• Dentists' warning over child tooth decay


    Twice as many children under the age of 10 receive hospital treatment for tooth decay as for a broken arm, figures for Eng­land show.

    There were 34,205 cases of children under10 needing hospital treatment for dental caries In the year to March, the youngest less than a year old, according to the faculty of dental surgery (FDS) at the Royal College of Surgeons.

    Over the same period there were 17,043 broken arms, 19,584 children under 10 treated in hospital for asthma, 10,397 treated for epilepsy and 3,805 cases of appendicitis, according to analysis of NHS Digital data.

    Tooth decay ls the most common reason children aged between five and nine need treatment in hospital, with 25,923 cases within this age group in 2016-17.

    Prof Michael Escudier, dean of the FDS, said; "Sometimes this can be unavoidable, simple preventative steps not being taken. Tens of thousands of children every year are having to go through the distressing experience of having teeth removed under genera] anaesthetic.

    “Reducing sugar con­sumption, regularly brushing teeth with fluoride toothpaste and routine dental visits will all help ensure this is avoided”

    The FDS says tooth decay is preventable in 90% of cases but many children are not going to the dentist, with parents often unaware that it is free for under-18s.

    There were 45,224 cases of children up to 19 who needed hospital treatment because of tooth decay in 2016-17.

    The British Dental Association (BDA) blamed a lack of a coherent national strat­egy to tackle the problem.

    Henrik Overgaard-Nielsen, the BDA's chair of general dental practice, said: "These shocking statistics are rooted in an abject failure by government to tackJe a preventable disease.

    "While we are hearing positive noises, ministers have not met words with action. Scotland and Wales have dedicated national programmes to improve children's oral health; England has been offered a new logo and limited action in a handful of council wards.”

    The FDS has backed a campaign by the British Society of Paediatric Dentistry calling for all children to receive a den­tal check by the age of one. Analysis by the faculty earlier this year showed that nearly four in five children aged between one and two had not seen an NHS dentist in the previous 12 months.

    Source: The Guardian


  • A fine mess for dental patients

    Many fines incorrectly imposed after dental treatment are because of mistakes over patients' addresses, says a health watchdog.

    The latest figures show 385,000 fines were issued in the last financial year - and dentists say tens of thousands of £100 fines have been wrongly applied.

    Healthwatch in Kirklees says problems with address records are a big factor.

    The NHS accepts this accounts for some of the incorrect fines and says it is planning an information campaign.

    The British Dental Association (BDA) last week called for urgent action to tackle a wave of £100 fines being wrongly applied to dental patients who had free treatment, with particular concerns about confusion among vulnerable people.

    They had been fined following checks designed to stop people from fraudulently using free dental treatment when they should be paying.
    10 fines at the dentist that weren't fine

    The BDA's research claimed as many as nine in 10 fines that were challenged were subsequently overturned, suggesting that many penalties were being wrongly applied.

    Figures from a wider range of NHS fines suggest that the rate for withdrawing penalties after they were found to be incorrect is closer to 50%.

    Healthwatch, which represents people using health services, has been researching the reasons behind this problem and says many mistakes seem to be caused by how patients' addresses are recorded.

    Director Rory Deighton says differences in spelling, variations in how addresses might be presented or mistakes in postcodes could be misinterpreted as being a different identity.

    When addresses do not match information held in databases used for checks, penalty fines could be triggered, he says.

    The NHS Business Services Authority, which oversees the fining system, says there is also a difficulty with patients not updating their addresses, leading to discrepancies between their current addresses and addresses held in databases.

    The agency says it will improve the information available to patients and make forms easier to complete, after concerns there was confusion about which benefits made people eligible for free treatment.

    A spokeswoman said the NHS wanted to make sure that patients and staff "understand the rules around eligibility for free treatment and the consequences of claiming incorrectly", but she admitted there is "still a lot of confusion".

    Mr Deighton said: "There is something intuitively wrong about an NHS organisation sending out incorrect penalty charge notices.

    "Thousands of people every month receive these notices, increasing stress in households all over England.

    "All we are asking for is a simple system, where eligibility for free treatment is clear to everyone. The current system is unclear and unfair on patients."

    Mr Deighton suggested that where there were uncertainties about addresses, checks should be made before any fine was issued.

