The Technologist February 2025

the the

technologist volume 18 11 issue 1 4 february november 2025 2018

issn 1757-4625 issn 1757-4625

the journal of the dental technologists association

DTA Charity of the Year

Headway

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In this issue: Youissue: Bullied at Work? Pam Swain MBE InArethis ‘Octopus’ contentDentures listing number one Age UK Advice content listing number two Healthwatch England – NHS Access content listing number three

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HOURS OF VERIFIED CPD

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in this issue the

technologist Editor: Derek Pearson t: 07866 121597 Advertising: Rebecca Kinahan t: 01242 461 931 e: info@dta-uk.org

2 A DTA Column A Fluoride Safety – Prof. Grant McIntyre 8

DTA administration: Rebecca Kinahan Operations Coordinator

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Address: PO Box 1318, Cheltenham GL50 9EA Telephone: 01242 461 931

A Are You Bullied at Work?

– Pamela A. Swain

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A Living and working with change – Part 2: Generational change

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Email: info@dta-uk.org Web: www.dta-uk.org Stay connected: @DentalTechnologists Association

– Kevin Lewis 25

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A Legal Expenses for Dental Laboratories 27 28 A Age UK Advice for an ageing dental

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A Octopus Sucker Denture Fix – Dr Eda Dzinovic

@The_DTA @dentaltechnologists association Dental Technologists Association (DTA) DTA Council: Delroy Reeves President Joanne Stevenson Deputy President Tony Griffin Treasurer

technologist workforce 30 A Alternatives – Dr Chris Turner A Mental Health: Part 2 – Common Mental 33

Chris Fielding, David Gale, Dominika Krowiarz Robert Leggett, Patricia MacRory and Jade Ritch.

Health Conditions – Tracey O’Keeffe A Healthwatch England: Priorities For Patient Access – Rebecca Curtayne

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The Technologist is published by the Dental Technologists Association and is provided to members as part of a comprehensive membership package.

Editorial panel: Tony Griffin Joanne Stevenson

For details about how to join, please visit: www.dta-uk.org or call 01242 461 931

Editorial assistant: Dr Keith Winwood

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Published by: Stephen Hancocks w: www.stephenhancocks.com

ISSN: 1757-4625

Find out the 10 reasons to join DTA by visiting: www.dta-uk.org

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Views and opinions expressed in the publication are not necessarily those of the Dental Technologists Association. the

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Effective Communication

Effective Management

Knowledge & Skill

Professionalism

Cost effective professional indemnity insurance for dental technicians and laboratories

Tel: 01634 862 525

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PPP Representing you Looking ahead to 2025, we have exciting plans in place, including a series of webinars focused around digital dental technology education. These will provide enhanced CPD opportunities and ensure that we remain at the forefront of our profession. Plus, we will be giving back to you, our members, worthwhile additional membership benefits which will soon be announced.

A New Year Message Dear Members,

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s we look back at another remarkable year, I want to extend my heartfelt gratitude to each of you for your unwavering support and dedication to the Dental Technologists Association (DTA).

Your commitment and passion for excellence in dental technology continues to inspire us all and is at the heart of all we strive to achieve as an association and as an essential part of the dental community.

This year has been filled with significant achievements and milestones. We have

seen incredible advances in our field, and your contributions have played a crucial role in these successes. From the adoption of new technologies to the continuous pursuit of professional development, your efforts have not gone unnoticed.

I am particularly proud of our ongoing support for our nominated charity, Headway. Their work in supporting individuals with brain injuries is truly commendable, and I encourage you all to continue contributing in any way you can to this worthy cause.

I would also like to extend a special thank you to our voluntary council members for their invaluable support in guiding the association, for the benefit of our members and ultimately for the nation’s oral health.

Your dedication and hard work are truly appreciated.

Thank you once again for being an integral part of the DTA community. Together, we will continue to achieve great things and fashion a very positive impact on our dental technology profession.

Warm regards, Delroy Reeves President, Dental Technologists Association

Fellowship

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he newly established ‘DTA Fellowship’ and ‘Master’ award have been created to offer experienced DTA members in good standing the chance to receive recognition for their exceptional custom-made dental device manufacturing within their specialised field of dental technology.

DTA Fellow Jo Stevenson shares her experience: “Whenever something unique comes to my bench, I take before and after photos, plus I record the processes involved in a step-by-step fashion while writing a the

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brief summary for each step that could then be put forward as my application for Fellowship and appear as an article within The Technologist – it was really that simple for submitting my fellowship application, yet the experience proved really rewarding.

“I can’t stress the sense of achievement I felt when I was awarded with my Fellowship. It demonstrates the quality of my work while also enhancing my CV, and it benefits my fellow members by providing practical tips they can use at the workbench. I urge you to share your pride in your work, and be

rewarded with our coveted Fellowship, making you one of the best of the best within the UK’s leading dental technical association.”

On Facebook: @DentalTechnologists Association

On Twitter: @The DTA / #The_DTA

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MHRA Compliance We would like to take this opportunity to reinforce the importance of compliance with the Medicines and Healthcare products Regulatory Agency (MHRA) Medical Device Regulations (MDR) for custommade dental devices. This initiative aims to ensure that all dental appliances are safe, effective, and meet the highest standards of quality.

If you are a manufacturer based in the UK and you intend to supply medical devices in Great Britain then you need to be aware of the following legislation: ● the Medical Devices Regulations 2002 (SI 2002 No 618, as amended) (UK MDR) ● the General Product Safety Regulations 2005 (SI 2005 No 1803) ● the Medicines and Medical Devices Act 2021 (MMD Act) For the purposes of enforcing the UK MDR, the MMD Act introduced a set of enforcement provisions consisting of compliance notices, suspension notices and information notices (along with a specific recall power), which are discussed below.

Schedule 3 of the MMD Act also makes provision for a criminal offence for breaching a provision of the UK MDR. That criminal offence has not yet come into force, and until it is, section 12 of the Consumer Protection Act 1987 will continue to apply to breaches of the UK MDR, so that such breaches will continue to be a criminal offence.

Regulation 61 of the UK MDR places a duty on the Secretary of State (in practice the MHRA) to enforce the UK MDR. These enforcement duties are listed in paragraph 10 of Schedule 5 to the Consumer Rights

Act 2015, which enables the MHRA to exercise the investigatory powers (including powers of entry) in Schedule 5 to that Act. The General Product Safety Regulations 2005 might apply to consumer products that are also medical devices, where these products are not covered by the UK MDR. Therefore, if you are involved in the supply of medical devices that are intended to be used by a consumer, you need to understand your obligations under these regulations. ● For more information on the General Product Safety Regulations, see https://www.gov.uk/guidance/product -safety-advice-for-businesses.

Key Highlights: ● The DTA underscores that only General Dental Council (GDC) registered dental technicians are authorised to sign off custom-made dental devices as fit for the marketplace. This requirement is crucial as these devices are intended for use in patients’ bodies, necessitating rigorous standards and thorough knowledge of the manufacturing process and materials used. ● The MHRA is responsible for enforcing the MDR, and the GDC has stated that it will take action against dental professionals who fail to meet their legal

responsibilities. Manufacturers are advised to reference the MHRA MDR and the GDC document ‘Standards for the Dental Team,’ particularly sections 9.1 and 9.2. ● The DTA disagrees with the notion that Laboratory Assistants and Dental Nurses can sign off custom-made dental devices. The association refers to the GDC document ‘Standards for the Dental Team,’ emphasising sections 1.3, 1.7, and 1.9.

Supporting the UK Market: ● The DTA strongly advises against importing custom-made dental devices from overseas. It is impossible to know how devices manufactured overseas have been made or the materials used, and therefore, they cannot be signed off as being fit for purpose. The liability for any dental device provided lies with the UK GDC registrant. By supporting the UK market, we ensure that all dental devices meet the stringent standards set by the MHRA and we work to the GDC’s remit to protect the public, thereby safeguarding patient health and safety ● Make sure you check your MHRA information is up-to-date. In the UK the MHRA is the competent authority responsible for the Medical Devices Regulations (MDR). If you manufacture custom-made dental appliances such as fixed bridges, bleaching trays, crowns, splints, retainers, you are required by the MDR to register with the MHRA, and provide your business address and a description of the devices you produce. the

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Professional events: Dental Technology Showcase (DTS) 2025 The DTA is proud to announce that we will once again be exhibiting and speaking at the Dental Technology Showcase (DTS) 2025.

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his prestigious event, taking place on May 16-17 at the NEC Birmingham, is the UK’s only dental lab-focused showcase. It provides a unique platform for dental laboratories to network,

learn, and discover the latest initiatives in the field. Attendees will have the opportunity to meet with forward-thinking suppliers, listen to industry-accomplished speakers, and gain insights that will help them stay ahead of the competition.

With over 1,500 visitors, 80+ exhibitors, and 50+ speakers, DTS 2025 promises to be an unmissable event in the dental calendar for anyone involved in dental technology. We

look forward to welcoming you to our stand (D02) during a packed two days. ● You can register your interest now at https://www.the-dts.co.uk/2025 and the organisers will keep you informed when you can book your place free of charge. See you there!

BDIA Dental Showcase 2025 The BDIA Dental Showcase 2025 is set to take place on March 1415 at the ExCeL London.

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raditionally the event is more geared toward the wider dental community however, the organisers have told the DTA they are also considering adding content specifically for dental technologists.

The organisers claim that: “This event brings together the best and brightest in the dental community, offering unparalleled opportunities to discover cutting-edge products, innovative solutions, and industryleading expertise.

With over 300 exhibitors, hands-on workshops, and a comprehensive educational

programme featuring leading clinicians and experts, BDIA Dental Showcase is the ultimate platform for dental professionals to enhance their skills, expand their network, and stay ahead of the curve.”

Our 2025 Nominated Charity - Headway

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hroughout 2025 DTA will continue to support the work of Headway the brain injury association. Brain injury can challenge every aspect of your life – walking, talking, thinking, feeling – and the losses can be severe and permanent.

We all think ‘it will never happen to me’, but every year around 350,000 people are admitted to hospital with an acquired brain injury. That’s one every 90 seconds.

The charity’s long-term strategic aims for 2024-2029 include increasing awareness and understanding of brain injury, the

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developing new support services, and supporting research to improve access to specialised services.

Headway’s commitment to these goals is reflected in its ongoing efforts to provide comprehensive support and advocacy for brain injury survivors and their families.

Please take some time to help support our chosen charity in any way you feel you can. ● Visit https://www.headway.org.uk/ for more information about the support and resources available to you and your peers.

On Facebook: @DentalTechnologists Association

On Twitter: @The DTA / #The_DTA

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2024: The DTA Looks Back at a Year of Change The dental technology profession has seen significant advances and challenges throughout 2024. One of the most notable trends has been the rapid adoption of digital workflows and technologies, such as intraoral scanners, 3D printing, and AI-driven diagnostic tools.

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hese innovations have revolutionised the way dental technicians work, enabling more precise and efficient creation of dental prosthetics and appliances.

A case in point demonstrates cutting-edge UK advances in the 3D print arena. Remora® a Scottish-based company that has recently gained FDA approval in North America and Canada manufactures new biocompatible

materials for 3D printing and milling, containing the unique Remora anti-biofilm technology. These new materials, presented in a resin and milling blank form, are for the 3D fabrication of dental devices, for example splints, an area highly susceptible to harmful biofilms. Remora’s patented technology disrupts the communication of bacteria (quorum sensing) by mimicking the natural protective mechanism of red seaweed, therefore significantly reducing biofilm and plaque build-up on surfaces.

The innovative MSI® technology (multi species inhibition) that includes Remora is the result of a pioneering and awardwinning collaboration with Pro3dure Medical GmbH – world leaders in 3D printing materials for medical applications.

The ‘printodent® GR-10 guide MSI’, ‘printodent GR-19.1 OA / MSI’ and the Thermeo milling blanks are Class II medical

devices. This regulatory approval from the FDA and Health Canada endorses the safety and efficacy of the Remora technology in real world applications. The products are now available for use in dental environments across the US and Canada.

The first, ‘printodent GR-10 guide I MSI’, was launched in March 2023 at the IDS dental trade fare in Cologne. The global 3D-printed dental market is estimated to be worth $6.5 billion by 2025 and is likely to continue to grow thanks to an increasing adoption of these products in dental clinics and laboratories.

Taste by Stanley Tucci It is rare that the DTA will recommend a book to our members but a remarkable work has recently come onto our radar that we feel is not only a worthwhile read that will sometimes make you laugh out loud – and certainly tickle your mental tastebuds – but has also got an honest and inspiring message for all dental professionals.

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tanley Tucci is a highly regarded writer, director and actor with an international reputation. He is also a mouth cancer survivor.

In his book Taste, My Life Through Food Tucci’s battle with mouth cancer and his treatment for the disease is revealed in all its uncomfortable detail.

Thanks to investigations to discover the cause of frequent shooting pains in his jaw a large tumour was found at the base of his tongue.

Although the disease had not spread, the surgical option was ruled out because removing a good portion of his tongue would have seriously impacted his ability to speak, not good for an actor/director. It would have also affected his ability to eat, a

tragic outcome for a life-long foodophile.

We say no more here, but we do say invest in a heart-warming, brilliantly written book, you won’t regret it.

