – Flynotes CEO, Govin Murugachandran, and Faculty member and Deputy CDO for England, Jason Wong – as well as Wesleyan and Practice Plan for their generous support, which has enabled both the development of the calculator, and its free publication for the benefit of the whole profession.

“The tool is based on the recent SDCEP recommendations, which provide a sensible, pragmatic and safe approach to managing fallow time and the potential risk from bioaerosol. I am confident that the Fallow Time Calculator will be seen as a significant aid to the dental team and will support dental practices to continue their transition back towards delivering routine care.”

CGDent & FGDP(UK) COVID guidance update reduces fallow times

The College of General Dentistry and Faculty of General Dental Practice UK and have updated their guidance on the implications of COVID-19 for the safe management of general dental practice, incorporating the reduced ‘fallow’ times recommended by the Scottish Dental Clinical Effectiveness Programme.

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The guidance, first published on 1 June, supports dental professionals to take a risk-based approach to providing safe care, whatever the national COVID-19 threat level, at each step of the patient journey.

Among the distinguishing features of the document was its consideration of the risk of exposure to potentially-infectious aerosols arising from dental procedures as being on a continuum, rather than defining some procedures as ‘non-AGPs’ and treating all ‘AGPs’ as if they carry equal risk.

Members of the guidance task group felt compelled at the time to accept the 60-minute fallow period recommended by Public Health England following higher risk procedures. However, they also felt it would be more appropriate to adopt a more nuanced approach which also considered the length of procedure, as well as the potential to employ procedural and environmental risk mitigations, and suggested that reduced fallow times based on such factors might be justified.

The SDCEP review of aerosol-generating procedures in dentistry, published last week, takes just such factors into account in recommending context-specific fallow periods of between 10 and 30 minutes. While the FGDP-CGDent guidance has been thoroughly reviewed in light of the latest evidence and the experience of dental practices over the last four months, the most significant change is therefore the adoption of SDCEP’s fallow time recommendations, which have also been incorporated in an accompanying Fallow Time Calculator, which will be launched soon.

SDCEP’s review also divides dental procedures into groups according to their potential to generate aerosols, and to avoid any confusion over which procedures require fallow time, the FGDP and CGDent have ensured that those they classify in their guidance as posing a ‘higher exposure risk’ correspond to SDCEP’s highest-risk ‘Group A’ categorisation.

Available free of charge at https://cgdent.uk/standards-guidance and https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide, the revised document also provides additional detail and updated guidance on:

  • air ventilation and air cleaners
  • the use of the 3 in 1 syringe
  • the risk of aerosolisation from dental handpieces
  • decontamination of the surgery
  • the relevance of the R number and prevalence rate
  • the protection of vulnerable staff

Dental professionals are invited to learn more by joining two related webinars, which will be free to view live through Prodental. On Monday 5 October at 7pm, representatives of FGDP, SDCEP, the BDA and the Office of the CDO for England will discuss The Mitigation of Aerosol Generating Procedures in Dentistry, and on Monday 19 October, Mythbusters 2 will look at the latest changes and challenges of COVID-19 in light of the recommendations of SDCEP, FGDP and CGDent.

Onkar Dhanoya FFGDP(UK), Vice Dean of FGDP(UK) and Chair of the task group which developed and revised the guidance, said:

“Our revised guidance, incorporating the fallow time recommendations arising from SDCEP’s thorough review of evidence on the generation and mitigation of aerosols in dentistry, will enable general dental practices to increase delivery of patient care while maintaining the safety of both patients and members of the dental team. “This in turn should help improve access to dentistry, addressing some of the unmet oral health need which has built up in recent months, and support the viability of dental practices as the pandemic continues. Thanks are due to all the members of the task group, which represents a huge range of organisations and professional disciplines, for once again pulling together for the benefit of our profession at this critical time.

CGDent & FGDP(UK) to update COVID-19 guidance following SDCEP AGP review

The College of General Dentistry and Faculty of General Dental Practice UK have welcomed the Scottish Dental Clinical Effectiveness Programme’s review of the mitigation of aerosol-generating procedures, and will be issuing updated COVID-19 guidance shortly in view of its recommendations.