    In response to growing concerns about the fines, the Dental Defence Union (DDU) has warned dentists to alert patients to rules about payment exemptions.

    "Patients are often aggrieved by being fined when they believed they were exempt," a DDU spokesman said.

    "A large number of complaints of this sort come from the fact that patients feel they were either given poor advice or misinformation when they were filling out the exemption form."

  • Helping children overcome fear of the dentist

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    A new way has been found to help reduce the number of children who are scared of their dentist.

    A self-help guide has been developed by experts at the University of Sheffield. It shows how to use cognitive behavioural therapy (CBT) to reduce the anxiety experienced by many children when in the dentist's chair.

    According to research, more than 30 per cent of children don’t have regular check-ups or fail to complete a course of dental treatment because of anxiety.

    But the academics at Sheffield found more than 60 per cent of children felt less worried after using the guide, which is available online or as a hard copy.

    Designed with children to help them work with their dentist, it uses methods such as writing a message to the dentist, squeezing a stress ball and choosing their own small reward.

    Dr Zoe Marshman from the University’s School of Clinical Dentistry said children who are scared of the dentist often end up with poor dental health and stay scared of the dentist for the rest of their lives.

    Most of these children end up having sedation or being given a general anaesthetic for their dental treatment. This can be a traumatic experience for children and their parents as well as incurring high costs for the NHS.

    The National Institute for Health Research (NIHR) funded the project and the team worked with 48 children and their families at Sheffield Teaching Hospitals NHS Foundation Trust and a community dental clinic in Derbyshire.

    Dr Marshman explained the guide had been designed with children to give them choice and control to challenge commonly held unhelpful thoughts and provide information on dental procedures.

    The team plans to further trial the guide to determine the cost-effectiveness compared to normal treatments.

    The research has been published in the international journal JDR Clinical & Translational Research.


  • Four in 10 children not going to dentist


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    A child being seen by a dentistImage copyright: SCIENCE PHOTO LIBRARY


    More than 40% of children in England did not see a dentist last year, NHS statistics show - a figure the British Dental Association says is embarrassing.
    The BDA said regular dental check-ups were the key to preventing tooth decay in children and urged the government to invest in educating the public.

    Tooth decay remains the most common reason young children go to hospital.

    Guidelines recommend children see a dentist at least once a year.

    The statistics from NHS Digital show that 6.7m children went for a free dental check-up in the year to June - equivalent to 57.9% of all under-18s in England.

    A regional breakdown of the figures shows that attendance in the north of England was highest, with 62% of children seeing a dentist there, but in London the figure was just 48%.
    Apart from examinations, children were most likely to receive a fluoride varnish treatment - which is painted on to the teeth to strengthen the enamel, making it more resistant to decay.

    Last year, these treatments went up by 20% compared with the year before.

    Although these figures suggest a small dip in children having teeth extracted in dental practices, there are indications that tooth extractions due to decay continue to be the top reason children aged five to nine are admitted to hospital.

    Figures from 2014-15 show an almost 10% rise in children needing tooth extractions from those recorded in 2011-12.
    Henrik Overgaard-Nielsen, chair of general dental practice at the British Dental Association, said: "It's clear we have a problem when one in three children are missing out on free dental treatment.

    "NHS dentistry has been left to fend for itself, without investment, a strategy, or any attempt at public education.

    "These numbers are a national embarrassment, and will not budge until ministers change tack."

    He added: "We need a concerted effort to get parents, health professionals and government on the same page."

    Source: BBC News website

  • A majority of dentists will vote NO to 'Brexit' in June

    The majority of Britain's dentists will vote to remain in the European Union after the national referendum this June according to a survey conducted by Dental Tribune Online during February and March this year.

    After analysing the results of the poll, Dental Tribune found that more than 55 per cent of dentists who participated in the survey intended voting against Britain leaving the EU, while 44 per cent were in favour of a Brexit.

    Less than 1 per cent were still undecided on the issue, but perceived an overall more negative future should Britain decide to split from the Union.
    Similar responses were given by the participants when asked whether a Brexit would have positive or negative consequences for the country. A larger share of dentists, however, replied “I do not know” to this question.

    The overall majority of respondents to the survey said they will definitely vote in the referendum. Only one in ten did not intend to participate in it.