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ELECTION OF MEMBERS TO THE DENTAL TECHNOLOGISTS ASSOCIATION (DTA) 1 Notice is hereby given that an election of three Council Members of the Dental Technologists Association is about to be held.

2 Any Member of the Company is entitled to be nominated as a candidate.

3 Any person entitled to vote may take part in the nomination of any number of candidates not exceeding the number to be elected.

4 Each candidate must be nominated separately by the signatures of not fewer than three Members of the Company on not more than two nomination papers to be obtained from the Returning Officer; and every nomination paper shall contain the name, registered address and title to registration both of the candidate and of the nominated and will accept office if duly elected.

5 The nomination paper or papers for each candidate must be delivered by hand or by registered post to the Returning Officer on or before the 1st day of May 2025.

6 A nomination in respect of which any of these rules has not been complied with will be invalid.

The Secretariat as the Returning Officer The Dental Technologists Association, PO Box 1318, Cheltenham GL50 9EA

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DTA Strides Forward in 2024 Throughout 2024, the DTA has been actively involved in discussions with key stakeholders to address the challenges facing the profession.

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hey have called for accurate representation of dental technicians in occupational statistics, highlighting the unique challenges and demands of the profession. The DTA has identified that dental technicians are being grouped with medical technicians, which does not accurately reflect the profession’s specific needs and challenges.

Additionally, the DTA has been working to support the education and professional

development of dental technicians. We have encouraged laboratory employers to support students and offer apprenticeships, investing time into the future generations to ensure that dental technicians are trained on the most advanced tools available. The DTA has also been involved in discussions with Chief Dental Officers to discuss the future of dental technology education and ensure that training programmes are adequately supported.

Overall, 2024 has been a year of significant progress and advocacy for the dental technology profession, with the DTA playing a crucial role in advancing standards and supporting dental technologists across the UK.

CPD Expiring soon! ● Nanocomposite Mouthguards, Biomimetic Inspired Materials, and a Bacteria Busting Artificial Tongue – Articulate March 2024 ● Training to Perform CPR – Articulate March 2024 ● Agreements and Disagreements: Part 1: Agreements, Contracts, Ethics and the Law – Kevin Lewis – May 2024 TT ● Perio-Cardio Disease Link Explained – British Endodontic Society – May 2024 TT ● Dental labs at crisis point – Ashley Byrne – May 2024 TT

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● Complete Denture Examination – Dr Chris Turner – May 2024 TT ● Provisional Registration and Workforce Challenges – Stefan Czerniawski – May 2024 TT

On Facebook: @DentalTechnologists Association

On Twitter: @The DTA / #The_DTA

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■ Regulator News: PSA review recognises GDC progress and challenges The DTA reports on the dental regulator’s PSA review at the end of last year, which had many of the profession’s commentators making heated observations.

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he General Dental Council (GDC) has met 16 out of 18 Standards of Good Regulation for 2023/24, making significant improvements that achieved the standards in registration, without meeting the standards for EDI and fitness to practise timeliness, according to the Professional Standards Authority (PSA) annual review. A GDC spokesperson offers more information.

The GDC successfully met the Standards for Registration this year, reducing the backlog of overseas-qualified dentists who applied as dental care professionals (DCPs) significantly. The backlog of unworked DCP applications which stood at 5,700 in April 2023 following a change in legislation has now been eliminated, with all remaining applications scheduled to undertake a panel assessment by April 2025.

Key achievements highlighted in the review include reducing the average processing time for UK graduate registration to two weeks, enhanced support systems for those involved in fitness to practise (FtP) cases and strengthened stakeholder engagement and consultation processes. Tom Whiting, Chief Executive of the GDC, said: “We welcome the PSA’s recognition of our progress across multiple areas, particularly in registration, while acknowledging there is more work to do. We remain firmly committed to improving fitness to practise processes and implementing our EDI strategy.

“Our priority is ensuring we deliver effective regulation that protects patients and supports dental professionals. We welcome close working with partners and stakeholder organisations to build trust in effective regulation and achieve a goal that

we all share, which is patient safety and public confidence in the dental professions.”

The PSA commended the GDC’s work in seeking and acting on feedback from diverse stakeholder groups and its commitment to evidence-based policy development. It recognised the regulator’s efforts to improve communication with registrants during fitness to practise investigations, noting positive feedback about the more empathetic tone and improved signposting to support services. However, the review identified ongoing challenges in the timeliness of fitness to practise cases, particularly in cases older than 156 weeks.

With only nine cases older than 101 weeks, the GDC continues to reduce the number of older cases, which is more effective in FtP stages where the regulator can exert greater influence over timeliness.

The GDC has revised its fitness to practise processes to improve timeliness when investigating single patient clinical practice concerns. The move follows the successful pilot of revised processes for handling fitness to practise concerns raised about dental professionals with no allegations of impaired fitness to practise in the previous 12-months. The regulator has plans in place to further enhance communication and support for those involved in fitness to practise cases as well as reviewing its decision-making guidance to ensure that it addresses allegations of discriminatory conduct. The GDC recognised the PSA’s concerns that it needs to provide clearer visibility of the work underway to deliver the current EDI strategy and has published an update on the strategy that shows progress and areas where it needs to do more. The GDC’s EDI vision and approach will be incorporated into its corporate strategy from 2026, to ensure that EDI is embedded within its broader strategic objectives.

DTA Council meeting The DTA management team met during the annual autumn hybrid full council meeting in November 2025.

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resident Delroy Reeves, was very pleased to receive contributions from DTA Council members and also welcomed a new student representative Dan Bant. The team revealed that exciting plans are in place for the development of a series of webinars during 2025 that will focus on digital dental technology education while providing enhanced CPD. It was noted that the association’s Legal and Counselling helpline is highly regarded by members and considered a valuable membership benefit.

There was a strong consensus to investigate additional membership benefits, including the establishment of a Mental Health Helpline. Our flagship publication The Technologist and the online resource Articulate was discussed and we have issued a call for members to get in touch with videos and articles for these resources.

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■ Prof. Grant McIntyre Defends Fluoride Safety We often gain information regarding developments around us from social media and professional journals that purport to offer expert insights – when all too often those expert insights can be proven wrong.

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n this example a Scottish authority demonstrates that a US study regarding fluoride in water is at best flawed and at worst misinformed. Professor Grant McIntyre, Dean of the Faculty of Dental Surgery at the Royal College of Surgeons of Edinburgh, reacts to a new study published in the US ProfGrantMcIntyre

Aims: ■ To better understand the value of fluoride in drinking water ■ To gain an insight into the way research can sometimes drive misinformation

“Even the study’s authors admit there are flaws in the report’s methodology. For example, while the study analysed data from 74 studies conducted in 10 countries, 52 of these studies were in their view of ‘low quality’. Indeed, the report’s authors themselves acknowledge that ‘there is not enough data to determine if 0.7 mg/L of fluoride exposure in drinking water affected children’s IQ’.” He continues: “Furthermore, almost all of these studies were conducted in settings where other contaminants, such as coal pollution in China, were present, and based on single-point urine samples instead of 24-hour collections which provide greater accuracy.

“Fluoride is a naturally occurring mineral found in soil, food, and drink and also in drinking water supplies that helps restore

minerals lost to acid breakdown in teeth, reduces acid production by cavity-causing bacteria, and makes it harder for these bacteria to stick to the teeth. In some parts of England, local geology means the level of fluoride in public water is already at the level (1mg/l) that fluoridation schemes run at. This, one should note, is well below the World Health Organization’s safety limit of 1.5mg/L.” This limit is based on a daily water consumption of two litres.

Professor McIntyre added: “Public Health England estimate that if all 5-year-olds in England drinking water with 0.2mg/L of fluoride instead received fluoridated water of at least 0.7mg/L, then the number experiencing decay would fall by 17% in the least deprived areas, rising to 28% in the most deprived areas. “We are confident that fluoridation is safe and has significant benefits to public health in reducing tooth decay, particularly in more deprived areas.

Indeed, a further benefit of water fluoridation over other approaches is that it does not rely on behaviour change, which is particularly important for children and vulnerable groups.”

1 https://jamanetwork.com/journals/jamapediatrics/ fullarticle/2828425

Development Outcome C – 30 minutes

CPD Outcomes:

To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details.

■ Development of knowledge within your field of practice ■ Clinical area of study

Q1 Of the 74 studies conducted by the US team, how many were of ‘low’ quality?

A 12 B 30 C 52 D 47

Development Outcome: B

CPD Outc ome C

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Journal of the American Medical Association (JAMA) Paediatrics,1 that purports to link higher exposure of fluoride in water to lower IQ in children. Professor McIntyre said: “This study should not be regarded as providing any proof that fluoridation in water is harmful. On the contrary, there is overwhelming evidence to show that fluoridation has huge public health benefits.

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Q2 The report’s authors said there was not enough data to determine if how much fluoride in water will affect children’s IQ? A 0.5mg/L B 0.7mg/L C 0.9mg/L D 1.0mg/L Q3 In how many countries were the studies conducted?

A 10 B 23 C 40 D 15 Q4 Fluoride occurs naturally in what?

A Soil B Food C Drink D All of the above Q5 What is the World Health Organization’s safe limit for fluoride in water?

A 0.7mg/L B 0.2mg/L C 1.5mg/L D 2.0mg/L

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■ Are You Bullied at Work?

Pamela A. Swain MBE, MBA, FCMI is the BADN Chief Executive All at the DTA would like congratulate Pam Swain on her recent and well-earned MBE.

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urprisingly, bullying itself is not illegal in the UK. There is no current anti-bullying legislation in this country, although 32 US states – most notably Massachusetts, New York and West Virginia – have enacted workplace bullying legislation, the Healthy Workplace Bill.1 But what is bullying? According to Gov.UK and ACAS,2 bullying is unwanted behaviour from a person or group which is: ● Offensive, intimidating, malicious or insulting ● An abuse or misuse of power which undermines, humiliates, or causes physical or emotional harm to someone

Aims: ■ Discover what bullying is and how it manifests itself ■ How you might be bullied without knowing it ■ How you might be a bully without knowing it

Bullying Helpline are from public sector employees – predominantly NHS staff.

The Helpline website speaks scathingly about the NHS’ “tendency to appoint senior medical personnel into Head of Department or Team Leader posts, without first ensuring they have the relevant people management skills, leadership training, or basic employment law training”; and underlines the fact that the NHS is, “notoriously slow to take relevant, timely, action.

This might be a one-off incident, or a regular pattern of behaviour. It might take place face-to-face, on social media, in emails, in telephone calls... it presents itself in many ways, but most importantly, it might not be obvious to others, or even to the person being bullied.

“Disciplinary and Grievances Investigations have been known to take months and months to complete and are often carried out by managers who lack basic employee relations skills.”

In my opinion, this is also true in general dental practice. Employers (i.e., dentists) are not taught basic people management or leadership skills and know little of employment law. Practice managers are often the dental nurse who has been there longest, again without the required skills or training to manage staff.

The National Bullying Helpline3 speaks out regularly about the disturbingly high level of NHS employee calls to the helpline. Up to 80% of ‘work-related’ calls to The National

In this article, we will be looking at notimmediately-obvious forms of bullying, and exploding some of the myths surrounding it.

CPD Outcomes: ■ Effective management of self and others by recognising bullying in the workplace ■ Improved team working and leadership skills

Development Outcome: B

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bullying Myth 1: Bullying is always top-down – most bullies are managers. Not so – bullies can project horizontally, or even upwards, as well as downwards. Most managers bullied by their subordinates are loathe to admit to it, because they see being the target of bullies as a sign of weakness.4 Myth 2: Bullies work alone. Again, not always true. Bullying can be undertaken by groups of people who work together to isolate their target – otherwise known as “mobbing”. We will look at this later in the article.

Myth 3: Most bullies are male. Also, not true. Bullying is insidious, manipulative and emotional – it doesn’t require physical strength. Apparently, 80% of female targets are bullied by other women.5 According to Pelago Health,6 ‘Queen Bee Syndrome’ is a term used to describe “a high-ranking female employee, usually a manager, (who) intimidates and excludes her female subordinates, often leading to a hostile and uncomfortable work environment.” This can include, “making disparaging remarks about other women’s looks or abilities, refusing to help or mentor other women, and actively working to undermine their success”.

Myth 4: Only weak, timid people are bullied.

I know that this isn’t true, because I was bullied at work.

For those who don’t know me, I am 66 years old and not exactly backwards at coming forwards. I have been doing my job for 32 years now, and have p****d off a lot of people in dentistry by speaking up for dental nurses over those three decades.

Prior to working for the Association, I lived and worked in five different countries on both sides of the Atlantic – working for the Home Office in London, selling newspapers on a street corner and as an au pair in Vienna, working for the military at the NATO HQ in Brussels, working in investment banking in Bermuda and training as a holistic therapist in Boston, Massachusetts.

A timid wallflower, I am not!

I love my job. But, some years ago, I found myself suffering from anxiety, panic attacks and insomnia. I was suffering from minor ailments that gave me an excuse not to go to work. I had panic attacks every Sunday evening, dreaded turning on my computer in the morning and seeing the barrage of emails from the bully, and tried to avoid answering my phone.

