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Magnification: Magnifying the point

Article in British dental journal official journal of the British Dental Association: BDJ online · June 2015
DOI: 10.1038/sj.bdj.2015.399 · Source: PubMed

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LETTERS TO THE EDITOR
Send your letters to the Editor, British Dental Journal, 64 Wimpole Street, London, W1G 8YS
Email [email protected]. Priority will be given to letters less than 500 words long. Authors must sign the letter,
which may be edited for reasons of space. Readers may now comment on letters via the BDJ website
(www.bdj.co.uk). A 'Readers' Comments' section appears at the end of the full text of each letter online.

MAGNIFICATION
Magnifying the point SAFEGUARDING CHILDREN to the GP is courteous. This may also
Sir, we were interested to read Sir, the tragic death of a child in occasionally enable another procedure to
K. F. Marshall’s letter about the use of 2000 eventually led to the statutory be done simultaneously under the same
magnification in dentistry (BDJ 2015; enactment of a national database for general anaesthetic if one is required.
218: 369). A study in October last year at children in 2007 called ContactPoint.1 This can be especially helpful and kind
New Zealand’s only dental school showed ContactPoint was to contain key health for patients with additional needs.
that 23% of the 285 BDS students surveyed personnel that came into contact with The mandatory inclusion of a dental
used magnification loupes. The percentage children. It was scrapped by the govern- surgeon and optician on the NHS Spine
increased from 2% among the second year ment in 2000. would help satisfy the ‘be healthy’ com-
students to 48% in the final year. All final Key health personnel recorded in ponent of safeguarding. If a child has a
year students without loupes intended pur- ContactPoint were the GP, midwife, mouthful of dental abscesses and cannot
chasing them. Over half of those wanting health visitor and school nurse. see the whiteboard, the ‘be healthy’
to buy cited expense as the limiting factor. Dental surgeons and opticians were component of safeguarding has not
Among the clinical teachers 72% of the omitted. The same omissions appeared been achieved, even though the child
85 surveyed used loupes, most with 2.5× to have happened with the NHS may have a reasonable BMI and can
magnification. Exactly half of their loupes Spine. These two groups are the very run around.
had an attached light. clinicians that should have regular The age by which a child should have
Loupes are therefore not an alien con- contact with all children. Not having a mandatory entry on the NHS Spine of
cept in all dental faculties. We strongly and not regularly visiting a dentist is a a dentist or optician associated with their
encourage their use, not only to enhance safeguarding issue. care should be decided by the relevant
clinical outcomes but also to improve the In some hospitals, an electronic profession. Now is the time to act and
student's posture. discharge summary copy is sent auto- bring the two professions in from the
C. M. Murray, N. P. Chandler matically to the GP as a result of the cold. Their inclusion would make use of
Dunedin, New Zealand IT system’s link to the NHS Spine. For an existing IT infrastructure and would
DOI: 10.1038/sj.bdj.2015.478 dentists, this still has to be on paper. benefit everyone.
The first time a GP hears of a dentally- R. W. Mills, Bristol
GOOD PRACTICE related hospital admission is sometimes
1. The Children Act 2004 Information Database
The gloves are on via the automatic electronic discharge (England) Regulations 2007. Statutory Instrument
Sir, I read with interest the article ‘Glove summary. Dentists refer patients to 2007 No. 2182
wearing: an assessment of the evidence’ hospitals and a consented referral copy DOI: 10.1038/sj.bdj.2015.482
(BDJ 2015; 218: 451–452) and find myself
in full agreement with the closing sentence
‘…it is the responsibility of the wider medi- initially treated him as a case of traumatic The incident made us realise that condi-
cal fraternity to look ahead on the basis of pulpitis. As the subsequent clinical and tions such as malingering and factitious
science and logic rather than emotion’. radiological findings did not corroborate disorders have not received due attention
I have therefore come to the conclusion with the persisting complaint, he was in our professional education and practice,
that there is more evidence in favour of the referred for specialist opinion. The dental thereby leaving many dentists inept when
wearing of gloves while treating patients students who took this case for work-up they encounter them. It’s time we include
than in the practice of orthotropics. were also clueless about the condition. some basic training about these entities in
P. Ramsay-Baggs, During consultation, the history provided the dental curriculum and prepare ourselves
N. Ireland by the child was often incongruent with his to recognise and handle them appropriately.
DOI: 10.1038/sj.bdj.2015.479 mother’s version. Further, his pain reaction H. Gayathri, B. Madhan
to percussion of the allegedly traumatised Puducherry, India
CASE REPORT tooth appeared exaggerated, inconsistent DOI: 10.1038/sj.bdj.2015.480
Malingering and factitious disorders with the facial expressions, and erratic
Sir, recently a 12-year-old male child, during repetition. Following a separate FLUORIDE VARNISH
accompanied by his mother, reported with interview and a bit of gentle persuasion, Coating over FV
a complaint of frequent and severe pain the child confessed to malingering. He Sir, the recent paper by Yusuf, Wright,
in his maxillary left central incisor. The admitted to playing truant by frequently and Robertson1 has stimulated me to write
problem had started following trauma four enacting ‘tooth-ache following injury’ about our attempts to properly legitimise a
months back. The previous dentist had learnt from his friend. fluoride varnish programme.