    The poll was conducted among 16,000 recipients of the Dental Tribune UK & Ireland weekly newsletter, with almost half of all replies from dentists in southern England, particularly London, which made up almost 20 per cent of the survey respondents. There was less participation by dentists from the northern regions, with slightly less than 30 per cent taking part in the poll.

    Only one in ten respondents were from the Midlands.

    Dentists from Scotland, Wales and Northern Ireland, who made up 12 per cent of the participants in the poll, were split, with almost the same number voting for the Brexit as voting against it.

    Almost one-third of those who responded to the survey said they were in private practice, while one-quarter said they were employed in the National Health Service. Forty per cent worked in practices that offered both NHS and private dental care services.

    Regarding the age of the respondents, more than half were between 30 and 50 years old, followed by a large group aged 50–60.

    Britons have to decide on 23 June whether they want the UK to remain a member of the EU. Mirroring the results of the Dental Tribune survey, the latest national polls indicate that the slight majority of the population will vote to stay in the UK. However, 10 per cent of eligible voters have still not decided which way to vote. Prominent political and economic figures have argued that a decision to leave the EU will have widespread negative consequences for the UK.

    Source: Dental Tribune

  • Third world dental charity fixing teeth in the UK

    A charity set up to provide dentistry in third-world countries has opened a clinic in West Yorkshire, amid claims that desperate people have resorted to pulling their teeth out with pliers.

    Dentaid says a shortage of NHS funding is leaving vulnerable patients without access to affordable dental care.

    The British Dental Association (BDA) says the organisation has exposed "a very serious problem with the commissioning of dentistry" in England.

    Dentaid's weekly clinic in Dewsbury opened in December and the charity has now announced plans to expand into Leeds and Huddersfield.

    Recently, four people in agony with toothache received emergency treatment from volunteer dentists including owner Nick O'Donovan and Ian Wilson, a colleague from Leeds.

    Three of them said they could not afford the emergency fees charged by NHS dentists, which can run into hundreds of pounds.

    Nathaniel Dickinson, a 24-year-old father of two who works at a supermarket, told Sky News he had lost more than a stone in weight from pain after paying £55 for emergency treatment three weeks ago in Batley.

    He says he cannot afford to pay again.

    "When I'm not on a big wage I can't afford that. I can't cope anymore, so that's why I come here," Mr Dickinson said.

    A 19-year-old patient told Sky News she had been unable to register with an NHS dentist because no practices in Dewsbury are accepting new patients.

    The BDA says it has received reports of people in the area pulling their own teeth out with pliers and called on the NHS to increase dentistry funding.

    "There are dentists that can do the work, but the NHS will simply not pay for it, and the patients we are talking about here do not have the money to pay privately for their dental treatment," says the BDA's Henrik Overgaard-Nielsen

    Kathryn Hilliam, from NHS England, acknowledged that problems exist in West Yorkshire, but said they were working to tackle the issues.

    "This work will then help shape the future commissioning of dental services in the area," she added.

    Source: Sky News

  • Don't be fooled by your selfie...

    People taking selfies often believe they have huge horse-like teeth.
    This is because some phone cameras are fitted with lenses that make objects close to them look distorted at the centre of the screen.
    In an article in The Times, clinical director of the London Smile Clinic, Dr Tim Bradstock Smith said: “Teeth often look more protruding than they are in real life, which can also be emphasised by the light of the flash. As teeth are at the centre of the image, people are understandably driven to make them look nicer.”
    He said that over the last five years he’s seen a 30 per cent rise in people showing him selfies because they are concerned about their front teeth.
    He added: “When they come in, often the teeth don’t look too bad, We dissuade two to three patients each week from treatment, and for many others, will recommend simple alignment of front teeth instead of major intervention.
    “The two front teeth look good being a little more dominant, with a step in length between these and the next two. It creates a ‘smile curve’ and it’s a natural appearance.”
    As reported in The Guardian.
  • Putting the 'T' in children's teeth

    BRITAIN’S love of tea could help save the nation’s youngsters from a less pleasant tradition: bad teeth.

    Researchers have found that children as young as four would benefit from drinking regular cups of tea, according to a report in the Sunday Times

    Carrie Ruxton, a public health nutritionist, and her colleague Tim Bond analysed 49 types of teabag bought in British shops and supermarkets to discover their levels of fluoride. The mineral strengthens the enamel coating of teeth, protecting them from bacteria that cause dental caries.