I made an appointment with my doctor, who asked me lots of questions about work and then announced that I was being bullied and that she was sending me for counselling. My first reaction was one of disbelief – what do you mean, I’m being bullied? I’m a grown up, for heaven’s sake, an adult, not a child in a playground! But, during the six months counselling which followed, I began to see that she was right.

Types of “Subtle” Bullying According to the National Bullying Helpline, ‘Subtle Bullying’ is: “The actions of someone who behaves with mischief, often intentional and usually behind your back, with negative motive i.e., to ease you out of your role or cause you professional embarrassment... ...to bring you into disrepute or have you excluded in some way.” 7 This behaviour, “creeps up slowly but impacts on you negatively and leaves you questioning yourself.”

Mobbing: This is perpetrated by a group, rather than an individual, rather like a group of magpies surrounding a smaller bird and attacking it! However, mobbing – orchestrated by the bully – can be much more subtle, and some of those taking part may not be aware of exactly what they are doing.

Examples of mobbing include: ● Excluding you from social events – birthday celebrations, drinks after work, lunch, etc ● Colleagues stop talking when you enter a room ● You are kept out of the loop – excluded from/not informed about meetings, for example, or not included in e-mails, what’s app groups, etc., ● Gossip or rumours about you are circulated Gaslighting: The term “gaslighting” comes from a 1938 play set in 1880s London in which the husband dims the gas lights in their home and makes strange noises, removing items from the home and

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bullying manipulating his wife into thinking she is insane so he can steal from her; there is also a 1944 film starring Ingrid Bergman based on the play.

The term gaslighting has come to mean a cocktail of practices manipulating someone into doubting their own sanity. An employee who is the target of this subtle but unhealthy manipulative behaviour will struggle to understand what is happening.

The 2017 TV drama “The Replacement” deals with the same subject, but in an updated workplace environment.

The target of a gaslighting bully will: ● Believe they are imagining things ● Feel non-credible ● Feel constantly undermined and/or excluded ● Start to develop trust issues ● Lose confidence in themselves and their abilities

● Constantly putting someone down, devaluing their input or ridiculing their opinions ● Spreading gossip or malicious rumours about the chosen target ● Excluding a specific staff member from team social events

Are You Being Bullied?

The target may start to feel unwell, or even be signed off work by their GP with workrelated stress. Let’s be clear about this – gaslighting is an abuse of power. It is a manipulative power-game, which the bully plays with deliberate intent to control another individual.

Some Examples of Bullying ● Constantly criticising someone’s work – and not in a constructive manner! ● Deliberately giving someone a heavier workload than other staff ● Demanding that a specific staff member perform menial tasks not appropriate to their role ● Giving someone unattainable tasks and deadlines so that they fail to complete the task ● Withholding information – including details critical to the successful completion of the task they’ve been given ● Withholding tasks – re-assigning tasks to junior or less competent staff ● Giving impression that a specific staff member is unskilled or incompetent

● Do you feel intimidated or threatened at work? ● Are you regularly humiliated or ridiculed or made to look incompetent in front of colleagues? ● Are your efforts consistently undervalued or disregarded? ● Do you feel sick when you have to work with a particular colleague? ● Do you suffer frequently from minor ailments which cause time off work? ● Do you have the Sunday night jitters because you dread going to work on Monday?

If your answers to even some of these questions is “Yes”, then you are probably being bullied at work!

Why Me? According to VeryWellMind:8 Professional jealousy. Workplace bullies target those with talent because they either feel inferior or they worry that they are overshadowed by the other employee’s work and abilities. So, if you:

● Are intelligent, determined, creative ● Regularly contribute new and innovative ideas ● Go the extra mile and gain recognition for your hard work ● Move through projects quickly while others are struggling ● Are a perfectionist and striving for success you are a likely target for a workplace bully.

Social Envy. As we saw above, it is a myth that only weak, timid people are targets of bullies. In fact, targets are often popular, capable, socially adept and experts in their own field.

Control. Are you caring, social, collaborative – all characteristics which drain a bully’s power? If you are a team player, this may be the reason for the bullying. “Team-building is the antithesis of what a bully wants.

Bullies want to be in control and to call all the shots. So, you may be targeted by bullies because you are a team player9.”

Prejudice. You may be being targeted by a bully due to race, gender, age, sexual preference, religion/beliefs or disability. If so, under UK law, this constitutes harassment under the Equality Act 2020. Your employer MUST do all they can to prevent this and MUST take any complaint seriously and investigate it thoroughly. You can take legal action against your employer if you have been harassed in the workplace.10

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bullying Portrait of a Bully An article in the Guardian11 by Dr Mary Lamia suggests that bullying is a response to internalised shame. Bullies: “Tend to have high self-esteem and hubristic pride. They attack others to take away their shame, which allows them to remain unaware of their feelings... ...bullies cause shame to others by recognising and attacking their insecurities. Attacking others not only blots out the shame they are feeling, but it also stimulates the experience of power.”

According to VeryWellMind, bullies are insecure and bully others to make themselves feel superior. They may be resentful or jealous of the person they are targeting and lack empathy, so have no problem dominating, blaming, intimidating, or taking advantage of others. They lack the ability to relate to another person’s experience, refusing to acknowledge the repercussions of their behaviour and driven by a desire for power and attention.

A Family Lives’ article on Serial Bullies12 suggests that methods used by bullies to make it harder for others to recognise actual bullying include emotional blackmail, malicious gossip and one-on-one confrontations with no witnesses. The article goes on to say that when the bully realises that their target is close to complaining or exposing their misconduct, they neutralise the target by isolating them, destroying their credibility and reputation and then eliminating them through

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dismissal or forced resignation.

According to Family Lives, bullies are often charismatic and charming, portraying themselves as clever, successful, important, wonderful, kind, caring and compassionate.

In reality, they are frequently self-opiniated and arrogant with a superior sense of entitlement and an unhealthy need to feel recognised and admired.

They feel no remorse and have no conscience, seeing nothing wrong with their behaviour; are often convincing liars, particularly when asked to account for their actions; and are duplicitous, pretending to be acting in the interests of others when in fact acting in their own interests. They think of themselves as being of superior intelligence.

They manage others’ attitudes and allegiances by indoctrination and manipulating emotions, through being untruthful and drawing others into believing in their false reality. They will use intimidation and criticism to isolate their targets. They will also use gossip, backstabbing and lies to discredit their targets, plus plagiarising and taking credit for others’ work while feigning victimhood.

Family Lives sets out three stages of response when a bully is called to account: ● Denial: “Sometimes the denial is direct and robust, and sometimes it involves avoiding discussion of the matter that

has been raised, never giving a straight answer, deliberately missing the point and creating distractions and diversions.” ● Retaliation or counter-attack: “Firm criticism of the target, including counterallegations based on distortion or fabrication. Lying, deception, duplicity, hypocrisy and blame are the hallmarks of this stage” ● Feigning Victimhood: Can include bursting into tears, indignation, pretending to be “devastated” or “deeply offended”, being histrionic, playing the martyr and generally trying to make others feel sorry for them by creating a “poor-me” melodrama that allows the bully to avoid accepting responsibility for what they have said or done.

What Should You Do if You Are Being Bullied? ● Keep detailed notes, who, what, where, when. It is not necessary to “prove” that you are being bullied, but if you can produce a diary, letters, e-mails etc., this will strengthen your case. ● Inform your line manager – or their manager – or the HR Department – or the boss! All you have to do is raise the issue with your employer. Once you have lodged a formal complaint through the practice grievance procedure, it is the responsibility of your employer to ensure that your concerns are thoroughly and independently investigated. ● Contact the National Bullying Helpline – www.nationalbullyinghelpline.co.uk or 0845 225 5787. ● Contact ACAS – the Advisory, Conciliation and Arbitration Service 0300 123 1100 or https://www.acas .org.uk/discrimination-and-bullying ● If you are a dental nurse (or non-clinical manager/receptionist) who is a current member of BADN, your professional association, you can contact our Legal Helpline for free legal advice (number in the members’ area of our website www.badn.org.uk), contact our counselling/support Helpline in the Health & Wellness Hub (also in the

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Q1 Is there any anti-bullying legislation in the UK? A Yes but not in England B Yes but only in Scotland C No, not in the UK D Yes but not in England or Northern Ireland members’ area) or contact the BADN office (01253 338360). ● If you are a dental nurse (or non-clinical manager/receptionist) who is not currently a BADN member, you can join your professional association at www.badn.org.uk/join. ● Other members of the dental team can contact their own professional associations – eg the BDA (dentists), BSDHT (hygienist/therapists), BADT (therapists), DTA (technologists and clinical dental technicians at www.dtauk.org), BACDT (clinical dental technicians)

Q2 How many US states have enacted workplace bullying legislation?

A 48 B 32 C 15, largely in the northern states D 37 Q3 What percentage of work-related calls to the National Bullying Helpline are from public sector employees (largely NHS)?

A Over 37% B Up to 65% C Over 28% D Up to 80% Q4 Do bullies always work alone?

A Yes, it is a personal and targeted attack B Not always they sometimes work in groups (mobbing) C No, they sometimes involve others who may not actually know that they are bullying someone.

D b) and c) only Q5 What percentage of female targets are bullied by other women?

A 43% B 80% C 70% D 33%

BADN Survey on Abuse This recent impromptu survey showed that over a third of dental nurses had been the target of abuse in the workplace. Examples provided by respondents revealed that the majority of the abuse was in fact bullying by dental colleagues. BADN will be taking further action on this subject in 2025.

References: 1 https://healthyworkplacebill.org/ 2 https://www.acas.org.uk/bullying-at-work 3 https://www.nationalbullyinghelpline.co.uk /employees.html 4 https://www.corporatewellnessmagazine.com/ article/bullying-what-are-the-myths 5 https://www.corporatewellnessmagazine.com/ article/bullying-what-are-the-myths 6 https://www.pelagohealth.com/resources/ hr-glossary/queen-bee-syndrome/ 7 www.nationalbullyinghelpline.co.uk 8 https://www.verywellmind.com/reasons-why-workplacebullies-target-people 9 https://www.verywellmind.com/reasons-why-workplacebullies-target-people 10 https://www.gov.uk/workplace-bullying-and-harassment 11 https://www.theguardian.com/careers/2017/ mar/28/the-psychology-of-a-workplace-bully 12 https://www.familylives.org.uk/advice/bullying/bullyingat-work/serial-bullies-in-the-workplace

Q6 According to Pelago Health, ‘Queen Bee Syndrome’ involves a high-ranking female who does NOT do what?

A Intimidates and excludes female subordinates B Insists on mentoring and emotionally supporting colleagues C Makes disparaging remarks about other women’s looks or abilities D Refuses to help or mentor other women Q7 How many months of counselling did Pam undergo before admitting she was the target of bullying?

A 15 B Two C Four D Six Q8 Which of the following will the victim of ‘Gaslighting’ NOT experience?

A Begin to believe they are imagining things B Begin to feel emotionally dependent on the bully C Lose confidence in themselves D Develop trust issues Q9 What is listed as one of the common reasons for workplace bullying?

A Professional jealousy B Religious persecution C Frustrated desire D Dislike dating back to school days Q10 In an article in the Guardian, Dr Mary Lamia suggests that a bully is responding to what?

A An inferiority complex B Suppressed rage C Internalised shame D Imposter Syndrome the

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■ Living and working with change Part 2: Generational change Kevin Lewis Aims: ■ To demonstrate the continuous nature and accelerating pace of change ■ To explain the basics of generational theory and how it seeks to explain differences between different generations ■ To provide practical illustrations of the challenges of generational change and how it affects both our personal and professional life

CPD Outcomes: ■ Effective communication with patients, the dental team and others across dentistry, including when obtaining consent, dealing with complaints, and raising concerns when patients are at risk; ■ Effective management of self and effective management of others or effective work with others in the dental team, in the interests of patients; providing constructive leadership where appropriate; [Effective practice and business management].

■ Maintenance and development of knowledge and skill within your field of practice; Clinical and technical areas of study: Emerging technologies and treatments: ■ Maintenance of skills, behaviours and attitudes which maintain patient confidence in you and the dental profession and put patients’ interests first.

[Professional behaviours]

Development Outcomes: A, B, C & D

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his is the second in a series of three linked articles looking at the implications of change in our professional and personal lives. These implications are often practical and/or human in nature but they may have professional, ethical and often legal consequences – many of which might not be immediately apparent. In the opening article we focused upon the fast pace of technological change, and the impact of various forms of technology. In the current article we consider generational change as part of social and demographic change, and in a future issue of The Technologist we will conclude with an exploration of how attitudes and behaviour are influenced by change – and vice versa.

Much research has been carried out over the years to explain what is popularly known as ‘the generation gap’. It is hardly a recent phenomenon; it has existed over time and across continents but has

probably manifested itself in different ways not only because of world events and the effects of social and technological change, but also because of cultural differences. In some cultures, respect for older generations and a reluctance to challenge them is more deeply embedded than in others.