610 BRITISH DENTAL JOURNAL VOLUME 218 NO. 11 JUN 12 2015

© 2015 British Dental Association. All rights reserved

 In the past, when fluoride varnish adrenaline is contraindicated in diabet- residual premolar extraction spaces at the
(FV) trained dental nurses applied Duraphat ics,4 whereas lidocaine with adrenaline end of fixed appliance treatment, when
varnish, they were doing this under the is not,5 and this has to be reflected in the evidence is that to do so will preserve
legislation provided within the prescription their PGDs. labiolingual incisor alignment in the lower
only medicine (POM) order (1997)2 which Nowadays it is not acceptable to run arch for many years until these spaces
permits the administration to human beings programmes or promulgate extended finally close?2
of a POM which is not for parenteral admin- duties without due diligence in their Less is understood about the cause
istration, without the need for a patient design. Our recent experience with of relapse of corrected rotations. As
group direction (PGD) or prescription. Duraphat varnish shows the potential Johnston and Littlewood state this is
In order to improve governance we pitfalls even in apparently simple pro- thought to be due to the stretching
recently included the FV trained nurses grammes, or am I being too fussy? of transseptal and supracrestal periodon-
in a PGD so they could more legitimately D. Howarth tal fibres which then try to return the
apply the Duraphat varnish (which is a London tooth to its original rotated position.
prescription only medicine). But why, in this area of very high cel-
1. Yusuf H, Wright K, Robertson C. Evaluation of a pilot
Writing the Duraphat Varnish PGD oral health promotion programme ‘Keep Smiling’: lular and collagen turnover, does the
highlighted the following issues: perspectives from GDPs, health champions and school rapid replacement of these fibres not
staff. Br Dent J 2015; 218: 455–459.
• Application to patients suffering from retain the tooth in its new position rather
2. The Prescription Only Medicines (Human Use) Order
asthma is contraindicated. Many 1997. Available online at http://www.legislation.gov. than cause its relapse? If these obdurate
training courses substitute the phrase uk/uksi/1997/1830/made (accessed June 2015). fibres are indeed the cause, why is it that
3. Product details for Duraphat 50 mg/ml Dental
‘...hospitalised for severe asthma’ Suspension. Available online at http://www.mhra.
the once popular surgical procedure of
although the summary of product gov.uk/home/groups/spcpil/documents/spcpil/ ‘pericision’ (circumferential supracrestal
characteristics (SPC)3 specifically con1416548968142.pdf (accessed June 2015). fiberotomy), be it undertaken by scalpel
4. Product details for articaine. Available online at http://
mentions asthma as a contraindication. www.mhra.gov.uk/home/groups/spcpil/ or YAG laser only reduces, rather than
Some trainers advise using other documents/spcpil/con1418105030968.pdf (accessed eliminates the relapse? Nevertheless, it
varnish products to circumvent this. June 2015). seems this support mechanism must
5. Product details for lidocaine with adrenaline. Available
These products are not presently online at http://www.mhra.gov.uk/home/groups/spcpil/ be implicated since, given adequate
licensed for caries prevention and documents/spcpil/con1404110297100.pdf (accessed space, emerging rotated lower incisors
therefore cannot legally be substituted June 2015). correct spontaneously until they are half
for Duraphat varnish DOI: 10.1038/sj.bdj.2015.481 erupted and the gingival attachment
• Insofar as the Duraphat varnish becomes established.3
tube contains latex, and there is a
ERRATUM Francis Bacon observed that ‘nature
