Last week, Pfizer and BioNTech announced a breakthrough in the fight against the SARS-CoV-2 virus. Pfizer proclaimed its initial Phase 3 data showed its vaccine is 'more than 90% effective'. The news was hungrily devoured and then regurgitated by the national press in an excited fanfare. The BBC reported Health Secretary Matt Hancock as saying the NHS will be ready from December to roll out the new coronavirus vaccine if it gets approved.

Last week, Pfizer and BioNTech announced a breakthrough in the fight against the SARS-CoV-2 virus. Pfizer proclaimed its initial Phase 3 data showed its vaccine is 'more than 90% effective'.

The news was hungrily devoured and then regurgitated by the national press in an excited fanfare. The BBC reported Health Secretary Matt Hancock as saying the NHS will be ready from December to roll out the new coronavirus vaccine if it gets approved. The UK has reportedly bought 40million doses of the jab – which is impressive since we are competing against the USA which has bagsied 100million doses and the decision to take up such vast number of vaccines would appear to have been taken without asking NICE nicely, first.

But the at the moment, Pfizer and BioNTech haven’t yet applied for emergency-use approval from the FDA, although they are expected to do so within the next month provided their final results are as positive as their initial announcement suggested.

When, or if, the vaccine is rolled out, everyone over the age of 80 are expected to be the first recipients of the vaccine with NHS staff being next to receive it. Now bearing in mind that NHS dental staff weren’t included in the roll out of the free flu vaccine this year, it will be interesting to see if NHS dental people will be included in the COVID-19 vaccination programme. It’ll doubtless come down to whether dental people who get as close as is possible to virus-laden breath, are considered to be ‘frontline’ medical staff.

When the vaccine is finally distributed more widely, the development of ‘herd immunity’ is only thought to be possible when more than 70% of the population is vaccinated. That figure is thought to be more than 46 million UK inhabitants who would need to receive a working vaccine.

I personally think what we really need is a compulsory vaccine that would bring people out in a permanent, embarrassing itch if they don’t socially distance properly. You only have to look at the new cases of coronavirus 33,470 diagnosed yesterday (as I write) and the pictures of youngsters in pre-lockdown benders as featured in the Mail Online, to see my idea has legs.

Problems associated with approval delays, storage and availability aside, what could possibly go wrong to prevent the accomplishment of effective immunity among the UK population?

One word: Uptake.

Pfizer CEO Albert Bourla warned last week that people who don’t take the COVID-19 vaccine will become a “weak link” that allows the coronavirus to spread.

Reasons for a lack of uptake in vaccines generally range from mistrust and a fear of perceived side effects – stirred up by the ever-increasing army of anti-vaxxers - such as those surrounding the MMR vaccine linking it to autism, which are largely discredited, to a simple fear of needles, to the influence of conspiracy theorists.

The anti-vaxxers are particularly vociferous at the moment – some may have genuine concerns at the side-effects that vaccines may have on their health and the health of their children – but some views are off-the-wall, to say the least.

I’ve read some anti-vaxxers spouting the science behind the ‘natural’ herd immunity theory and claiming it to be the best way forward. To that, I’d say, in 1347 to 1351, the world’s population had no alternative but to go along with the herd immunity theory. Yes, The Black Death. How did that work out?

One notable theory proposed by anti-vaxxers is that the worldwide COVID vaccination programme is being orchestrated by Microsoft co-founder Bill Gates. This theory says that Bill Gates is incorporating microchips in vaccines so that the movements of recipients can be tracked.

Other theories that have appeared online include one that says that governments are including an agent within the vaccine that will cause infertility in recipients as a means of exercising covert population control. Other theories put forward include one that says the pharmaceutical companies fake their data and suppress poor results in order to get approval for their ‘vaccines’ so they can maximise profit.

But in dentistry, we are well-versed in sussing out yampy conspiracy theories proposed by patients.

They may not be quite in the same league as the far-fetched ‘Bill Gates building a robot-army’ theory, but in the narrow-ish field of dentistry, are still often beyond reason.

The ‘F’ Word

The water fluoridation controversy is one of the main issues that has dogged dentistry over the years. And yes, I would call it a conspiracy theory.

Although not cited specifically by the modern-day anti-fluoridation lobby these days, the much-maligned 9^th element of the Periodic Table, Fluorine, has had a chequered, if not glorious, history.

During the McCarthy era in the States in the 1940’s and 50’s, far right activists apparently labelled fluoridation as a tool by socialists to impose a communist regime and said it was part of President Harry S. Truman’s aim to socialise medicine. Interestingly, the extreme right-wingers also opposed mass vaccination. One anti-fluoridationist even said fluoridation was more effective than the atom bomb. He said that when the 5^th Column took over, the fluoride stocks next to water supplies would be ready for deployment to mass poison the population. Not surprisingly, the water fluoridation programme was halted in the USA. It didn’t recover until the 1990’s.