The particular relevance of this topic for dental technology and for individual dental technicians and CDTs, was brought into sharp focus by Ashley Byrne’s excellent article in a recent issue of this publication1 – summarising a message he has been taking to wider audiences. In that article he highlighted the existential threat to the dental technician workforce with 60% of technicians being aged 55 or older, and 22% being aged 65 or older. As the older cohorts retire and younger technicians leave the profession for one reason or another, the profession is shrinking fast with around 400 technicians leaving the ranks of the profession each year, and barely 5,000

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generationalchange Figure 1: Proportion of different catagories of dental registrant split by age cohort being registered currently (compared to 46,000 dentists and a fast-growing UK population of 69 million). Fig 1 places this in the context of the wider dental profession to illustrate why this age distribution has become such a key issue in dental technology and why dentists would be ill-advised to assume that they would be unaffected by this direction of travel. It is relevant to note in passing that there are about 430 registered CDTs of which only15% are female, while females comprise 30% of all registered technicians. In terms of new additions to the two registers, the proportion of females is also higher for dental technicians than for CDTs but the most significant fact in recent years is that the number of dental technicians is steadily falling while the number of registered CDTs is steadily rising, albeit from a smaller base.

Make of that what you will.

Yet as Ashley Byrne points out, the technological changes we are witnessing in dental technology would appear at first sight to make it an extremely attractive and exciting career option for young people at the cutting edge of the digital revolution. If this takes its logical course and the underpinning training and infrastructure is put in place, we may soon be approaching a new and very different challenge that has been experienced by so many other employers and workplaces in a variety of fields up and down the country, viz integrating very different people from very different generations and with very different career and life aspirations, expectations, attitudes and behaviour, into a single (hopefully cohesive) workforce.

Generational Theory It has long been the case that people from different generations tend to think and act differently; they often live their lives in different ways, by different norms and sometimes different values, and they respond to different peer influences. A number of theories have been advanced to explain and interpret this, the earliest published research by Karl Mannheim

Dentists

All DCPs

Technicians

Proportion who are Aged 55 and over

17%

14%

60%

Proportion who are Aged 65 and over

4%

1.8%

22%

Source: Extracted from GDC Registration Statistical reports Annual Review 2023 and Monthly October 2024

dating back almost a century. In today’s world where we place a higher value on hard evidence than upon anecdote and fashionable wisdom, current ‘generational theory’ is more in the latter category than in the former – but it is instructive nevertheless, and also of practical assistance in helping us to understand the views, attitudes and behaviours of people who are a lot older or younger than ourselves.

Generational theory is based on the premise that the things and events that surround us in our formative years, will have lasting effects on our views and values, attitudes and behaviours.2 From that starting point, the architects and purveyors of this theory have clustered the various age sub-cohorts into a number of ‘generations’ and ascribed various characteristics and labels to them. If one accepts that this is an artificial model with all the generalisations that are an inevitable consequence of that, it becomes easier to take it at face value and appreciate the many ways in which it helps us to make sense of the sometimes disparate forces that are at play in society and in the workplace.3 For example, Fig 2 illustrates a broadlyaccepted overview of what generational theory tells us. But if you look closely, you will be thinking very quickly that not every

Baby Boomer was ‘swinging’ in the 1960s – especially not the ones who weren’t born until 1965 (unless they were on the swings in the local playground of course). There is no doubt that post-war austerity hit some families a lot harder than others, just like more recent periods of austerity, and while the Great Depression of the 1930s and the Global Financial Crisis (GFC) of 2007-2008 are regularly quoted as points of reference, far less is spoken of the extreme economic volatility of the 1980s and early 1990s during which time many people became unemployed, many businesses failed and many UK families lost their homes. Some believe that generational change is cyclical, not linear, and that does resonate where economic change is concerned.

Similarly, not every member of Generations Y and Z owned a smartphone as they were growing up, just as not every Gen X had a personal mobile phone of any kind, nor every household in the Silent Generation had access to even a landline telephone.

Much of the period-defining technology attributed in Fig 2 to a particular generation has a lasting effect for subsequent generations and sometimes, previous ones too (social media being an obvious example) - but other technologies which are briefly groundbreaking are quickly the

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generationalchange superseded (audiocassettes and fax machines being a good example of this) and others (such as vinyl records) go out of fashion before making a re-appearance. The point to bear in mind with key technologies is that the generation which was growing up when they appeared, will have little or no understanding of what life was like before that (nor much interest in it either).

The labelling of these generational cohorts in this way, with sharp cut-offs, creates the slightly preposterous anomaly whereby someone born in (say) 1980 clearly has much more in common with someone born in 1979 than someone born in 1995, but is considered as part of the latter generational cohort. The term ‘cuspers’ has

been used to describe people who sit on the cusp between two cohorts and not surprisingly they relate to and demonstrate the characteristics of both to a varying extent – often moulded by whether they have older or younger siblings. But the real

value of the model rests in its ability to provoke thought, reflection and debate.

Those readers who have ‘Gen Alpha’ children or grandchildren may wish to pass some idle hours filling in the column on the right of Fig 2 – this can be quite a sobering

Figure 2: The generational cohorts and key events/things that have shaped them 79-96

59-78

45-58

29-44

13-28

12 or Under

Born 1928-1944

Born 1945-1965

Born 1966-1979

Born 1980-1995

Born 1996-2012

Born since 2012

SILENT GENERATION

BABY BOOMERS

GENERATION X

GEN Y [MILLENNIALS]

GEN Z [Post Millennials]

GENERATION ALPHA

DEFINING EVENTS

Great Depression World War II Rationing

Post War Austerity Cold War (The Swinging 60s) Moon Landing

Live Aid Computers

Twin Towers 9/11 GFC Social Media

COVID-19 Pandemic Diversity Environment

TECH SHAPING EARLY LIFE

Wireless Radio Motor Car Aircraft

Television Travel

Video PCs and Tablets Mobile Phone

Smartphone

Smart Tech AI and VR Climate

LINKS TO WIDER WORLD

Newspapers Reading

TV

The Internet

Music Streaming Social Media

Streaming and Sharing Video Content – Gaming

DRIVERS re WORK ATTITUDE

Fear of Unemployment Job Security Strong work ethic

Career Job for Life/Pension Home Ownership

Training Qualifications Quality of Life

Portfolio Careers Rights/Entitlement Assertiveness

Mental Health Inter-Generational Fairness

HOPES AND FEARS

Peace in our Time

Comfortable Retirement

Prospect of Deferred Retirement

Student Debt Work/Life Balance

What’s a Mortgage?

What’s a Pension?

Churchill

Thatcher/Blair

Bill Gates

Mark Zuckerberg

Greta Thunberg

AGE IN 2024

ICONIC FIGURE

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generationalchange exercise. It is highly probable that a social media influencer or media / performing arts celebrity will for that group be considered as iconic as Churchill had been for the Silent Generation.

Something very profound was already happening in the workplace long before the Covid-19 pandemic, reflecting a change in attitude amongst younger members of the workforce (Gen Y in particular, but also many Gen X). The demand for flexible working including home/hybrid working, compressed hours and a shortened working week, was building - fuelled in part by the 2014 Flexible Working Regulations4 made under the Employment Rights Act 1996 but strengthened by an increasing awareness of work-life balance and well-being. At that time many businesses were still owned and run by baby boomers who had been brought up on the notion that employees ‘went to work’, worked hard, interacted face-to-face with work colleagues and it was the boss who determined how that work was done and what hours were worked, where and when. Once more of those bosses were drawn from a different generation it became inevitable that some of these long-entrenched attitudes might start to change.

But it was technological change and the fast-tracking of emerging technology in response to the constraints of the pandemic that suddenly opened up not only the tools to make the recent transformation possible, but the change in attitudes and behaviour too. Online meetings and other forms of communication have become the rule rather than the exception, and a lot of CPD is delivered online too (as we explored in a previous issue of The Technologist)5. But work-life balance and mental health awareness had suddenly arrived centre stage and the post-pandemic working world would be very different from the one that had existed previously. Few of us could have imagined that by April 2024 a new employee could apply for and accept a job on its published terms, but having done so

would have a legal right to request flexible working from day one of their new employment.6 Obviously, an employer still has the right to refuse the request if it is clearly not practicable (or for other legitimate reasons) but there is no doubt that new technology has opened up possibilities that would have been unthinkable a decade or two ago – including for dental laboratories.

The workplace Having several generational cohorts in the same workplace can create both problems and benefits. The challenge is mostly one of fostering mutual understanding and respect, minimising conflicts and differences in understanding and perspective, and garnering maximum value and synergy from what the various groups can collectively bring to the party, The Silent Generation has become legendary for having quietly coped with one upheaval

after another during their lifetime – a major economic depression and a global pandemic (Spanish Flu), extreme climate events and in the middle of all that, World War II and its aftermath – and yet demonstrating extraordinary resilience and the apocryphally British ‘Blitz Spirit’, ‘stiff upper lip’ and ‘can do’ bravado. This was the ‘pick yourself up, dust yourself off…’ generation and rightly or wrongly they would probably force a wry smile at today’s emphasis on work-life balance, mindfulness, mental health and well-being, and the modern demand for counselling and support in coping with even the most trivial of life’s twists and turns.

But the differing attitudes and perspectives of different generations is also seen in changing attitudes to equality, diversity and inclusion, and in terms of the kind(s) of behaviours that are now considered appropriate and/or inappropriate, what is and isn’t acceptable ‘banter’ and what

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generationalchange represents harassment, bullying and coercion. The term ‘woke’ became more widely used in a pejorative sense, having expanded from its original (historic) narrow usage in the US, in the specific context of social, racial and gender equality, to embrace age and other forms of identity equality elsewhere in the world. This became (and continues to be) a source of contention within many UK workplaces and because the majority of people working in a dental laboratory will be GDC registrants, this can add a further layer of jeopardy for the unwary.

With issues of this kind gaining greater prominence, the workplace has become an increasingly complicated and risk-laden arena especially for employers, business owners, managers and supervisors, and we will examine this more closely in the concluding article in the series which will appear in the next issue of The Technologist.

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Digital immigrants – digital natives It has been suggested that the things that we grow up with are, from our personal perspective, neither ‘new’ nor ‘technology’ – they are just everyday ‘stuff’ that forms part of life’s wallpaper. Meanwhile, these same things may still be regarded as ‘new technology’ by older generations. Just as today’s younger generations can’t imagine any meaningful form of human life having existed before smartphones and social media, a sub-set of the baby boomers once wondered how they ever coped before Ceefax, Videocassettes or ‘Word Processors’.

Whatever happened to that cutting-edge technology, I wonder?

A catchy summarisation of the relationship between the various generations and technology is revealed in the terms ‘digital natives’ and ‘digital immigrants’.7,8 Millenials and Gen Z are described as digital natives

because they have never known a world without digital technology, so they are comfortable with it, and also with the language associated with it. It is literally second nature to them. But the Baby Boomers (and a significant proportion of Gen X) are collectively described as digital immigrants because they have had to learn from scratch about the unfamiliar digital world that they found themselves in. That is where the generalisation ends, of course, because within every age cohort there are the full-blown digital enthusiasts, always on the lookout for the next big new digital thing and ready to be fascinated, excited and energised by it - and then, those who participate only to the extent that they have to, in order to navigate life. There are many so-called ‘silver surfers’ amongst the Boomers who have taken to new tech and the digital world like a duck to water, and have become highly competent in its use.

In this context, gaming should perhaps be viewed as a type of postgraduate education, developing and refining necessary tech skills, rather than the vacuous, time-stealing leisure pursuit that many Baby Boomers see it as.

But the flip side is that digital natives have never needed to embrace and/or develop the ‘old’ skills of the analogue world, so they might place minimal value upon them.

Writing (and posting!) letters using pen, paper (and post boxes) and without the help of a spellchecker or predictive text is a fast-disappearing skill mostly reserved for Baby Boomers. Millenials and Gen Z want their interactions in bite-sized chunks – short, convenient, immediate and involving minimal effort. Hand-held devices are now the medium of choice. Pint-sized blogs and short summaries rather than long essays and books: reading a book in hard copy has become so yesterday (unless it features Harry Potter of course). And one of the casualties of that shift has been the time and thought that goes into everyday communications; what social media and instant messaging has spawned is the literary equivalent of ‘firing from the hip’ and a new shorthand language created to avoid

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generationalchange the onerous prospect of having to construct and type complete words and sentences.

We have entered the era of ‘Communication Lite’ and there is no way back.

Furthermore, one can no longer assume that conversations will always remain private and confidential, nor that images shared in confidence even with trusted contacts, will remain private. That misplaced presumption, coupled with the informality and ease of sharing of social media and other forms of modern communication, can have profound unintended consequences – and even digital natives can be caught out.

Demographics and the fabric of society The comedian Harry Enfield famously portrayed the exaggerated stereotype of Kevin Quentin Julius Patterson, the wellmannered child who morphed into the dreadful “Kevin the Teenager” on the stroke of reaching his 13th birthday. The character, along with Kevin’s legendary sidekick Perry Carter, reminded us that it has long been

the case that the generation going through their teenage years and entering adulthood at any moment in time, seem very different to those who completed that right of passage a decade or two earlier, or who have reached the other end of their working life. In very broad terms they are a couple of generational cohorts apart, so many of the explanations are to be found in Fig 2. But the actual differences are more nuanced than that, and it is the combination of all those underlying driving forces that creates the big picture that we see manifested in societal changes over time. As some sage once pointed out, every big picture is neither more nor less than the sum total of lots of smaller pictures. The trick is to understand how they all fit together.