    The team found that a deficiency of fluoride could be averted if adults drink at least four or five cups a day. The results are published in the journal of the British Nutrition Foundation.

    An excess of fluoride can be damaging, so Ruxton and Bond also examined the total fluoride intake of adults and children, concluding that 'tea can be consumed safely from the age of four years'.

    A survey of 2,000 people by the charity Contact The Elderly found that Britons drink on average 876 cups of tea a year, enough to fill two bathtubs.

    The survey also found that 18 to 24-year-olds drink just eight cups a week compared with 21 cups a week by over-55s.

    Source: The Sunday Times

  • Dentists give footballers a yellow card

    Professional footballers have worryingly poor teeth that could be affecting their performance on the pitch, say dentists.

    The study on players at eight clubs in England and Wales, in the British Journal of Sports Medicine, showed nearly four out of 10 had cavities.

    West Ham United's medical staff said athletes often had worse teeth than the general population.

    Regularly consuming sugary foods and drinks is one possible explanation.

    The dentists, from the International Centre for Evidence-Based Oral Health at University College London, examined 187 players' sets of teeth.

    They found 53% had dental erosion, 45% were bothered by the state of their teeth and 7% said it affected their ability to train or play.

    Around 40% had tooth decay, compared with 30% of people of a similar age in the general population.

    Prof Ian Needleman, one of the researchers, told the BBC News website: "These are individuals who otherwise invest so much in themselves so it's a surprising finding.

    "There are two main groups - some have a catastrophic effect, they have very severe abscesses that stop them in their tracks and they cannot play or train.

    "There'll be others experiencing pain affecting sleeping or sensitivity every time they take a drink.

    "At this level of athlete, even small differences can be quite telling."

    Nutrition is one of the primary suspects with frequent consumption of sugary or acidic foods during training potentially accounting for tooth decay and erosion.

    A lot of air in the mouth during exercise can also dry it out so there is less protection from saliva.

    Prof Needleman said that while "these findings are worrying" clubs were giving dental health a "higher priority" and were educating their players.

    Interview from 5Live with Prof Needleman

    Previous research has shown "striking" levels of bad teeth in athletes competing at the London 2012 Olympic Games.

    The teeth of athletes at London 2012 were broadly in the same state as those of footballers.

    Players from Manchester United, Hull, Southampton, Swansea, West Ham, Brighton, Cardiff and Sheffield United all took part in the study.

    Stijn Vandenbroucke, the head of medicine and sports science at West Ham, said there were "clear preventive benefits for athletes and club".

    He added: "Oral health is an area where many athletes have greater problems than the general population so it has been a massive achievement for so many professional football clubs to collaborate with each other to help us understand the scale of this problem better."

    Source: BBC News website

  • Public confused about orthodontics

    What is an orthodontist?

    The general public is confused about the role of dental specialists and a third of the UK population doesn’t know what an orthodontist does.

    A recent survey, published in Dentistry, found that only 64 per cent of people could correctly identify that an orthodontist specialises in straightening teeth. The survey was conducted on behalf of The Invisible Orthodontist, a network of specialist orthodontists in the UK.

    Nearly half of those surveyed were unaware that a specialist orthodontist would have completed up to three years of extra training after qualifying as a dentist – and men were less aware than women.

    The best way to combat public confusion over dentistry and orthodontics is to install Pro-Practice TV digital marketing to keep your patients informed, and tell them exactly what you do.

    The research also shows that people are also confused about the range of dental specialists with additional extensive training; many dentists claim to have a ‘special interest’ in orthodontics, and  they may have completed courses on particular teeth straightening systems so that they are able to offer orthodontic treatment to their patients.

    The Invisible Orthodontist is a network of specialist orthodontists who work together to advance the use of invisible orthodontic techniques, predominantly Invisalign.

    Catherine Duncan, marketing consultant of the organisation said: “We commissioned this survey to try to gain a deeper understanding of what people in the UK know about specialist orthodontics. We were not surprised to learn that there is a level of confusion around what a specialist orthodontist does.

    "The Invisible Orthodontist is dedicated to widening awareness of the skills a specialist orthodontist has to offer their patients; ensuring people can straighten their teeth – using virtually invisible techniques – and be confident that they are in the most experienced and knowledgeable hands.”

