Don't Panic! - You can handle the latest crisis...can't you?

I always try to be brave, so my Twitter followers will be unaware that I have been quietly and valiantly fighting off  a chest infection that I’ve had since before Christmas.  Two courses of antibiotics, a broken rib and a shedload of Jakemans Throat and Chest Soothing Menthol Sweets later, I think I’m almost on the mend, unlike my teeth which have been battered by alternate assaults from Menthol-flavoured glucose and Duraphat 5000 hosed on under pressure, as protection.

I was a frail, weak-chested child who was, over much of my 1960’s childhood,  more often than not,  full of snot, and I often found myself being frogmarched to the doctor in an itchy, Macramé balaclava by my mother, in search of a cure for a persistent cough that must have driven the other members of my family to near insanity. I dread to think how many chest-x-rays I had as a child and it was fortunate that we lived only about 400 yards from the main entrance to Dudley Road Hospital in Birmingham, so we didn’t get involved in bus journeys or extortionate hospital car-parking charges, not that I remember the hospitals charging in those days in any case. I try not to think about the radiation hit I took.

There was never any resolution to my childhood chest problems (asthma hadn’t been invented then) and the best the doctor could come up with was an allergy to cat fur (we never had a cat) or feathers (we never had a budgie either).  We did have feather pillows however, and my mother threw them out and invested in the new-fangled synthetic foam things that felt like floating on a cloud to me, rather than the rock-hard, duck down allergenic monster I was used to.  Though my head was comfortable, my chest remained a medical mystery during my childhood.  When I got into adulthood, my admittedly less frequent dry cough, had a potentially more  obvious explanation as far as my medical attendants were concerned.  “Do you smoke?” GP’s would always ask. “No. Never have” I would emphatically reply.  Stumped, they would then say “Probably a virus then. NEXT!”

Which brings me neatly on to COVID-19, the deviant cold-virus that has grabbed the headlines for the past few weeks and is now, according to the online press as I write  this afternoon, about to close dental practices because of a shortage of surgical masks. The Birmingham Live website said: “Dental surgeries in the UK are running out of face masks because of supply problems in China amid the coronavirus outbreak. The British Dental Association (BDA) claimed larger clinics in the UK could be out of masks next week (this week) and will not be able to treat patients safely under current rules.”

Why the current rules alone would stop dentists and staff from treating patients, I don’t really know.  Just having the prospect of a face full of your run-of-the mill mouth bugs in an aerosol would be enough to stop anyone but the most game of dental staff from having a go, let alone COVID-19.

So, dentistry is facing a ‘crisis’ which could, according to the BDJ (as well as the Brummie website which I trust more than the BBC because I am a Brummie) cause practices to close. BDA chair Mick Armstrong said: "Unless we see a rapid increase in supply, dentists without face masks will have little choice but to down drills."

But this is far from being the first national ‘crisis’ UK dentistry has faced over the years, and we survived, a mildly mauled admittedly, but we came through the crises which have on a couple of occasions, like petrol shortages, have been created by the media.

A mini crisis which caused consternation among patients and inspired a lot of awkward questions aimed at dental staff followed Tom Mangold’s Panorama report in 1993 on David Acer, the gay Florida dentist who infected six patients with HIV after treating HIV infected ex-lovers after hours, at his Jensen Beach practice. Dr Acer had HIV himself, and I seem to remember there were all sorts of unfounded rumours surrounding the case, one of which that he had deliberately injected patients with the virus. The truth was that he appeared to be taking short cuts in his cross-infection control regime as he started to develop the symptoms of AIDS and this documentary prompted a flurry of telephone calls from patients worried about ‘catching’ AIDS from our equipment.

I personally had a very awkward session with an elderly lady who cried all through a routine exam and scale. I had spent quite a bit of time explaining the Acer case and why she could be assured she wasn’t going to catch anything from our practice, but at one point she accused me of spraying her with AIDS from the air scaler. I have to say this was the SAME lady who also accused me of also spraying tartar in her mouth a few months later. It was around this time I vaguely remember local practitioners in the county clubbing together to advertise in a local newspaper to help dispel a rumour that an unwell dentist who had been out of action for a while was NOT suffering from HIV.