In very general terms, many areas of work that were once heavily male-dominated, are no longer so. But that is not universally the case – Fig 3 below demonstrates the stark contrasts even within a relatively small field such as dentistry. Dentists are the only subgroup within dentistry showing anything approaching an equal male/female

distribution - but that was not always the case; it required a proactive policy intervention from the1980s onwards in terms of recruitment, to have moved from a male/female split not unlike that seen today for dental technicians and CDTs (back in the 1990s about 75% of dentists were male).

It is also true that in wider society one sees a higher proportion of younger people working in some occupations, and a lot more older people working in others. People are living longer, and retiring later. The UK population has been rising very quickly, mostly through immigration rather than childbirth and consequently the average age of the population is also increasing,9 i.e. we have an ageing population within which the number of women of child-bearing age has reached an all-time high (these are mostly Millennials, but include Post-Millennials (Gen Z) also. Despite this, the birth rate has fallen to the lowest level on record (1.3 children per woman in Scotland and 1.44 across the UK as a whole) which if continued would not be sufficient to sustain the UK population at stable levels without net immigration.

Figure 3: Male/Female split of different catagories of dental registrant

Dental Nurse

Orthodontic Therapist

Hygenist

Therapist

Dentist

Technician

CDT

Male

2%

6%

9%

14%

47%

70%

98.5%

Female

98%

94%

91%

86%

53%

30%

1.5%

Source: Extracted from GDC Registration Statistical reports Annual Review 2023 and Monthly October 2024

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generationalchange Women in the MIllenial cohort are on average tending to have fewer babies, and having them much later than might have been the typical pattern hitherto,9 and there are many societal and economic reasons which would explain this trend. Many of those same factors explain why, in comparison to even 10-15 years ago, more women return to work, and do so more quickly, after childbirth. Meanwhile it is also true that men are typically older when they become fathers for the first time, and a greater proportion of them are taking paternal leave (which wasn’t a realistic option for previous generations). All of this feeds through to changes in the workplace and career patterns – although to a much greater degree in some occupations than in others. And in recent years the subject of care for the elderly has grown in prominence, especially in terms of the

balance between the state, social care and family members in shouldering the responsibility for this in all of the financial, practical, emotional and other ways involved.

Comparable changes in birth rates are being seen in many other parts of the world despite proactive political interventions in some countries to encourage and incentivise a higher birth rate.10 With older generations living longer and requiring ever-more-complex and expensive medical and social care, governments are faced with the accelerating dilemma of a growing, economically inactive but increasingly highmaintenance and expensive older generation, becoming increasingly reliant on the support (both financial and practical) of a rapidly-shrinking adult workforce. On the other hand, the Baby Boomers have been a relatively charmed generation in

comparison to those preceding and succeeding them, and they have enjoyed many freedoms and material benefits and advantages that younger generations can only dream of. Many of the Boomers had undergone higher training and graduated at a time when tuition fees and student debt were unheard of, and they even received non-repayable grants towards the cost of student accommodation, living costs and travel to and from their place of training, This is one manifestation of the recent debate about inter-generational fairness. Gen X had arrived into the adult workforce at a time when there was much talk about new technology being likely to transform their working life, making it possible to enjoy more (and higher quality) leisure time, shorter working hours, early retirement and a long, healthy and comfortable period beyond that. They are still wondering what happened to all those promises, and asking what went so badly wrong and why.

Set against the current access and workforce crisis in NHS dentistry, and a normal retirement age drifting further and further into the sunset for those approaching it, it is difficult to believe that NHS dentists were in 1991 and for some years thereafter, being offered very generous terms for an Early Retirement Scheme, encouraging them to retire on an enhanced NHS pension at age 55. Say it quietly, but this was yet another timelimited bonanza enjoyed by the Baby Boomers that will never be repeated.

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It may appear paradoxical, but many Boomers today are choosing to continue working in some way, long into what could and would have been their retirement.

Many companies find it helpful to tap into this huge pool of experience in a mutual beneficial way, while recognising that not all of yesterday’s skills are transportable into (nor relevant to) today’s working environment. On the other hand, it is short sighted to assume that younger team members have nothing to learn from these older colleagues.

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generationalchange Figure 4: Involvement of different age cohorts of dentists/DCPs in Fitness to Practice cases

Dentists

DCPs (All

Age Cohort

22–30

31–40

41–50

51–60

61+

Proporton of all registered dentists

16%

31%

26%

18%

9%

Proportion with a FTP case

9%

27%

28%

23%

7%

Proporton of all registered DCPs

22%

33%

23%

15%

6%

Proportion with a FTP case

21%

37%

24%

12%

3%

categories)

Source: Extracted from GDC Registration and Fitness to Pracise Statistical reports (2023)

The generations and the GDC In 2013 there was a defining, watershed move to a much smaller and whollyappointed GDC. For many years since its creation in 1955 a significant proportion of the 50 original GDC members had been elected by fellow registrants, reflecting the original “self-regulation” trade-off against the fact that the cost of the GDC was to be met wholly by the registrants themselves with no Government contribution on behalf of the public. These days, while registrants still fund the entire cost of running the GDC, the 12 remaining GDC members (6 lay people, 4 dentists and 2 DCPs) are not placed there for their first-hand knowledge of what it’s like to work as a member of the dental profession, nor what the current challenges are. In most cases, quite the reverse because with very few exceptions there is a clear tendency to appoint individuals11 who spend more time serving in representative positions and/or on committees than working at the clinical coal face. The GDC’s Fitness to Practise Panels12 are a little more representative and it is from this Panel that the members of key committees are selected – such as the Professional Conduct Committee, the littleused Professional Performance Committee,

the Health Committee, and the Interim Orders Committee. But within the GDC itself, and across all of its Committees and clinical advisors, you would still struggle to find a level of representation remotely approaching the 47% of dentists or 55% of DCPs who are aged under 40.

Yet if ever there was a setting where it becomes crucial to be able understand the views, perspective, attitudes and behaviour of someone who might be one or two generations apart from yourself, this must surely be it and let’s face it, the stakes are pretty high. But there continues to be a mismatch between the age distribution of the people who sit on (and Chair) these committees, and the age distribution of the registrants who appear before them. This can become crucial when different generations have very different perspectives on (and experience of) the matters under consideration. It will also be clear from Fig 4 that while the younger dentists are involved in fewer Fitness to Practise (FtP) investigations than one might expect statistically based on the proportion they represent of all registrants, the same cannot be said of older dentists in their 40s and 50s. Interestingly, the reverse also appears

to be true for DCPs, with the tipping point seeming to come around 10 years earlier. It is also true that a much greater proportion of FtP cases involving DCPs relate to matters arising from their personal and private life, while the majority of concerns raised about dentists relate to their professional life and clinical performance – but a healthy dose of caution is still advised when interpreting any statistics which ‘aggregate’ very different results from very different groups and especially when there are wide differences in age and gender from one group to another, as illustrated

by Fig 4.

The GDC is not the only regulator to find itself struggling to find an appropriate balance in a very different professional environment, but it has attracted more criticism than most healthcare regulators for appearing to be disconnected from the professions it is regulating, out of touch and in some respects, out of date. As the transition to digital workflows gathers pace this becomes a real concern.

We will be looking more closely at changing attitudes to authority and establishment, in the closing article in this series. the

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generationalchange The generations and the Law The law is mostly inflexible, and does not change to take account of generational differences. Nor does legislative change happen quickly, because of the long process involved and the debate and input from both houses of Parliament before a law enters the statute book and comes into force. Amending Regulations which draw powers from an existing Act can be quicker and easier than primary legislation, and in many instances, this can be made even simpler by issuing an Amendment Order, and this power has been used many times to change legislation which affects the dental professions – including the Dentists Act itself.

Tort Law, which governs Clinical Negligence,13 does nod in the direction of measuring a clinician against their peers, but that should be interpreted in the sense of the expected standard being that which would be regarded as being reasonable, by

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a responsible body of other clinicians claiming to have the same skills. This would be valid in the sense of measuring a registered specialist against other registered specialists on the same specialist list, and similarly a general dental practitioner against other general dental practitioners, or one clinical dental technician against other CDTs. It does not imply measuring the standard of care against that of other dentists (or technicians/CDTs) of the same age and/or experience. In that sense the law is unforgiving in its stance that you have a duty of care to provide the same reasonable standard, however long you have been qualified and irrespective of how much experience you might have. If you can’t achieve that standard, you shouldn’t be carrying out the procedure(s).

But it remains the case that society evolves and changes a lot more quickly than the law, and most of the time it is the law that is playing catch-up. However, one often sees

sharp differences in how new laws are received by different generational cohorts.

Summary As working lives have been getting progressively longer in the UK, and retirements postponed, we are witnessing as many as four (or even five) generational cohorts rubbing shoulders in the same workplace and professional environment for the first time in history. This article has sought to demonstrate the impact of generational change in the modern world, and especially in relatively conservative fields such as healthcare including dentistry, and also the consequences of very different attitudes to new technology and its use.

Generational theory is fashionable and interesting up to a point, but it involves sweeping generalisations and is simply one way of looking at differences between generations, and helping us to reflect on why these differences might exist. In this

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Kevin Lewis, BDS (Lond) LDSRCS (Eng) FDSRCS(Eng) FCGDent article we have placed generational theory into the context of wider social and demographic change, where we start to deal with hard facts and evidence.

In the next issue of The Technologist, the concluding article in this three-part series will look more closely at how generational and technological change can impact attitudes, behaviour and risk, and how this in turn affects dental technicians and dental laboratories.

References 1 Ashley Byrne. Dental Labs at Crisis Point, The Technologist Vol 17 Issue 2, May 2024, 2 Prof Bobby Duffy Generations: Does when you’re born shape who you are? (2021) Atlantic Books 3 Rachelle Focardi. Reframing generational stereotypes (2021) McGraw Hill

4 The Flexible Working Regulations 2014 5 CPD - Legal, ethical and practical implications The Technologist Vol 17 Issue 1 Feb 2024 6 The Employment Relations (Flexible Working) Act 2023 (Commencement) Regulations 2024 7 Prensky, M. Digital natives, digital immigrants. Part 1 (2001) On the Horizon 9 (5): 1-6.

8 Prensky, M. Digital natives, digital immigrants. Part 2: Do they really think differently? (2001) On the Horizon 9 (6): 1-6.

9 Office for National Statistics via https://www.ons.gov.uk/ peoplepopulationandcommunity/ 10 Bhattacharjee N, Schumacher A et al Global Fertility in 204 countries and territories 1950-2021 with forecasts to 2100 The Lancet. 20 March 2024. doi: 10.1016/S0140-6736(24)00550-6.

11 General Dental Council appointed members via https://www.gdc-uk.org/about-us/who-we-are/the-gdccouncil 12 General Dental Council. Dental Professionals Hearings Service Panel members via https://www.dentalhearings.org/about-us/panelmembers/191 13 Standards: Good... Better... Best. The Technologist Vol 13 Issue 4 Nov 2020

Graduated in London 1971. He spent 20 years in full time general dental practice and 10 further years practising part time. He became involved in the medico-legal field in 1989, firstly as a member of the Board of Directors of Dental Protection Limited (part of the Medical Protection Society group of companies). He became a dento-legal adviser in 1992 and from 1998 was the Dental Director of Dental Protection for 18 years and also an Executive member of the Council (Board of Directors) and Executive management team of the Medical Protection Society, roles from which he stepped down in 2016. Since 2018 he has been a Special Consultant to the British Dental Association, in relation to BDA Indemnity.

He is a Founder and Ambassador for the College of General Dentistry, and was a Trustee Board member 2017-22 Kevin has been writing a regular column in the UK dental press since 1981 – originally as the Associate Editor of Dental Practice and since 2006 as the Consultant Editor of Dentistry magazine.

He still writes and lectures regularly in the UK and internationally, and has been awarded honorary membership of the British, Irish and New Zealand Dental Associations. He is also an Honorary Member of the British Society for Restorative Dentistry. the

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generationalchange Development Outcomes A, B, C & D – 60 minutes To complete your CPD, store your records and print a certificate, please visit www.dtauk.org and log in using your member details.

Q1 What proportion of registered dental technicians are aged 55 or older?

A 40% B 50% C 60% D 70% Q2 Reflecting recent demographic trends and other factors, what is the current ratio of registered dental technicians to registered dentists?

A 1 technician for every 11.2 dentists B 1 technician for every 9.2 dentists C 1 technician for every 7.2 dentists D 1 technician for every 5.2 dentists Q3 Someone who is aged 50 today is said to be part of which generational cohort?

A Millennial (Generation Y) B Baby Boomer C The Silent Generation D Generation X Q4 Who is credited for having created in 2001 the terms ‘digital natives’ and ‘digital immigrants’?

A Mark Prensky B Mark Zuckerberg C Mark Twain D Mark McDougall Q5 What was the full name of Harry Enfield’s fictional TV character “Kevin the Teenager”?

A Kevin Hieronymus Lewis B Kevin Ponsonby Caesar Henderson C Kevin Quentin Julius Patterson D Kevin Horatio Nelson Anderson Q6 98% of registered dental nurses are female, compared to only 2% male dental nurses. In which category of registrant does one find almost exactly the reverse of that extreme female/male split?