While fluoridation gets widespread support from dental associations and governments across the world, proclaiming its efficacy, safety and benefits and safety, opponents say fluoridation of water supplies is an infringement of individual rights. Some claim it’s even a violation of medical ethics – giving individuals no choice in the water they drink. Others, backed by some scientists, claim that in any case, fluoridation brings no benefit and is not cariostatic.

In the late 80’s there was even a writer who claimed that he’d been told by Charles Perkins (A research worker in chemistry, biochemistry, physiology) that “Repeated doses of infinitesimal amounts of fluoride will in time reduce an individual’s power to resist domination, by slowly poisoning him and narcotising a certain area of the brain and thus make him submissive to those who wish to govern him.” Ian E. Stephens even went on to say that Germans and the Russians added fluoride to the water of prisoners of war to make them stupid and docile.

Not surprisingly, this assertion was debunked in the same manner that a nurse’s threat to me once: “Touch my Cadbury’s fingers and you’re dead meat, matey!” came to nought.

We’ve all had patients who have occasionally objected to fluoride being placed on their children. Often those parents questioned its safety – a fair enough enquiry, but they more often than not were unable to give a logical reason for refusal, other than “I read it’s not good for you on Google.” I once asked a mum what she’d read and could only answer “All sorts of things, but it stunts the growth.”

A dentist I follow on Twitter said this week that you needed to listen to anti-vaxxers in order to understand and engage with them before you can change their views. Over the years, I found that explanations of the science didn’t particularly work, no matter how carefully you tried to expound, especially with patients who had strong ‘beliefs’ despite no evidence to back it up. Try convincing a Trump admirer that the man is totally off his chump, despite having all the evidence.

As an example I had a patient in his late 30’s who had an upper lateral that was non-vital and had a chronic infection at the apex. I kept on trying to explain patiently that the tooth was dead and needed root-treatment. I went into all the intricacies and showed him the radiograph, explaining the cause of his pain and the innervation of the periodontal ligament, but his answer was always the same. He’d tap the tooth until he winced, and say “You’re wrong. That feels alive to me.” That went on for a couple of years until he mercifully moved back up North where I hope his new dentist had more luck, or found comfort from banging his head against a wall with spikes in it.

Over the years I’ve realised that beliefs really are ethereal things and they laugh in the face of science.

Some years ago I treated a practising homeopath and her teenage twin daughters. Mum was a formidable character and one day she brought in one of the girls who the following week was due to go away to join the Royal Air Force.

Not only did the teenager not look well, she could barely speak. She clearly had pyrexia and severe trismus, only opening by about 1.5cm. I’d never felt such knobbly lymph nodes before, or since. From the history, she appeared to have severe pericoronitis (at the previous exam there had been an upright eight lurking) and the only thing that I could think of doing since I couldn’t get to the tooth, was prescribe liquid antibiotics – and a whacking great dose at that.

Before I’d gotten to the third syllable of ‘antibiotics’ the mother had cut me short. “NO WAY” she expostulated. At that she beckoned her daughter to accompany her out, saying that she would treat it herself with homeopathy. She ignored my plea to consider antibiotics in view of the possibility of her daughter developing septicaemia, but she said she believed ‘natural’ healing with the helpful boot from her sugar pills (my term for them) was far better than ‘toxic’ antibiotics.

The upshot was, the teen was admitted to the local general hospital two days later, and after five days of intravenous antibiotics, she was fine.

I’ve also had a couple of patients over the years who have been off to specialist clinics to have amalgam fillings removed because they were of the belief that mercury was causing their illnesses. Both spent a skipload of cash on having their amalgams removed by dentists wearing the sort of gear you lot are sporting now. Neither of the patients had any discernible improvement to their health, but one of them did end up needing two root-canals.

At my last practice I inherited a family and two of the children had rampant caries in their deciduous teeth that had rendered the back teeth, stumps. The dad dutifully brought in the kids every time they had toothache, but steadfastly refused to give them Calpol because he didn’t ‘believe’ in treating pain (even his own), but in treating the cause of the pain – although he stopped short of letting us remove the recurrently infected teeth. Presumably every time he had a headache, he would be demanding a brain scan.

I had another bloke who had an intact mouth apart from a non-vital upper central that had been injured during a football match as a youth. It had become infected and really needed RCT. He duly went off and Yahoo-ed ‘root-canals’ (it was a while ago) and came back demanding extraction and a bridge. Despite my entreaties to consider a root-filling, he was adamant. He insisted that a root-filling would cause cancer and he was despatched to a primitive implantologist (it was a while ago).

At the time, I couldn’t believe that there was such tripe on the internet, until…

I have just Googled ‘dangers of root-canal fillings’ and this came up on an American dental clinic website:

“While a root canal removes  some of the bacteria associated with the original source of infection or decay in your tooth, the procedure never fully eliminates the bacteria. The bacteria are then free to spread around your body and cause chronic and possibly deadly conditions such as heart attacks, strokes, and cancer, among others.”

You guessed it. It was an implant clinic.

Beliefs are funny things.