It was the same journalist, Tom Mangold who was also responsible for the controversial Panorama documentary on amalgam in 1994. Entitled “The Poison In Your Mouth,” the documentary gave the nation the impression that the dental profession was systematically mass serial killing the population, and a lot of my patients believed it.

By July in 1994 I was running my own practice. Having grown up in the 60’s I lived on a well-balanced diet of Spangles and Opal Fruits and in consequence by my late teens I had wall to wall amalgams, which I hated – I can’t remember which wombat actually used amalgam in a lower incisor, but one of my childhood dentists did. As a dentist, I loathed amalgam. I couldn’t stand the sight of it and despite the lack of ‘evidence’ that the mercury in amalgam causes harm, it’s my own personal feeling that inserting mercury in the body in whatever form, is a tad ‘iffy.’

So, once this documentary came out, I decided there and then to abandon the stuff and only used composite on posteriors, even on the NHS – taking the financial hit and being able to live with myself rather than have the niggling worry that I was a professional serial poisoner. Prior to the documentary I had already started using composite quite a bit on back teeth and my move neutralised a lot of expressed anxiety coming from patients. At that time, I was probably in breach of some NHS rule, now abandoned.

The introduction of regulations many years later that banned the use of dental amalgam in children under 15 years old, or pregnant or breastfeeding women confirmed in my own mind, that I was on the right track. The regulations helped particularly in an argument with a corporate clinical director in recent years, who tried to stop me from doing posterior composites on the Nash.

While neither the HIV or amalgam documentaries threatened to close practices like the current mask shortage does, they were temporarily disruptive and took a bit of diplomatic juggling, like trying to out shuffle an angry grizzly bear. The peak of the Bovine Spongiform Encephalopathy (Mad Cow) epidemic also occurred in the 90’s and the sudden appearance of questions on the medical history sheets about brain transplants or relatives with CJD put a lot of patients on their guard and again we had to reassure patients that despite the fact we really didn’t have a clue what a prion was, we were chucking out endo files away in case that pulp nerve had a bit of Daisy The Cow’s brain bits in it.

Probably the biggest practical crisis we had in NHS dentistry came from the introduction of the UDA-based contract, when a fair number of the saner members of the profession decided enough was enough and fully or partly took the private route to relative tranquillity. Many though, chose to remain in the NHS and see it through to the ‘bitter end,’ as I used to call gutta percha that had perforated the apex. A lot of practices survived (just) the new contract, but a significant number didn’t and Google News is full of reports of dental practice closures on a daily basis, largely because of the inability to recruit suitable staff to work on the ludicrous target-driven hamster wheel of death.    But don’t forget, there was also an outflux of dentists in the early 90’s when the NHS contract had capitation introduced, for which we took a 10% pay cut in order to pay for it. That seemed like a crisis at the time, but we got over it. What we didn’t get, was a refund of the 10% they nicked off us when they abandoned capitation in the 2000’s.

Of course we’ve had mini-crises, or what we have perceived as crises, such as the introduction of HTM 01-05 and the Care Quality Commission. Suddenly we all thought we’d have to knock walls out in order to create designer decontamination rooms, whereas the reality was you had to put post-its on one wall with ‘Dirty Sink’ and ‘Not Quite So Dirty, But Still Don’t Drink The Water Sink’ on the other.

The CQC didn’t quite live up to the fearful organisation we were led to expect. Far from acting like Parisienne riot police quelling civil unrest among the French about the price of Mangetout, the build-up was a bit of fuss about nothing. If you were a practitioner who followed the rules, the CQC was a sloppy pussy cat who likes tummy tickles and a valid waste transfer notice, whereas if you were a slapdash individual who didn’t fastidiously slap a local rules notice on every x-ray unit in the building, you could make your practice manager the scapegoat.

As for local in-practice crises, I can name hundreds that were a pain-in-the-proverbial that were incredibly disruptive and I’ll save for another blog.

In the meantime, following a request from ex-colleagues desperately short, I’m off to Macramé them some reusable face masks.