A Dentists B Clinical Dental Technicians C Dental Technicians D Orthodontic Therapists Q7 It is believed that all other things being equal, the UK population would be naturally sustained at a stable level if the birth rate were to be approximately 2.1 children per woman in the population. What is the approximate UK birthrate currently?

A 2.4 children per woman B 1.4 children per woman C 3.4 children per woman D 4.4 children per woman

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Q8 Approximately 47% of registered dentists and 55% of all registered DCPs are aged 40 or less. Which ONE of the following statements regarding the generational representation of individuals appointed onto the GDC itself and its Committees, and amongst its clinical advisers is NOT true?

A The Under 40s representation broadly mirrors that of the registrants as stated above B The representation of dentists aged 40 or under on the Council and its committees and clinical advisers is smaller than the 47% stated above C The representation of DCPs aged 40 or under on the Council and its committees and clinical advisers is smaller than the 55% stated above D The representation of both dentists aged 40 or under, and DCPs aged 40 or under on the Council and its committees and clinical advisers is smaller than the 47%/55% levels stated above Q9 Amongst 41-50-year-old registrants, the number involved in Fitness to Practise investigations is broadly comparable to the proportion of total registrants represented by this age group (within a margin of 1%/2%). In relation to this statement, which ONE of the following assessments is CORRECT? A The statement is true for dentists but not for DCPs B The statement is true for DCPs but not for dentists C The statement is true for neither dentists nor DCPs D The statement is true for both dentists and DCPs Q10 Under UK Tort Law*, which governs negligence claims, an individual’s Duty of Care is to deliver a standard that would be regarded as being proper and appropriate by who/what? (select the ONE option that you believe to be most accurate) * The detail differs slightly between Scotland/the rest of the UK but the underlying principle is comparable A A responsible body of other individuals of the same age registered by the GDC in the same category B A responsible body of other individuals of the same gender registered by the GDC in the same category C A responsible body of other individuals professing to have the same skills, such as being registered by the GDC in the same category, irrespective of their age, experience or gender D A responsible body of other individuals with equivalent qualifications and experience registered by the GDC in the same category

D

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■ Octopus Sucker Denture Fix Dr Eda Dzinovic Before we move on to talking about the way the octopus has inspired the latest development in denture retention let’s take a quick look at what is a truly remarkable creature. There are about 300 species distributed around the globe. They have blue blood due to the copper in their blood which is more efficient for transporting oxygen at low temperatures.

T

hey have three hearts: two just to pump blood through the gills and one more to circulate it to the organs. Many octopuses are able to escape danger by releasing a squirt of obscuring ink as they zoom away on a jet of water. All octopuses (plus all cuttlefish and some squids) are venomous, although only the blue-ringed octopus of Australia is dangerous to humans.

The animal has a huge brain. They can navigate mazes, solve problems, remember, predict, use tools and take apart just about anything from a crab to a lock — all but that last one are sophisticated hunting behaviours.

Octopi, along with squids and cuttlefish, are masters of camouflage, literally changing colour, brightness, pattern and even texture in a flash to hide in plain sight or advertise for a mate. Its eight arms can perform separate tasks simultaneously thanks to a large nerve cluster, like a mini-brain, at the base of each arm controlling its movement.

Aims: ■ To explore the latest in denture holding technology ■ Keeping up-to-date with denture developments

CPD Outcomes: ■ Maintenance and development of knowledge and skill within your professional scope ■ Technical areas of study ■ Emerging technologies

The curling and unfurling arms, dotted with more than 2,000 individually moving suction cups, contain two-thirds of the animal’s neurons. The suckers are equipped with chemical sensors that not only feel, but taste and smell as well. So, while an

octopus concentrates on hunting, its arms are moving it forward, testing the water and ocean floor, probing coral crevices and maybe even prying open a clam that it’s already caught.

It is these suction cups that interest us most.

Scientists are harnessing the power of nature by mimicking octopi suckers to help dentures stick to the mouth. A spokesperson for King’s College London explains.

For the first time, tiny ‘suction cups’ have been designed into 3D-printed dentures, helping them to stay in position. The research could help the 11% of the UK population who use a denture and the 350 million of people around the world who have no natural teeth at all.

Dentures remain the most common treatment for people who lose their teeth, particularly with age. Other options include dental implants, but these are expensive and not always available for people.

Many denture wearers will know the challenge of getting dentures to stay in place – known as ‘retention’. People are often reliant on supermarket denture adhesive, used to glue dentures back in place, but this option is unhygienic and unpopular with users.

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octopussuckerdenturefix To improve the situation, an interdisciplinary team of scientists at King’s College London explored how they could replicate the same process which enables octopuses to stick to slippery surfaces in dentistry. Octopuses have ‘suction cups’ in their tentacles which create a negative pressure and a vacuum, creating strong suction to fix them to rocks.

The team theorised that similar suckers could be added to dentures, allowing them to fix to the soft mucosa of the mouth. They designed 3D-printed models using computer-aided design (CAD) of upper and lower dentures.

When the models were analysed, they showed greater retention than standard dentures – though, thankfully, not so strong that users couldn’t remove them from their mouths entirely. The models had twice the amount of retention as normal dentures.

The scientists, from King’s Faculty of Dentistry, Oral, and Craniofacial Sciences, then explored how chemical changes could be used to help fix dentures in place. With dentures made from plastic, they showed how covering them with a thin lining of the keratin – the same protein found in skin and hair – forms a chemical bond with the keratin of the skin in the mouth (mucosa).

This further helps retention and is also invisible to the eye – not impacting the look of the dentures.

Lead author Dr Sherif Elsharkawy, King’s College London, said: “Having worked with denture wearers, who I often see in clinic,

for several years, I really wanted to improve their experiences.

“I first had the idea to replicate sticky surfaces in nature while biting into a peach.

I noticed how the furry skin stuck to the palate of my mouth and decided to investigate other sticky surfaces in nature.

Octopus suckers seemed like the perfect place to start.

“This research bridges nature and technology to tackle a long-standing challenge for denture wearers. By mimicking the ingenious adhesive strategies found in octopus suction cups, we have developed a prototype that offers improved grip and comfort in even the most demanding oral environments. Our findings pave the way for a new generation of dentures that can transform the quality of life for millions worldwide.”

About the author Dr Eda Dzinovic, researcher in dental materials, King’s College London, added: “This work showcases the power of ‘biomimicry’ (the practice of imitating nature’s systems, models, and elements) in solving real-world medical challenges. It’s inspiring to see how insights from nature, combined with cutting-edge manufacturing techniques, can lead to innovations that improve both functionality and patient satisfaction. Contributing to this project has been an incredible opportunity to push the boundaries of dental material science.”

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Development Outcome C – 30 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details.

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Q1 What percentage of the UK population use a denture?

A 23.5% B 19% C 11% D 17% Q2 How many people around the globe have no natural teeth at all?

A 627millio B 350million C 217million D 876million Q3 How do octopus suction cups work?

A By creating a negative pressure and suction B They exude a resin-like sticky substance C The muscles in octopus’ arms (they are not tentacles) can flex the suction cups to grip like fingers D When the octopus arms grip a surface, they form ridged contours Q4 What is keratin?

A An enzyme found in the sea B The same protein found in skin and hair C It is the filaments also found in sea urchin outer skins D It is type of salt that melts under pressure and helps octopus arms adhere to any surface Q5 How does keratin aid denture retention?

A It is stickier than shop-bought dental cement B Fine filaments painlessly insert themselves into the mucosa C It creates a chemical bond with the skin of the mouth D It is activated by saliva to create a biomimetic surface

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■ Legal Expenses for Dental Laboratories A spokesperson for UK Special Risks helps dental technologists to better understand legal expenses Legal expenses covers the advice, defence and costs associated when dealing with legal proceedings. For businesses, such as dental laboratories, this insurance offers financial protection and peace of mind when facing legal proceedings or threats of legal action being taken against them.

Access to legal expertise: Insurance policies often provide access to a network of legal professionals who can offer advice and representation, which is crucial in navigating complex legal issues and threats of legal action.

Why is this beneficial to me?

Claims Case Study Example:

unning a dental lab involves not only the technical and operational aspects but also (as with most businesses) there are various legal considerations and obligations. It’s essential to be aware of potential legal expenses that may arise in the course of running a business. Dental laboratories may incur various legal expenses related to their operations. Here are some potential benefits of investing in Legal Expenses Insurance.

Below is an example of when this type of cover could prove beneficial: Robert is a registered dentist as well as being the proprietor of the Insured business, RH Dental Ceramic Studio. Robert is facing fitness to practise proceedings before the GDC. The investigation involves an allegation of misconduct. It is alleged that Robert employed an unregistered person as a dental technician at their practice as they did not have the correct indemnity insurance in place which means Robert faces the potential consequence of being removed from the GDC register.

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Regulatory compliance: Expenses for legal advice and defence in respect of compliance with health regulations and standards set by organisations like the GDC Contractual disputes: Conflicts with suppliers or clients over contracts can result in complex legal dispute.

Access to documents: a suite of templates and standard legal documents by way of a document library for you to use in the dayto-day running of your business as required.

As the laboratory has legal expenses in force, the legal expenses claim is accepted and covered under the compliance and regulation section of the policy and an approved firm of solicitors are then appointed to provide Robert with advice and

guidance. Upon the advice of the solicitor, Robert submitted his representations to the Case Examiners for assessment.

The solicitors felt that the prospect of winning this case is above 51% (should this go to court) and they prepared a defence to send to the GDC. The defence states that there is well supported documentation that the technician in question was employed in the role of a process worker rather than as a dental technician and providing there is a registered GDC technician signing off or overseeing this work then there is no misconduct.

Eventually the case is concluded in Robert’s favour and no sanctions were placed on Robert or his GDC registration.

Conclusion In conclusion, legal expenses cover is an essential component of the insurance programme for a dental lab. It provides crucial protection, helps navigate complex legal situations and supports the business with legal advice when it needs it most. By investing in this coverage, dental labs can feel more secure and focus on what they do best: providing quality dental products and services. ● For more information, visit https://ukspecialrisks.co.uk/

Employment law: Costs for legal advice on employee contracts, disputes, or compliance with labour laws.

Dispute resolution: Fees related to mediation or litigation if disputes arise with clients, suppliers, or regulatory bodies.

Tax / VAT investigation costs Employee disputes: Issues such as wrongful dismissal or discrimination claims can arise, necessitating legal intervention. the

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■ Age UK Advice for an ageing dental technologist workforce It is a known fact that our dental technologist workforce faces a dilemma in that fewer young people are coming into the profession while many of our existing technicians are approaching or are already over retirement age but continue working. Here, driven by recent Arctic conditions, The Technologist reports the charity Age UK’s timely advice as the season gets colder and the flu bug bites, as does COVID and RSV.

Caroline Abrahams

Aim: ■ To advise technologists in the older age groups of more effective ways to protect themselves from winter diseases.

CPD Outcomes: ■ Better infection control and staff welfare ■ Awareness of respiratory infections and their effects

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● AGE UK urges every older person to protect their health by having a winter COVID-19 and flu jab as soon as they can. ● Some older people are also eligible for a Respiratory syncytial virus (RSV) vaccination this year and Charity encourages them to take advantage of it. ● RSV hospital admissions rose dramatically in October and November 2024, and in 2025 flu is still impacting NHS services.

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ith the roll-out of the winter flu and COVID vaccination programme underway until March, Age UK urges older people to do all they can to stay well this winter by having the vaccinations for which they are eligible as soon as they can. By having a vaccine those most at risk from respiratory illnesses can be protected through the colder months, preventing nasty winter bugs from developing into more serious illnesses and helping to minimise hospitalisations.1 Studies show that older people and particularly those managing health conditions are among those most at risk from the serious impacts of flu, COVID-19 and respiratory virus. The UKHSA weekly flu and COVID surveillance reports show those aged 85+ had the highest hospital admission rate for influenza between

December 2023 and May 2024. This was followed by those aged 75-84 who had the second highest rate.2 During January 2025 the BBC reported that patient hospitalisation thanks to the flu virus had risen to over 5400 a day!

The weekly rates of hospital admissions for older people with RSV has risen sharply since October 2024, leaping from 0.3 per 100,000 patients on October 14, to 2.92 on November 25 for the 65-74 age group. For the 75-84 age group, those figures have risen from 0.5 to 5.95 per 100,000 patients (almost 12 times as many) during the same period. For those 85+, the admission rate for RSV has risen from 1.27 to 14.05 (over 11 times as many) during the same period.3 Despite the risks across eligible groups, influenza vaccine uptake in the UK has generally been lower during the 2024 to 2025 season, compared to the previous 2023 to 2024 season among the 65+ age group. However, estimates show the effectiveness of the influenza vaccine against hospitalisation was 30% in those aged 65 and above,4 making it a vital tool in protecting ourselves against serious winter illnesses.

For the first time, the NHS is also offering vaccines for RSV, a common cause of

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ageukadvise coughs and colds which can be dangerous to older people. The jab was made available to all adults turning 75 on or after 1st September 2024. It is reported that one million patients took advantage of roll out.

In the first year of the programme, there will also be a one-off catch-up campaign for adults already aged 75-79 years old on 31st August 2025.5 Influenza and COVID vaccines will be available and are considered safe to have at the same time, but the RSV vaccine will be offered on a different day to the others.