The SDCEP document, published today, represents the agreed positions of a working group comprising dental professionals from across primary care, secondary care, academia and public health, in addition to expert opinion from subject specialists in particle physics, aerobiology and clinical virology. The consensus report was compiled following a review of the currently-available evidence on the generation and mitigation of aerosols in dental practice, and the associated risk of coronavirus transmission.

Among the key positions, and in contrast to those adopted to date in official protocols, the report divides dental procedures into three categories of aerosol generation potential according to the instruments used, with fallow periods recommended only for the highest risk procedures, and suggests the determination of fallow time using a multifactorial approach with a ‘benchmark’ of 15-30 minutes.

The CGDent-FGDP guidance, published in June, also set out a more nuanced approach to considering the generation of aerosols in dental practice, and while allowing for potential adjustment of fallow time, accepted a 60 minute period following procedures carrying a higher risk of exposure to potentially-infective aerosols.

Ian Mills, Trustee of CGDent and Dean of FGDP(UK) – and a member of the SDCEP’s review group – said:

“SDCEP’s review of dental AGPs has been extremely thorough, and followed a rigorous and methodical approach. Its publication is potentially a very significant moment in the recovery of dental practices in the midst of the coronavirus pandemic and I commend the SDCEP Team for the hard work and dedication they have shown in producing this report.  

“We welcome in particular the more refined stratification of the transmission risk inherent in types of dental procedure; the allowance for fallow time to be calculated from the cessation of the procedure; and the sophisticated approach to calculating fallow time, which considers both procedural and environmental mitigation factors such as high-volume suction, the use of rubber dam and provision of adequate air ventilation.

“These approaches align exceptionally well with our own guidance and we feel it is important that current standard operating procedures are reviewed in light of SDCEP’s recommendations. Adoption of these measures will enable the increased delivery of patient care to tackle the backlog of unmet need, and avoid further deterioration in dental access and oral health inequality. A reduction in fallow time will also support the viability of practices, while the maintenance of universal precautions will continue to keep both patients and members of the dental team safe.

“We aim to update our guidance as soon as possible, and are currently working with partners to develop an online Fallow Time Calculation Tool to support its implementation.”

SDCEP’s Mitigation of Aerosol Generating Procedures in Dentistry – A Rapid Review is available at https://www.sdcep.org.uk/published-guidance/covid-19-practice-recovery/rapid-review-of-agps.

The current CGDent-FGDP guidance, Implications of COVID-19 for the safe management of general dental practice – a practical guide, is available at https://cgdent.uk/standards-guidance and https://www.fgdp.org.uk/implications-covid-19-safe-management-general-dental-practice-practical-guide 

Returning to Dentistry after COVID-19: Implementing Safe Practice

9 August 2020

11.00am -12.30pm (British Summer Time), Sunday 9 August 2020

The recent COVID-19 pandemic has caused dental practices across the world to close for several months. As practices now start to re-open, dentists, dental care professionals and governments are trying to work out the optimum way in which dental care can resume, while ensuring the safety of patients, staff and the community. The volume of information that is coming out can be challenging to navigate for the practising dentist and this webinar will provide practical and evidence based guidance for the safe return to practice. 

This webinar has been developed in particular for dentists and dental care professionals practising outside the UK, with the opportunity to address the most popular and relevant questions, and is being hosted in association with the Faculty of General Dental PracticeSri Lankan Dental AssociationKenya Dental AssociationProdental CPD and the Nepal Dental Association.

The Panel members are from the task group which developed the recent FGDP(UK)-CGDent guidelines, Implications of COVID-19 for the safe management of general dental practice, and several have experience of dental practice in South Asia.

Chair:

Panellists:

  • Dr Abhi Pal, GDP, Chair of the FGDP(UK) Professional Affairs Committee and Past Vice-Dean of FGDP(UK)
  • Dr Mick Horton, GDP, Trustee of the College of General Dentistry and Past Dean of FGDP(UK)
  • Dr Andy Edwards, Consultant in Oral and Maxillo-Facial Surgery and Vice President of the Royal College of Physicians and Surgeons of Glasgow
  • Prof Phil Taylor, Professor in Prosthodontics at the University of London and Dean Elect of the Faculty of Dental Surgery of the Royal College of Surgeons of Edinburgh
  • Dr Chet Trivedy, Consultant in Accident and Emergency Medicine

To register, follow this link.

Participants will be invited to submit two questions on registering, and the most popular questions will be selected for the panel to answer.