  • One in three people in the UK suffer from dental neglect

    Although tooth decay is a big problem in undeveloped countries, a recent study of oral health has shown that one in three people in the UK and one in five in the US are also suffering the consequences of dental neglect, according to a report in the Dental Tribune.

    Tooth decay is the fourth most expensive chronic disease to treat, and studies have shown that if left untreated it can lead to poor productivity at work and absenteeism in adults as well as poor school attendance and performance in children. 

    There is a vital need to develop effective oral health promotion strategies, says Prof. Wagner Marcenes from the Queen Mary University of London. “We have seen a clear shift in the burden of tooth decay from children to adults. The current perception that low levels of decay in childhood will continue throughout life seems incorrect,” he added.

    Make sure your patients are receiving the treatment they need - keep them informed with Pro-Practice digital marketing! 

    His comments follow a Global Burden of Disease study which involved a systematic review of all data on untreated dental decay, leading to a comprehensive report on rates of tooth decay for all countries and age groups and both sexes for 1990 and 2010.

    The team analysed 192 studies of 1.5 million children aged one to 14 years old, across 74 countries, and 186 studies of 3.2 million people aged five years or older, across 67 countries. They found that 35 per cent of the world’s population currently suffer from untreated carious lesions in their permanent teeth, and that 621 million children worldwide have tooth decay that goes without dental care.

    Hundreds of millions of new cases are expected to add to the burden of dental decay annually owing to neglected treatment, according to a paper by researchers from the UK, the US and Australia, published online in the Journal of Dental Research.

    Prof Marcenes added: “It is alarming to see prevention and treatment of tooth decay has been neglected at this level because if left untreated it can cause severe pain, mouth infection and it can negatively impact children’s growth.

    “The fact that a preventable oral disease like tooth decay is the most prevalent of all diseases and injuries examined in our report is quite disturbing and should serve as a wake-up call to policymakers to increase their focus on the importance of dental health. Extending oral health promotion activities to the work environment is necessary to maintain good oral health to reduce the major biological, social and financial burden on individuals and healthcare systems.”

  • Great dental care keeps your patients looking younger

    Researchers in the Netherlands have found that people who look after their teeth and oral hygiene can appear up to ten years younger.
    Make sure your patients are aware of this - keep them informed with Pro-Practice digital marketing.
    Scientists from Unilever and Leiden University demonstrated that good oral care, including regular flossing and brushing can have long-term effects on a person’s perceived facial age. The researchers took into account different lifestyle factors including smoking, sun-bathing and oral care.
    About 800 people took part in the study and these included smokers and non-smokers, aged from 45 to 75, from both the Netherlands and England.
    The study group were photographed with their mouths closed and the portraits then shown to 60 assessors, who were asked to estimate the age of each person within a range of five years. The average perceived age of each person was then compared with their lifestyle factors collected via questionnaires.
    The results showed that Dutch women with few remaining teeth were thought to be 10.9 years older than their actual age. Dutch men with dentures who did not floss were thought to be 9.3 years older than they really were.
    Similar findings were made in the English group: women who cleaned their teeth only once a day and wore dentures were thought to be 9.1 years older than a control group of women with natural teeth and a comprehensive oral routine.
    Dr David Gunn, a senior scientist at Unilever, commented: “The number of teeth and the condition of the surrounding gums are known to directly influence the appearance of overlying tissues.
    "For example, people look younger with their mouths closed after receiving new dentures, and the number of teeth or the use of dentures has been linked to lip size and the appearance of the labio-mental fold.”
    The researchers said that although oral care aspects could have been influenced by other lifestyle factors, such as diet, dental aspects were significantly associated with perceived facial age in the groups studied.
    The study, entitled “Lifestyle and youthful looks”, was published by the British Journal of Dermatology and reported in the Dental Tribune.
  • Why is your waiting room like a lift?

    How to reduce anxiety in your waiting room

    A news item about alleviating boredom and anxiety when using a lift was aired by the Today programme on Radio 4 recently.

    Although the interior of a lift may not immediately bring to mind your waiting room, there are similarities.

    Jason Whale, sales manager at Elevators Ltd explained there was a growing trend to fit lifts with screens showing videos and adverts which gave the occupants something to concentrate on. 

    This philosophy could equally be applied to your dental practice.