Caroline Abrahams, Charity Director at Age UK said: “This winter is shaping up to be another worrying one for many older people as they struggle to balance keeping warm this winter with the cost of energy, changes in eligibility for the Winter Fuel Payment, and the rising cost of food. But having our vaccines when they are offered is something we can all do to help avoid serious illnesses, particularly as the weather turns cold.

“There are also other preventative steps that older people can take to help keep them healthier this time of year too, including proactively managing long-term conditions, keeping as warm as they can, eating well, and washing hands regularly, so they have the best chance of staying fit and well for as long as possible.

“If you’re eligible for a vaccine we would urge you to do everything you can to protect your health and take up the opportunity when it is offered. I am certainly doing so and I hope you will too.”

For some older people RSV may cause symptoms that are much like a cold, but this respiratory virus can also lead to more serious infections such as bronchiolitis or pneumonia. We understand that those who are not eligible at the moment may be frustrated to be missing out. However, this particular age range has been selected as there isn’t yet enough evidence regarding the vaccine’s effectiveness in the older age groups.

Hopefully, eligibility may be extended in the future, depending on the outcome of this initial vaccine roll out. For the RSV vaccine, you will be contacted by your GP to make an appointment, whereas for the winter COVID and flu vaccine, you can book on the NHS website, through the NHS App, or by calling 119 for free, you may also be contacted by your GP practice.

References 1 People who had received at least a third dose, or booster, of a COVID-19 vaccine have been less likely to die from COVID-19 since September 2021 compared with people who are unvaccinated.

2 a) https://assets.publishing.service.gov.uk/media/ 66f525f0a31f45a9c765ec5c/Weekly_flu_and_COVID19_report_w39.pdf b) Age UK analysis of: Cumulative cases by specimen date, England. UK Coronavirus Dashboard (2023).

Available at: https://coronavirus.data.gov.uk/details/ cases?areaType=nation&areaName=England 3 https://ukhsa-dashboard.data.gov.uk/ respiratoryviruses/influenza 4 Visit https://www.gov.uk/government/statistics/ surveillance-of-influenza-and-other-seasonalrespiratory-viruses-in-the-uk-winter-2023-to2024/surveillance-of-influenza-and-other-seasonalrespiratory-viruses-in-the-uk-winter-2023-to-

2024#:~:text=Respiratory%20syncytial%20virus%20( %20RSV%20)&text=Several%20surveillance%20syste ms%20indicated%20a,aged%2065%20years%20and %20above.

5 NHS England: More than one million people get RSV jab in first ever NHS rollout

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Q1 Which age group had the highest hospital admission rate for influenza between December 2023 and May 2024?

A 65-74 B 55-64 C 85+ D 75-84 Q2 Between 14 October to 25 November 2024 the hospital admission rate for RSV for the 65-74 age group rose from 0.3 per 100,000 to what?

A 0.6 B 2.92 C 1.60 D 5.93 Q3 Over the same period the rate of hospital admissions for RSV in the 85+ age group rose from 1.27 per 100,000 to what?

A 14.05 B 8.6 C 18.2 D 12.3 Q4 In the 65+ age group how effective was the influenza vaccine against hospitalisation?

A 22% B 30% C 40% D 14% Q5 How many patients took advantage of the RSV vaccination roll-out from 1 September 2024?

A 532,000 B 623,000 C One million D 1.5 million the

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■ Alternatives

Dr Chris Turner MSc, BDS, MDS, FDSRCS, FCGDent Specialist in Restorative Dentistry (Rtd) In this article I would like to consider what used to be, and maybe still is, a restorative challenge for both technicians and their dentists. I refer to the case of six maxillary crowns, from right canine, through the four incisors to the left canine. This may be related to a new smile design to correct imbrication when you will have followed the usual protocol of mounted study casts, your cast alteration and wax-up to create a new smile, prior to approval by both the patient and the referring dentist before preparations begin.

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n alternative is the case where the six maxillary anterior teeth are quite heavily restored and do not require a smile makeover, simply crowns keeping the existing mesio-distal widths of these teeth and therefore the correct emergence profiles of the crowns in relation to the periodontal soft tissues. My suspicion is that you will be presented with an impression containing six prepared teeth and if you are lucky a maxillary study cast to follow.

Aim: ■ To advise technologists in the older age groups of more effective ways to protect themselves from winter diseases.

CPD Outcomes: ■ Better infection control and staff welfare ■ Awareness of respiratory infections and their effects

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I suggest that this is making your work in the laboratory significantly harder than it should be and risking both incorrect emergence profiles and the possibility that the smile design you have created will be rejected by the patient and you will be asked to remake those crowns at no additional fee.

In an earlier article I stressed the importance of asking dentists to book in their work with you in advance to enable you to allocate

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sufficient time to each case and to ensure that you are able to maintain a reasonable work/life time balance. While you may not want to take this step for single crowns, I would urge you to insist when it comes to multiple crowns and bridgework and the increasingly complex cases we now see in older patients where heavily restored dentitions can require more complex rebuilding.

I should like to consider this complex case of a 58-year-old man referred to improve his appearance. (Fig 1). Where should we begin? I suggest that the choice of crowning just the six maxillary anterior teeth is not the place because there is a loss of posterior support and occlusal vertical dimension that needs to be corrected first. In this case, because he still had mandibular second molars in place it was possible to restore these arches with fixed-moveable bridges with telescopic crowns on the molars.

The maxillary arch required both crowns on natural teeth and implants. Some months later, by late November, this had been achieved (Fig 2). Some temporary anterior crowns have been made as a basic smile makeover. The right maxillary lateral incisor was left untouched – to show the patient and his family how much change had been achieved.

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time that you expect to spend on my patient’s crowns.

These complex cases require mounting onto a semi-adjustable articulator such as those made by Denar. I preferred Denar to say Dentatus because the facebow is ear fitting and more accurate rather than to a mark measured onto the skin. Many of you will have these and be prepared to loan a facebow to your dentists so that maxillary casts can be mounted at the hinge axis.

You need these mounted with a facebow in order to develop the correct incisal

guidance pathways on the anterior crowns and also to develop a canine guided occlusion.

Additionally, I preferred to have my own articulator that could be posted in its own blue plastic box as it is more informative to see mounted models rather than trying to hand-hold disarticulated models.

Turning to the crown preparations, in order to keep the mesio-distal widths of each tooth, then you should expect to receive two working impressions. The first with

‘Please can I have my new teeth for Christmas?’ asked my patient. This seems to be watershed time when demand increases and with it pressure on you and your time to meet this deadline before the long holiday break. I do not think this is reasonable, and was able to persuade my patient to wait until January, when we have all been refreshed from our holiday and can start again with time, that precious commodity, to give to complete the case.

Preparations were booked in for the first week in January for both patient and also with my technician. You may recall from a previous article how important a step this is for all parties and allows you to allocate the

Figure 4

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Development Outcome C – 60 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details.

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Q1 The writer suspects that the laboratory will be presented with an impression containing details of what?

A Lack of gingival details B Six prepared teeth C Perhaps a maxillary study cast D b) and c) only Figure 5 every other tooth prepared together with an elastomeric impression following gingival retraction, and the second after all six teeth have been prepared (Fig 3)).

This enables you to make three crowns on the first model and more easily establish both widths, emergence profile and labial contours. Once finished, they can be placed on the second model and the other three restorations similarly completed. An alternative solution making your work less difficult as the final result shows (Fig 4).

As you make the crowns you will create contact points. For central incisors these should be in the incisal third. Contacts move more gingivally as they progress distally as shown in this illustration (Fig 5).

The above technique may be a change of preparation methods for some dentists. I hope that my colleagues will listen to you as you advise and guide them about new ideas when they book in these cases with your laboratory.

Q2 In this case the maxillary arch required what?

A Crowns on natural teeth and implants B Prep for direct reconstruction using composite C Dentures on a cantilever bridge D Dentures on a Maryland bridge Q3 Which semi-adjustable articulator does Dr Turner prefer?

A Denar B Dentatus C Henau D Amann Girrbach Q4 What should you expect to receive to keep the mesio-distal widths of each tooth?

A Digital CAD files B Precision photographs C Bite registratio D Two working impressions Q5 What should the first working impression include?

A Full upper arch and margins B Every other tooth prepared C An elastomeric impression D b) and c) only Q6 When should the second working impression be taken?

A After radiography B Before the teeth are prepared C After all six teeth have been prepared D Once the patient has agreed to the digital smile design Q7 In relation to the maxillary model what does a facebow record?

A The occlusion B The hinge axis C a) and b) only D None of the above Q8 Which type of facebow does the author prefer in this case?

A One using skin reference points B No preference C An ear piece type D Facebows were not necessary for this case.

Q9 When you make three crowns on the first model what can you more easily establish A Widths B Emergence profiles C Labial contours D All of the above Q10 As you manufacture the crowns where should the contact points be for the central incisors?

A In the gingival third B In the mid third C In the incisal third D Adjacent to the canines

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■ Mental Health Part 2: Common Mental Health Conditions Tracey O’Keeffe, MA (Education), BSc (Critical Care), RN, MAFHP, MCFHP This is the second paper in this series on mental health. The first article explored the mental health continuum (Mental Health Matters 2022), risk factors for mental health problems (Mind 2017), as well as links between mental and physical health (Glew 2016; Naylor et al. 2016). It is clear that mental health is complex and not always linear. Poor mental health does not necessarily equate to a diagnosis, but there are some more common mental health conditions which will be discussed in this paper.

Mental Health deterioration icco et al. (2017) suggest that changes or deterioration in mental health can go unnoticed for a period of time, with potentially a slow movement away from positive mental wellbeing masked by coping mechanisms or even other problems more related to physical health. Many of the possible symptoms can also overlap with other conditions as well as being diverse and varied between individuals (see Figure 1).

and the situation may worsen more than if supported early on (Wang et al. 2005).

Dismissing signs and symptoms or incorrectly labelling them, can result increased uncertainty for that individual and their family with feelings of loss of control.

Fear of the unknown can be mitigated against by timely investigations to reach a diagnosis and responsive treatment plan.

Both professional and personal support networks can be initiated or strengthened.

Early detection and diagnosis clearly brings benefits (see Figure 2).

Lack of recognition can lead to a delay in diagnosis. This can be problematic as health interventions are not implemented swiftly, individuals are left to struggle with often very complex and disturbing health worries,

Specific mental health conditions

P

amount of conditions which can affect someone’s mental health. Anxiety and depression are two of the most common with McManus et al. (2016) suggesting that there are 8 in 100 people suffering in the UK with a mixed picture of both. Despite more mental health seeking behaviour and subsequent identification (Baker 2021), the figures here still do not represent all groups including homeless individuals or those in prisons or hospitals. The next sections will delve into both anxiety and depression, as well as touching on psychosis.

Anxiety

There are a varied and wide-ranging

Feelings of anxiety due to stress, change or pressure in life can be considered normal, but it becomes a problem when it feels

Physical

Psychological

Behavioural

Unexplained tiredness

Appearing anxious, distressed, tearful, sad or low

Unexplained tiredness

Indigestion or other stomach complaints

Irrational or illogical thought processes

Indigestion or other stomach complaints

Headaches

Forgetting things and/or difficulty taking in

Headaches

Figure 1: Signs and Indicators of Mental Ill Health

information Fluctuations in weight and/or changes in

Mood changes and indecision

appetite

Fluctuations in weight and/or changes in appetite

Sweating or always feeling cold

Finding it difficult to relax

Sweating or always feeling cold

Joint or back pain, chest pain, throat pain

Loss of motivation or sense of humour

Joint or back pain, chest pain, throat pain

Not being able to sleep

Being more sensitive than usual

Not being able to sleep

Shaking or obvious tension

Distracted or confused

Shaking or obvious tension

Responding to situations that others cannot see

Talking of hopelessness which may indicate suicidal thoughts the

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mentalhealth Figure 2: The Importance of Detection and Early Diagnosis Benefit

Reason

Clear up uncertainty

It can be upsetting to live with symptoms like memory loss and changes in personality, particularly if you don’t understand why they are happening. As there are a number of conditions that have similar symptoms it is important that an accurate diagnosis is made. Although the diagnosis can be hard news to hear, it can clear up uncertainty and help someone to feel more in control.

Help the individual and their family and friends

Planning for the future provides the opportunity to consider, discuss and record wishes and decisions.

to plan

This is known as advance care planning; the individual makes plans about what they wish to happen while they are most able to plan and make decisions.

Identify possible treatments and therapies

An individual may want to consider taking medication for example, to relieve the symptoms of dementia or depression. They may also benefit from therapies such as counselling or cognitive behaviour therapy.

Provide the right information, resources and

Through accessing information at an early stage someone can make best use of what is available

support

such as support groups. They can also identify financial support that they may be entitled to.

uncontrollable and the feelings are relentless and persist beyond a manageable timeframe (NHS 2022). Anxiety at this level can start to affect someone functionally within their life. Anxiety varies and subcategories exist (see Figure 3).

social or work activities. Breaking this cycle is difficult and is often the focus of treatment such as cognitive behavioural therapy (CBT) which helps to bring back a rational and logical perspective.

