Guidance notes for dental practitioners on the safe use of x-ray equipment – 17 February 2022

Thursday 17 February 2022, 7pm, live webinar

To register for this event, please visit: https://www.prodentalcpd.com/webinars/-p124-talking-standards-guidance-notes-for-dental-practitioners-on-the-safe-use-of-x-ray-equipment-

This webinar is part of our ‘Talking Standards’ series which sets out to examine areas covered by our evidence-based standards and guidance. The webinar explores the content of the Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment – 2nd Edition (published October 2020) and will draw attention to areas where the guidance differs from that in the first edition, or where new guidance has been introduced.

The first edition of the Guidance Notes for Dental Practitioners on the Safe Use of X-ray Equipment (the Dental GNs) was published in June 2001 following the establishment of a working party by the National Radiological Protection Board (NRPB) and copies of the guidance were distributed to every dental practice in the UK by the Department of Health.

In the 20-plus years since then there have been significant changes requiring further guidance to be developed. These include:

  • a move from film-based dental radiography towards digital imaging techniques,
  • the appearance of dental cone-beam CT and hand-held dental X-ray equipment in general dental practice,
  • revised radiation protection legislation.

Good practice guidelines for the dental profession have also moved with the times, with, for instance, evidence-based selection criteria and national diagnostic reference levels now available for all imaging modalities. A substantial amount of experience has also been accrued by those organisations and individuals providing radiation protection advice and services to dental practices.

The webinar aims to refresh and update viewers on:

  • the means of restricting the exposure of staff and patients as far as is reasonably practicable,
  • the principal requirements of relevant legislation, namely –   The Ionising Radiations Regulations 2017,  The Ionising Radiation (Medical Exposure) Regulations 2017and the associated guidance: Guidance Notes for Dental Practitioners on the Safe Use of X-Ray Equipment – 2nd Edition.
  • how to apply the basic principles of practical radiation protection in a dental practice.

Speaker:

  • Andrew Gulson, Specialist Radiation Protection Scientist and Certificated Radiation Protection Adviser

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/

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Reduce antibiotic prescribing to pre-pandemic levels – it’s time to act!

Ahead of the annual global campaign on antibiotic awareness, Dr Wendy Thompson says that rates of antimicrobial prescribing across dentistry have been slow to reduce since passing the peak of COVID-19, even though we are returning to more normal practice and dentists should no longer be providing remote prescriptions.   

Providing the right care for patients with acute dental pain or infection at the right time was a challenge even before the coronavirus pandemic struck. At the CGDent/ProDental webinar on Tuesday 5 October, we heard some shocking statistics about how the public continues to experience urgent dental care.

Jacob Lant from HealthWatch told us that before COVID-19, dentistry accounted for around 5% of feedback from members of the public. However, the situation has deteriorated over time and the most recent statistics from Spring/Summer 2021 show that 25% of all feedback received by HealthWatch relates to dentistry. Sadly, the vast majority is about negative experience from people who are unable to access care for their toothache. Without additional funding, how on earth is the NHS system to deal with this backlog of care caused by the pandemic?

But to my mind doing this whilst keeping our patients safe from the potential adverse events of antibiotics is even more of a problem. We know that procedures are the most effective way to cure someone’s toothache and that dental surgeons are well equipped to diagnose and treat dental pain and infection during urgent dental appointments. However, we also know that this needs appointments which are at least 20 minutes long. The 15-minute appointment slots referenced in the NHS unscheduled dental care commissioning standard are simply not long enough to provide the procedures indicated by clinical guidelines.

The COVID-19 lockdown dramatically reduced access to urgent dental care suddenly and almost totally. For a while, remote care via advice, analgesics and antimicrobial (where appropriate) became the emergency guidance to get us out of a hole where there was simply not enough provision. Unsurprisingly during this time, rates of prescribing rather than procedures increased dramatically.

Confidently diagnosing acute dental conditions remotely is really hard. And without a diagnosis there should be no treatment. In normal times, therefore, remote diagnosis and management is rarely appropriate for dentistry.

Imagine how you would feel if your patient suffered a dramatic adverse reaction to the antibiotic which you remotely prescribed. How would you defend your position to the Coroner about why you gave a remote prescription rather than booking them into a face-to-face appointment? How would it wash that you, as a highly trained professional, were doing what a manager (with no prescribing competences within their scope of practice) told you to do?

In December 2020, the FGDP(UK) Antimicrobial Prescribing in Dentistry Good Practice Guidelines were updated, including highlighting the benefits of penicillin V over amoxicillin. Penicillin V is a narrower spectrum antibiotic and therefore less likely to drive the development and spread of antibiotic resistance. Now that we are returning to a more normal practice after COVID-19, the care we provide to patients with acute dental pain or infection should also be returning to normal. It is no longer appropriate to be providing remote prescriptions.  If someone’s condition is bad enough that they might need an antibiotic (ie a spreading swelling as indicated by guidance), then it’s bad enough for them to need to be seen.

Unfortunately, the rates of antibiotic prescribing across dentistry have been slow to reduce and the whole dental profession needs to work together to get back to the prescribing levels we were at before the pandemic. This isn’t just about dentists prescribing less, it’s about practice owners leading by example and holding their dental teams to account.  

Within the NHS, it’s about national commissioning teams, Local Dental Networks and managers within dental provider organisations setting the context to facilitate low rates of antibiotic prescribing, including long enough appointments for urgent dental procedures AND managing and monitoring service provision to ensure inappropriate antibiotic use is minimised (as per the Health and Social Care Act’s code of practice on the prevention and control of infections – Appendix B Primary Dental Care).

In the latest issue of the Primary Dental Journal, it is my pleasure to share with you papers from around the world about how urgent dental care has been provided since the start of the COVID-19 pandemic.  I am especially proud of a paper authored by members of dental teams who participated in (and helped deliver) my doctoral research about urgent dental care in general dental practice and out-of-hours clinics. The insight was particularly useful for me as I plan my next research in urgent dental clinics, and I hope that it might encourage you to get involved in research in the future.

During the World Health Organisation’s World Antimicrobial Awareness Week 2021, I will be hosting a CGDent webinar on antimicrobial prescribing and how dental professionals around the world are tackling antimicrobial resistance locally. The webinar is free to view live for everyone (Thursday 25 November, 7pm – register here) and CGDent members can also access the recording and CPD hours for free. If you aren’t a CGDent member, there is a small free to receive certified CPD or to access the recording.  I hope to see you there!

Dr Wendy Thompson PhD MCGDent is a general dental practitioner, lecturer in Primary Dental Care and the College of General Dentistry’s lead on antimicrobial prescribing and stewardship. A College Ambassador, she also holds advisory roles on tackling antibiotic resistance with the Office of the Chief Dental Officer (England), FDI World Dental Federation and the National Institute for Health and Care Excellence.

Guest Editor of the forthcoming issue of the Primary Dental Journal, which examines Urgent Dental Care and COVID-19, she hosted a recent College webinar on this topic, and is also the host of the upcoming College webinar on antimicrobial prescribing. Our full list of upcoming webinars and events is available here, with more webinars added regularly. In addition to our live webinars, CGDent members have free, on demand access to a rich library of 900+ hours of CPD and a linked e-PDP with our partner ProDental 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/

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Antimicrobial prescribing in dentistry

Thursday 25 November 2021, webinar recording available

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

We 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.

Speakers:

  • Dr Wendy Thompson, general dental practitioner and academic
  • Vanessa Carter, ePatient and hcsm Consultant

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.

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

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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

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 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.

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.