    He pointed out that many people feel anxious when using a lift or feel awkward standing in a confined space with strangers. He said it was better to “have things around you to take away that awkwardness. We all look at our phones or look down at the floor. Surely it’s better to look at adverts on the walls.”

    Visiting the dentist can also be an anxious experience for many, and the time spent sitting in the waiting room can often be more fear-inducing than the treatment itself.

    Dentists who choose to place a screen on the wall showing adverts and other images will undoubtedly have more relaxed patients. And they will increase uptake of cosmetic dental treatment, as well as their profits.

  • Health benefits in a humble cup of tea

    Tea in general and green tea in particular, have long been thought to have beneficial properties, including helping to prevent cancer cells from forming, and now a new study has backed this up. 

    It found that green tea compounds in particular may trigger a cycle that induces cancer cell death and could be used in developing new treatments for oral and other types of cancer.
    Before now, although polyphenols, compounds found in tea, have been shown to inhibit tumour cell proliferation, there have been few clinical trials of tea consumption and cancer prevention and results have been inconclusive. 
    Researchers at the Pennsylvania State University grew both normal and cancer cells in petri dishes then exposed them to the green tea compound epigallocatechin-3-gallate (EGCG) at concentrations typically found in saliva after chewing green tea chewing gum. Testing for oxidative stress and signs of antioxidant response showed that EGCG triggered a process in the mitochondria that led to cell death.
    Dr Joshua Lambert, associate professor of food science at the university, explained: “It looks like EGCG causes formation of reactive oxygen species in cancer cells, which damages the mitochondria, and the mitochondria responds by making more reactive oxygen species.”
    However, the effect was not found in normal cells. In fact, EGCG appeared to increase the protective capabilities of the cell.
    Lambert thought the protein sirtuin 3 (SIRT3) may play a crucial role in the process, suggesting that EGCG might selectively affect the activity of SIRT3 in cancer and normal cells, turning them off or on respectively.
    These findings could help create effective anti-cancer treatments without harmful side effects, as experienced with chemotherapy.
    The study was published in the February issue of the Molecular Nutrition and Food Research journal and reported in the Dental Tribune.

  • Dentists not clear about costs, says Which?

    BDA chairman Mick Armstrong has described government rules on dental pricing "a recipe for confusion" following a Which? report indicating that dentists are overcharging and misleading their patients. He said: "It is essential that patients have a clear understanding about treatment options and costs when they visit their dentist.

    "Unfortunately, the rules determined by government have proved a recipe for confusion. Neither the NHS contract nor what the NHS will pay for is clear enough. It's a system that is failing patients and practitioners alike."

    A survey by Which? of 1,000 people in England found one in five was overcharged for treatment while 50% said no price list for treatment was displayed. The consumer magazine said dentists should be "upfront with patients about costs".

    The Department of Health said dentists were contractually required to display up-to-date charges.

    The people surveyed had all been to see their dentist in the past six months. While 80% said they trusted their dentist's advice on treatment, around 40% said they were not clear about what treatment they were entitled to on the NHS.

    Patients should only be asked to pay one charge for a course of NHS treatment, even if that means several visits to the dentist, yet 19% of NHS patients said they paid more than once for the same course of treatment. There was also evidence of confusion about how NHS and private treatments differ.

    Which? undercover researchers visited 25 dental practices in England and rated 12 of them as poor or very poor at explaining this difference. Which? executive director, Richard Lloyd, said some dentists were failing to provide clear information.

    "A visit to the dentist is an essential health check for millions of people across the country. Most of us will need dental treatment throughout our lives and it's important that when that happens people feel clear about the nature of the treatment and what it will cost upfront. We are calling on the NHS and the regulators to clean up dental costs and make sure the existing rules are put into practice consistently."

    The Department of Health said dentists have a contractual requirement to display an up-to-date poster on NHS dental charges for patients.

    Barry Cockcroft, the government's chief dental officer, said: "Dentists have a duty to be open and honest about payment and treatment options, always considering the best interests of their patients."

    the BDA's Mick Armstrong pointed out that this wasn't always easy: "In the narrow window available in a time-pressed NHS, a dentist must explain not just the technical details of clinical treatment options, but also the workings of the payment system and where the NHS and private treatment cross over. With such a muddled set of arrangements, the system almost sets up the dentists working in it to fail."

    Source: BBC

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