12 minute read
Climbing out of lockdown. By Sir Paul Beresford, BDS. MP
CLIMBING OUT OF LOCKDOWN
By Sir Paul Beresford, BDS. MP
Lockdown restrictions in the UK were announced by Boris Johnson, Prime Minister on 23 March 2020. This was a result of the increasing awareness that the United Kingdom was about to be hit by a pandemic caused by a totally new and highly dangerous virus. There is increasing evidence that China initially may have covered up the existence and progress of this deadly disease much earlier than the world became aware of it.
There is also high suspicion that the virus may have been accidentally linked from a research laboratory in Wuhan. The latest suspicion is of local Wuhan officials cover-up denying the brief chance to stop the virus in Wuha.
At that point little was known about the Coronavirus except that it is highly dangerous for many humans. Virtually every nation introduced varying degrees of restrictions on a normal life as this horrendous virus progressively spread from Wuhan in China as a pandemic throughout the world.
Inevitably there has been much discussion, particularly in the media, on our local current Lockdown policy and its implementation. Every conceivable position has been argued, from Lockdown should not yet be used, to Lockdown began too late, that Lockdown should be released immediately - plus everything in between.
Consequently, I looked with particular interest to the Imperial College London study which has assessed the impact of Lockdown on 11 European countries including ours, up to the beginning of May 2020. These researchers used sophisticated modelling to project how many deaths there would be if there had not been Lockdown.
At the beginning of May approximately 130,000 people had died from Covid in those 11 European countries. Of course, this is risen horrifically since. However, the Imperial study estimates that without Lockdown 3.2 million people would have died by 4th May if these countries have not imposed measures such as closing businesses and telling people to stay at home. The study estimates the Lockdown to have saved around 3.2 million lives at that time, including 470,000 United Kingdom, 690,000 and 630,000 in Italy.
Inevitably there will be much discussion and argument when finally, we may be able to push this disease off our landscape. There will be endless attempts by opponents of the Conservative Government to emphasise areas where we could have done better and underplay/ ignore successes. Of course learning from the past, to ready ourselves for the next occasion is good management. South Korea managed to successfully battled Sars and use that experience to their benefit in the attack against coronavirus. Japan where greetings generally involve a faceto-face bow at perhaps 1 metre distance had less community spread than some of our European neighbours where the obligatory on both cheeks peck clearly increased community spread.
The comparison that rankles with me as a dual NZ/UK passport holder is New Zealand. I noted at least one of the weekend papers there was New Zealand Government criticism of this country. Jacinda Arhern, the Labour Prime Minister, who introduced very harsh Lockdown on 19th March has been very successful in limiting the Covid toll to just 1504 cases and 22 deaths. A commendable achievement. However such simple comparisons are heavily flawed.
New Zealand is essentially a country of rural settlements of low-density suburbs where social distancing was not too difficult. Covid arrived in New Zealand the middle of summer when viruses are at the lowest chance spreading. Also New Zealand is self-sufficient in food hence has relatively little international supplies - New Zealand has 700 international flights a week whereas Britain has many more than that in a single day plus trains and ferries arriving from other European countries constantly, especially from Spain and Italy who was suffering from the virus before it hit the UK.
Arhern has elections later this year and will no doubt be returned on the wave of the New Zealand Lockdown success. Unfortunately for the country most voters seem relatively blissfully unaware of the huge cost per head of population of the financial support Arhern has given, along the lines of most European countries including the UK but then some! New Zealand will need a National ( Conservative) Government to return to economic sanity which is not helped by the continuing border closure causing the destruction of its international tourism business which constitutes a considerable proportion of its GDP.
I am a very part-time private only dentist undertaking, when Parliament allows, a few hours of practice a week. Like every other dental surgery in England, whether NHS, mixed, or private I closed my doors at the request of Sara Hurley, the English Chief Dental Officer at the beginning of Lockdown. From the limited knowledge we had of the transference of coronavirus this was a glaring and obvious step. Latterly there have been criticism of this action, from some private dentists and private dentists groups. These have been based on the belief that the Chief Dental Officer had responsibility for NHS dentistry only.
It is correct that she has responsibility for paying rations of NHS dental contractors but her role in dental health is very much broader. As the NHS England website puts it: “The Office of the Chief Dental Officer England represents the head of the dental profession in England, providing system wide professional and clinical leadership, by setting the strategic vision for England’s oral health.”
It is often said particularly by the BDA, that dentistry is treated as a Cinderella health service in England. I cannot but agree although I noticed that Sara Hurley’s drive to “put the mouth back in the body” slowly but steadily gaining traction at the Department of Health all the way up to the Secretary of State
For most dental practices Lockdown has been a financial disaster. Sara somehow managed to persuade the Treasury that partial NHS payments to NHS dentists was appropriate.
In addition, there were a number of other financial assistance schemes available to dentistry as for other UK businesses. Some of these were grants, some access to loans and delays in tax payment all offered help. As an MP, I and my team of three, over Lockdown have received in excess of 27,000 emails and letters, telephone messages. Many of these are from businesses and individuals facing the prospect of their livelihood disintegrating. It is a considerable relief to us when we are able to utilise what this Government made available to assist many. Inevitably such broad schemes, especially those designed to attempt to remove fraud, mean that very many people and businesses fall through the cracks. A lot of these have been dentists and dental surgeries.
As the only dentist in the House of Commons I have been frequent requests from dentists and patients. Over Lockdown fortunately all dental practices continue to provide remote consultations, advice, prescriptions for analgesics and antimicrobials where necessary. The NHS Dental 111 call line ran dental triage supported by the dental workforce for patients who do not have their own dental practice. Additionally, Sara Hurley managed in time to set up over 600 Urgent Dental Care Centres. As of 21st June the UDCCs gave 1,707,947 remote triage conversations and help. They referred 103,552 individuals to UDCs resulting in 69,656 faceto-face treatment. Under 1/3 of the face-to-face treatments necessitated an extraction contrary to the impression given by one Labour MP to the recent Health Select Committee hearing.
