Digest evolves, but the problems of access to dental care worsen. Almost a quarter of the way through the 21st century, what progress since SAAD was founded?
Welcome to SAAD Digest 40(1). This year marks an exciting milestone for SAAD Digest. We are moving to two issues per year: March and September. The Editorial Board have decided to make this change as a result of the continuing submission of large numbers of high-quality papers of interest to our readers. As I write this editorial, we already have ten papers submitted for Digest 40(2). You will notice a few other changes as you read through this edition.
Firstly, our cover has changed. Since our launch in 2006 we have mainly used photo- micrographs of molecules of interest to the readership courtesy of the National High Magnetic Field Laboratory at Florida State University, for whose support we are very grateful. The last two years we have moved away from that genre to mark specific occasions and felt it time for a refresh of Digest. You will see from the story behind the cover that we have moved to an AI generated image and thanks are due to Greg Gerrard for both pointing us to the programme and the generation of the image we have used.
The Editorial Board have also taken note of some of the feedback received about the layout of the Digest and have been working to reduce the ‘wasted space’ on the page, with a view to reducing our paper consumption. Alongside this we have explored with the printers reducing the thickness of the paper and making it more recyclable should you ever wish to throw the hard copy out.
Online presence is more and more important and one of the comments we have had is that the format of Digest online, with two columns per page, is difficult to read on devices such as tablets and mobile phones. In response, the online version of Digest will be presented as a single column of text that is full page width. The facility to download a pdf of a paper is also being introduced, and, as with other journals, when the pdf is downloaded it will be a reproduction of the paper as published in hard copy.
CPD will be offered for both editions of the Digest each year; all included in your subscription. SAAD is committed to continuing to publish Digest as a physical journal as well as online. It is appreciated that some members may wish to opt only to receive the digital version, and that is something that we are happy to facilitate. Should you wish to opt out of receiving the physical version please respond to the email that is circulated before each Digest or contact Digest@saad.org.uk
I hope you will enjoy the new look Digest. We would be happy to hear your views on the changes we have made.
In last year’s editorial I referred to the case of a BBC headline ‘Ukrainian from Bristol went home for dentist ‘to be seen faster’.1 On 6th February 2024 The Times published an article which indicated that there had been no significant improvement in the last year.2 One statistic in this article was that in Ukraine 67% of people can access a dentist if needed within 24 hours, whilst in the UK that figure was 23%, and that this figure had dropped by 13% in the last year. The publicity is not restricted to the general press with Dentistry publishing an article entitled ‘Like a battlefield’.3
The data presented in Dentistry quotes that 52,000 people attended A&E with dental abscesses in 2023: equivalent to more than 140 per day. In 2020/21 there were 9,860 diagnoses of mouth cancer, an increase of 12% on the previous comparable year. Also, the number of deaths increased to 3,000 in 2021, up from 2,075 a decade previously.
When SAAD was founded in 1957, our motto ‘Abolish Pain to Conquer Fear’ was targeted at improving patient comfort during dental treatment, recognising that there were a large number of patients who had been the victims of traumatic dental treatment resulting in increased levels of anxiety or phobia related to dental treatment. The founders of SAAD recognised significant deficiencies in both local anaesthetic and general anaesthetic provision, and this was one of Drummond- Jackson’s great motivators to develop his incremental methohexitone technique.
Since the 1950s dentistry has improved. Our choices in terms of both pharmacological and non-pharmacological management of pain and anxiety have increased, however, we are still seeing large numbers of patients with severe dental anxiety or phobia when faced with dental treatment. Given it is well known that a Primary Traumatic Experience is the major cause of dental anxiety and phobia, the aim should be to avoid such experiences.
Emergency dental treatment has the greatest potential to be traumatic. Patients who have not slept or eaten properly are not the most receptive to information, and often find it difficult to make informed decisions. Added to this, the inflammation-induced hyperalgesia making local analgesia more challenging, together conspires to make the experience difficult and unpleasant. Much has been said in recent years about increasing early diagnosis and intervention along with prevention to decrease the treatment need as well as morbidity and mortality. In my own view, to date, this has largely been paid only lip service.
There is a need for SAAD to tackle these problems in three ways. Firstly, we should continue to do what we do best: provide high quality education in pain and anxiety control for all members of the dental team. Secondly, we should campaign to ensure that the environment to deliver that care exists. The latter is not easy at a time when conflicting demands on the UK government purse are ever-present. Thirdly, we need to encourage the increasing use of non-pharmacological methods of anxiety management into dentistry.
One of SAAD’s main aims was to provide safe and effective dental care for patients. As the Society has evolved, we have used pharmacological methods of sedation to allow those patients who cannot tolerate treatment under local anaesthesia and behaviour management to access dental care. The foundation of SAAD was based upon providing education in sedation techniques. In more recent years, as witnessed by the publication profile of Digest, we have increasingly embraced the non- pharmacological techniques. The use of these methods of pain and anxiety control is increasing in importance as the population lives longer, resulting in more individuals living with significant comorbidities. All of the guidance that has been published has restricted the use of sedation in non-specialist settings to patients who are generally quite fit and healthy: ASA I&II, with guidance that ASA III or IV patients be treated in ‘specialist’ settings. Also, there are some countries where there is an upper age limit for sedation in general practice, and emerging evidence that older patients may not have as good an outcome post sedation as with general anaesthesia. It is, therefore, very timely that in this issue we have a report by one of our DCP members on the use of on the use of Cognitive Behavioural Therapy (CBT)
Enjoy this edition of Digest and good luck with the online CPD questions.
Nigel Robb
Editor of the SAAD Digest
References
1. BBC News. Ukrainian from Bristol went home for dentist to be 'seen faster'. 2023. Information available at https://www.bbc.co.uk/news/uk-england-bristol-64512024?_cldee=UT3ZG9XHyesTHxh_KmPwCVFcHr5AyHlZsRayrGr0BIfZvAMHEqLBOyTtqQP2OjTB&recipientid=contact-d7f62d1562c5ea11a812000d3a86aa92-ab68c23e0eef4ee78c10189fba988367&utm_source=ClickDimensions&utm_medium=email&utm_campaign=Weekly%20News%20Digest&esid=52671dbc-56a8-ed11-aad1-0022481b57b1 (Accessed 6 February 2024)
2. Dentists will be given bonuses to fix care ‘deserts’ Lay K, Smyth C. The Times 2024. https://www.thetimes.com/uk/healthcare/article/dentists-bonuses-nhs-patients-government-plan-dskwwcjxn#:~:text=Under%20the%20plans%2C%20dentists%20will,one%20new%20patient%20a%20day. (Accessed 6 February 2024)
3. ‘Like a battlefield’- dentist details volume of dental sepsis cases. Bissett G. Dentistry 2024 https://dentistry.co.uk/2024/01/22/like-a-battlefield-dentist-details-volume-of-dental-sepsis-cases/?_cldee=pEq3ySfwS38LVFu_7b4kZFU2jTm_mdiASnK4mXkHZHZ2OqLsF-2owvO05EHwFgxY&recipientid=contact-d7f62d1562c5ea11a812000d3a86aa92- (Accessed 6 February 2024).