possibility of allergic reactions to other Letter (BDJ 2015; 218: 556–557) is often hidden, sometimes overcome,
constituents of the varnish, our varnish ‘Oral cancer: A new therapeutic agent’ seldom extinguished’,4 and that ‘where
teams are carrying an emergency kit. In the above letter authored by A.N. the cause is not known the effect cannot
This is also required as Resuscitation Robinson and C. Scully, this heading was be produced’.5 I submit that the adoption
Council Guidelines state that an incorrect and should have read 'Behcet of semi-permanent retention should be
emergency kit should be available in disease: A new therapeutic agent'. regarded only as a pragmatic temporary
all clinical situations. Staff must have We apologise for any inconvenience solution to this intractable problem, for
appropriate training in the use of the caused. when a lingual bonded retainer fails it is
emergency kit, especially recognition DOI: 10.1038/sj.bdj.2015.483 often at a single tooth which the patient
and treatment of anaphyaxis. With the fails to notice until significant relapse
number of applications nationwide it
ORTHODONTICS has occurred. Surely it is incumbent on
may be only a matter of time before a Getting straight to our speciality to continue to research this
patient suffers a reaction orthodontic relapses area to clarify the underlying causes of
• Nurses applying Duraphat varnish must Sir, the recent paper by Johnston and relapse in its various forms and devise
be covered by indemnity as they are Littlewood (BDJ 2015; 218: 119–122) more satisfactory solutions?
undertaking a clinical task admirably summarises contemporary C. D. Stephens OBE
• As Duraphat varnish contains alcohol, orthodontic retention regimes, but in doing Bristol
patients and parents must be advised of so reveals that in the past 30 years there
this, in case they have religious qualms has been little progress in our understand- 1. Stephens C D, Houston W J B. Facial Growth and
lower pre-molar extraction space closure. Europ J
about the procedure. We have included ing of why almost all cases relapse to some Orthod 1985; 7: 157–162.
this in the consent procedure. degree, even after prolonged retention. 2. Swessi D, Stephens C D. The spontaneous effects of
lower first premolar extraction on the mesiodistal
While the common reappearance of
angulation of adjacent teeth and the relationship
Digging deeper into the legality of lower incisor crowding is not always of this to extraction space closure in the long term.
extended duties undertaken by dental noticed by the patient, it is frequently Europ J Orthod 1993; 15: 503–511.
3. Killingback N, Stephens C D. A study of the effect
care professionals and the use of PGDs accompanied by less acceptable reflected of removal of deciduous canines on the alignment
raises quite a few similar issues. Whilst changes in the upper arch. As the authors of mandibular incisors. J Dent Res 1989; 68: 571
therapists working in NHS Trusts are point out it seems very likely that the (abst).
4. Bacon F. In Scott M A (ed) The essays of Francis
covered by properly written and audited reappearance of lower arch crowding is Bacon, XXXVIII Of nature in men. p 178. New York:
PGDs, what is the situation with open due to growth-related forward migration Charles Scribener’s sons, 1908.
access? Also, perusal of the SPCs for of the buccal segments.1 How odd then 5. Bacon F. The new organon or True directions in the
interpretation of nature. Book 1, III. 1620.
common drugs raises some interest- that it is now regarded as unacceptable
ing issues. For example, articaine with for orthodontists to leave even small DOI: 10.1038/sj.bdj.2015.484

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