The brightest news for the profession was that from Monday 8th June surgery doors could be opened. Most surgeries phased in their return.
Concerns of the spread of the virus through dental surgeries was very real so practices are almost universally cautiously increasing what they offer and utilising extensive PPE. Preappointment and at the appointment triaging is becoming standard. Most practices back the extensive triaging with the taking of body temperature on arrival.
Patient flow, because of extra cleaning and sterilisation, has been driven down to a trickle for most practices. Add in the cost of PPE and the often expensive, extra equipment practices are being told to obtain we get severely damaged finances of the practice of dentistry whether NHS or private.
There are a number of hopeful prospects coming over the horizon. The first of these is that there is a real prospect that Covid will be beaten. The ultimate hope for this will be the production of a vaccine or vaccines for very widespread inoculations. I am appalled beyond all measure to be subjected to a small but vocal campaign against the use of vaccination by a few of my constituents and others. Additionally some antiviral drugs seem to help very ill patients meaning fewer deaths and faster recovery.
Next, somewhere in the near pipe line, there is a possibility of an individual on the spot test for coronavirus carrying that takes approximately 20 minutes. This may be developed to so that it could be used in the dental surgery- as well as at airports!
Of considerable significance, I believe from previous and imminently pending research that there is no evidence of aerosolized SARS-CoV-2 (including the current coronavirus) as the primary infective vector from any study worldwide. This includes, but is not limited to, aerosols of dental origin.
This brings me to the conclusion that realistic normality without the great expense of extra PPE and without the delay of excessive surgery sterilisation between patients a semblance of life as we knew it may be upon us.
GP1
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For anyone doing orthodontic treatment, there’s nothing more aggravating than hearing a patient report a cracked clear retainer. It sets in motion a chain of often time-consuming, unpleasant and always costly events. An additional patient visit, lost chair time, possibly another scan, retainer fabrication cost, ultimately a longer treatment time, and too often an unhappy patient.
Plus, you know there’s a good chance the new retainer isn’t going to last much longer than the previous one.
The first and most important step in the solution to fabricating a durable, crackresistant retainer is material selection. Any retainer you make will never be any better than the plastic material you use to fabricate it, no matter how experienced and talented a lab technician you are. Use an inexpensive commodity plastic engineered for broad use across many applications and chances are you’ll ultimately end up with a retainer that’s prone to cracking and deformation.
There are two basic categories of thermoplastic material used today to fabricate retainers. The first and most common is made mostly from commodity resins, mostly polyester, or PETG for short. Most of the retainer plastics from well-known manufacturers suppliers are all PETG.
Relatively inexpensive and easy to work, PETG is commonly used as the base resin for consumer products like plastic Coke and Pepsi bottles. All general and cosmetic dentists know PETG plastics well, since they’re a staple material used for a range of dental appliances like splints and bleaching trays. But PETG doesn’t have the properties essential for a crack-resistant, long-lasting retainer.
Hence the reason why most suppliers of PTEG plastics recommend using 1mm (040”) think material for retainers. Anything thinner will be too susceptible to cracking and likely won’t last more than a month or two.
The second category of plastic commonly used today for retainers is made from a specialized resin called polyurethane, or PU for short. It’s more expensive and harder to work with than PETG, but it provides the optimum balance of all the key properties essential for a highly crack resistant, durable, long lasting and highly stain resistant plastic.
Many of the clear aligner companies use only 100% PU material for their aligners. They also use it in their retainer materials. The exceptional performance and durability of those materials has played a key role in the success and lifespan of the aligners.
Zendura developed PU further and is a new generation plastic, meaning it’s hardier and more crack and stain resistant, most Zendura users buy 0.76mm thick Zendura A for all of their retainers. Even though it is about 25% thinner than most retainers, a properly made Zendura retainer will last from one to five years. Being able to use a thinner profile retainer material with confidence is a huge plus. The thinner the retainer the more comfortable it is in the patient’s mouth -- and most important -- the better the patient compliance. This is particularly important with pediatric patients.
Zendura retainers today are widely considered the benchmark in the orthodontic community for clear retainers.
So, if you want to fabricate retainers to the caliber of those made by the large aligner companies, really your only material choice is Zendura. It may cost more up front, but if you analyze the final cost of a cracked retainer, the cost of a premium material like Zendura pays for itself many times over in giving you the confidence of knowing the retainers you provide to your patients won’t crack and will perform exactly as prescribed for probably years to come.
Says Matt Norie, GM of S4S, one of the U.K.’s leading labs, “We have been using Zendura at S4S for a couple of years now. The strength and durability of the material is fantastic. Retainers made from this material last significantly longer than other standard pressure formed retainer materials, in fact, I can't remember having to remake a retainer made of Zendura.”
Distributed in the UK and Ireland by OrthoCare, Zendura is broadly used by orthodontists, dentists, and dental and orthodontic labs.
OrthoCare also distributes Bay Materials’ highly acclaimed Zendura FLX material, engineered specially for clear aligners. Introduced to the marketplace less than 2 years ago, it has already become the new benchmark in the clear aligner treatment market.
For helpful guidance on how to fabricate top-tier retainers, OrthoCare provides its customers with an illustrated guide titled Zendura Thermoforming Tips & Tricks Guide. It also has available on request another illustrated guide titled How to Manually CutTrim-Finish Aligners & Retainers.