As expected, symptoms will vary with individuals and with the type of anxiety experienced. It is important to note, however, that the effect can encompass not only psychological worries, but also cognitive, physical and behavioural/social presentations (see Figure 4). The complexity of this can result in a downward spiral of experiences with each element interacting. Worry may bring on physical breathlessness resulting in further anxiety, changes in behaviour for fear of possible illness, and a subsequent withdrawal from

Figure 3: Types of Anxiety Post Traumatic Generalised stress Anxiety Disorder Disorder Obsessive Compulsive Disorder

Anxiety

Panic Disorder the

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Social Anxiety Disorder

Specific Phobias

Generalised anxiety disorder (GAD) can often stem from long-term physical poor health, substance misuse, trauma in earlier life, or possibly genetics (NHS 2020). Social anxiety disorder results in an individual feeling judged by others, and this can result in problems with social situations. Common manifestations are trembling, sweating, blushing, or feeling unable to relax into conversation (National Institute of Mental Health 2022). Long-term it can result in social isolation and withdrawal from society.

Another anxiety disorder is phobias, and whilst it is not unusual for people to be fearful of something, a long-lasting phobia which impacts the person’s life can become a diagnosable and significant condition.

Mind (2021) suggest the fear moves from general dislike or anxiety towards a particular thing to a worry completely out of proportion to the real level of danger.

Similar to GAD, this can result in limitations in life. The National Institute of Health and Care Excellence (2011) also describe panic disorder which manifests as overwhelming fear, occurring unexpectedly and frequently.

Physical symptoms often occur alongside creating breathlessness and sensations not dissimilar to a heart attack.

Obsessive compulsive disorder (OCD) is quite a well-known term, and most people usually associate it with cleanliness, checking and repeating. This can be troublesome for the individual, but it can manifests as, or escalate to, responsibility obsessions, identity obsessions, or even violent obsessions. OCD, as with other types of anxiety, can affect functioning and feel hugely impactful on the person and their life (International OCD Foundation 2022). One further anxiety condition is post-traumatic stress disorder (PTSD) which stems from previous lived experience of trauma, or indeed being a witness to traumatic events. The individual may re-live those moments and experience dissociative reactions including social withdrawal and detachment. Full amnesia may also occur if the symptoms become too emotional distressing (Royal Society of Psychiatrists 2021).

Other types of anxiety disorders exist, but all (including those above) can cause disruption to the individual, their family, and their lives. Treatments are varied and must be tailored to the individual in order to be useful and impactful. The include medications to help break the cycle and

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mentalhealth Figure 4: Symptoms of Anxiety

create confidence alongside various psychotherapy and counselling methodologies.

Depression Although we can all feel low at times and our mood can fluctuate, with depression these feelings become overwhelming, engulfing and can affect daily functioning.

There can be associated feelings of emptiness, sadness and irritability with the experience lasting for a fortnight or more with consistency despite distraction attempts and activities (WHO 2021).

Furthermore, these emotions can lead into a sense of hopelessness which can indicate an increased incidence of suicidal ideation.

As well as waking hours, depression often affects sleep further compounding the situation as energy levels drop and the desire to feel different depletes. Depression can range from mild to moderate with very severe depression often related to bipolar disorder. The individual experiences extreme “highs” and “lows”, often with associated reckless behaviour and increased sleep issues. Support can be challenging as safety needs to be ensured through each cycle of changing emotions and behaviours. (WHO 2021).

Depression can also be linked to physical poor health (Naylor et al. 2016), so any interventions, whether medication or therapeutics, need to be tailored accordingly again to individual requirements through a holistic approach.

Psychosis Rethink Mental Illness (2022) discuss psychosis suggesting it can be a one-off episode or linked to a particular condition. It can result in a disconnect from reality, often with experiences of delusions, hallucinations and cognitive impairment.

There are multiple causes, including life experiences as well long-standing health conditions (see Figure 5).

The experience of psychosis can be scary and disturbing with hallucinations focused any of the senses including visual, hearing

Physical symptoms

Cognitive symptoms

Increased heart rate. Difficulty breathing, Dizziness

Changes to thought processes/repeated negative thoughts

Psychological symptoms

Behavioral or social symptoms

loss of control. Fear of dying or having a heart attack. Wanting to escape or run away

Not wanting to leave the house. Substance abuse. Not being able to function

or even smelling. For that person, the experience is very real and can include frightening voices or a sense of being touched. Delusions can also be traumatising. Both symptoms can result in a feeling of persecution, punishment or responsibility to carry out acts on themselves and others. As well as extremely difficult for that individual, it can be a challenging situation for people close to that person too. Memory, decision-making and concentration can also be affected.

Each person is unique and the approach needs to be accordingly tailored. Causative factors include lived experience of trauma, physical health, and support networks. The next paper in this series, will focus on suicide and self-harm and what that means to those experiencing suicidal ideations or a need to self-harm, as well as their family and friends around them.

Psychosis can be treated with medications but it will depend on causative factors.

Therapeutic interventions can help, such as CBT, family support and other creative outlets to help understand the experiences of the past which may have triggered the condition (Rethink Mental Illness 2022).

Conclusion This second paper has explored some mental health conditions. There are many more with multiple variations in terms of presentation, symptoms and treatment.

References – Baker, C. 2021. Mental health statistics: prevalence, services and funding in England. [online] [viewed 2.12.22]. Available at: Mental health statistics: prevalence, services and funding in England - House of Commons Library (parliament.uk) – Glew, S. 2016. Closing the gap between physical and mental health training. British Journal of General Practice. 66 (651). 506-507 – International OCD Foundation. 2022. About OCD. [online] [viewed 2.12.22]. Available at: International OCD Foundation | What is OCD? (iocdf.org) – McManus S, Bebbington P, Jenkins R, Brugha T. (eds.)

2016. Mental health and wellbeing in England: Adult Psychiatric Morbidity Survey 2014. A survey carried out for NHS Digital by NatCen Social Research and the Department of Health Sciences, University of Leicester. [online] [viewed 2.12.22]. Available at: Mental health and wellbeing in England: Adult psychiatric morbidity survey 2014.

– Mental Health Matters. 2022. The Mental Health Continuum. [online] [viewed 25.8.22]. Available at:

Figure 5: Causes of Psychosis (based on Rethink Mental Illness, 2012) Life experiences Stress/anxiety. Homelessness.

Delirium. Grief or divorce.

Childbirth

Part of neurological condition

Triggered by severe stress or anxiety

Linked metal health conditions Schozophenia. Bipolar disorder. Depression.

Triggered by Postpartum psychosis. brain injury Delusional disorder

Psychosis Triggered by menopause

Genetic causes

Side effect of medication Effect of substance misuse and withdrawal

Brain chemicals

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mental-health-matters.org – Mind. 2017. What are mental health problems? [online] [viewed 25.8.22]. Available at: www.mind.org.uk – Mind. 2021. Phobias. [online] [viewed 2.12.22].

Available at: What is a phobia? - Mind – National Institute of Health and Care Excellence. 2011.

Generalised anxiety disorder and panic disorder in adults: management. [online] [viewed 2.12.22].

Available at: Panic disorder | Information for the public | Generalised anxiety disorder and panic disorder in adults: management | Guidance | NICE – National Institute of Mental Health. 2022. Social Anxiety Disorder: More Than Just Shyness. [online] [viewed 2.12.22]. Available at: NIMH » Social Anxiety Disorder: More Than Just Shyness (nih.gov) – Naylor, C., Das, P., Ross, S., Honeyman, M., Thompson, J., and Gilburt, H. 2016. Bringing together physical and mental health. A new frontier for integrated care. [online] [viewed 28.8.22]. Available at: www.kingsfund.org.uk – NHS. 2022. Overview – generalised anxiety disorder in adults. [online] [viewed 2.12.22]. Available at: Overview - Generalised anxiety disorder in adults - NHS (www.nhs.uk) – Picco L, Seow E, Chua BY, Mahendran R, Verma S, Chong SA, Subramaniam M. 2017. Recognition of mental disorders: findings from a cross-sectional study among medical students in Singapore. BMJ Open. Dec 21;7(12):e019038. doi: 10.1136/bmjopen-2017019038. PMID: 29273669; PMCID: PMC5778286.

– Rethink Mental Illness. 2022. Psychosis. [online] [viewed 3.12.22]. Available at: www.rethink.org – Royal Society of Psychiatrists. 2021. Post-traumatic stress disorder (PTSD). [online] [viewed 2.12.22].

Available at: Post-traumatic stress disorder (PTSD) | Royal College of Psychiatrists (rcpsych.ac.uk) – Wang P.S., Berglund P., Olfson M., et al. 2005. Failure and delay in initial treatment contact after first onset of mental disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 62:603–13.

10.1001/archpsyc.62.6.603 – World Health Organisation, 2021. Depression. [online] [viewed 3.12.22]. Available at: Depression (who.int)

■ Healthwatch England Priorities For Patient Access Rebecca Curtayne, Westminster Health Forum Priorities for Patient Access:

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ebecca Curtayne is the External Affairs Manager for Healthwatch England. She was one of the keynote speakers during the Westminster Health Forum policy conference ‘Next steps for dentistry in England – access, prevention, and reform. This is The Technologist version of her presentation.

Healthwatch England has been campaigning about access to NHS dentistry in England for years. In 2021 they launched #fixNHSdentistry but by 2023 there were still problems. A Healthwatch England poll carried out in September by Savanta, reveals that most people in England have misconceptions about their ‘right’ to an NHS dentist and want changes to how they access dentistry. Healthwatch England has published the first-ever research on people’s understanding of NHS dentistry and what they want from the service as the government develops its ‘Dental Rescue

Aims: ■ Understanding of the present situation for NHS dental patients ■ Potential solutions to the NHS access problem

CPD Outcomes: ■ Concerns raised about NHS patient care by Healthwatch England ■ Discussion of ethical issues in NHS dentistry

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Plan’ and revealed five key priorities that need to be addressed.

Access to NHS appointments – the survey found that one in six respondents surveyed in September hadn’t been seen by an NHS dentist in the previous two years because they couldn’t gain access to an appointment. Cancer treatments have had to be put on hold because the patient hadn’t seen a dentist.

One sufferer responded: “I need a dental sign off in order to continue essential treatment related to a cancer diagnosis. I am unable to find an NHS dentist and cannot afford private treatment, therefore I cannot have the medication required to continue my treatment.”

Another said: “Since lockdown ended, I’ve been trying to find a dentist accepting new NHS patients. Unfortunately, no result. Since then, the condition of my teeth has deteriorated rapidly – I have to blend most of my meals because I can’t chew them.”

Affordability – one in five people who had managed to access an NHS practice found it difficult to gain information regarding charges. A respondent explained: “I’m on benefits and can access free dental treatment because of this. I was sent an appointment for a scale and polish which the dentist had done for many years. This time it was the dental nurse, and I was told that they would be doing it from now on.

“After the appointment they charged me £58 and told me this is no longer a free treatment. However, no-one told us this beforehand and it was a lot of money to find. Charges should be made clear before any treatment/appointments, as if I’d known I wouldn’t have gone.”

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mentalhealth Finding an NHS practice – even those liable for free treatment such as pregnant mothers find it difficult to track down an NHS service. Even the NHS website is often out of date, and a change to the wording of an NHS questionnaire served to obfuscated the question of provision. It used to say ‘Do you provide NHS dentistry to new patients? Yes/No’. A simple yes or no answer. It now asks ‘Do you provide NHS dentistry when available?’ The answer might be yes but the practice is too busy at present. A patient might then contact that practice thinking they could book an appointment and discover that NHS care was not available after all.

A patient told the survey: “Not able to register as an NHS patient in or near Norwich since moving to Norwich in March 2022. None accepting new NHS patients. As a result, am still travelling to Wakefield in West Yorkshire where I was already registered for dental care.”

Lack of local services – if, as with the respondent above who has to travel from Norwich to Wakefield to access NHS dental services, you have to travel a great distance for treatment, that incurs an additional cost that some would find difficult, perhaps impossible, to afford.

getting NHS dental care, over half, 54% of 1,791 respondents said they want to be able to register with an NHS dentist as a permanent patient in the same way as they can with an NHS GP. This latter fact has been communicated to government by Healthwatch England, but to date no practical initiatives have been forthcoming.

In fact, the NHS dental service is only funded to cover half the population. We desperately need a debate about how NHS dentistry can be provided to those who need it most.

These are Healthwatch England’s key recommendations: ● The government to fundamentally reform NHS dentistry, following public consultation and clarity about who NHS dentistry is really for – and what proportion of the population’s needs will be funded. ● NHS England and the government to publish an evaluation of the new patient incentive payment introduced in March

this year. ● Department of Health and Social Care (DHSC) to confirm how it plans to deliver 700K extra urgent appointments as pledged during Labour’s election campaign. ● NHS England and dental commissioners to improve public awareness of how the NHS dental system works, to help people plan for alternative care if their practice opts out of the NHS contract. ● Better promotion of charge exemptions and low-income scheme. ● Dental practices to provide clear information about NHS charges ● IT improvements to create centralised booking for urgent NHS appointments and better real-time appointment information. ● Transparency over Integrated Care Board (ICB) spending of their dental budgets ● For more information about Healthwatch, visit https://www.health watch.co.uk/

Development Outcome A & D – 30 minutes To complete your CPD, store your records and print a certificate, please visit www.dta-uk.org and log in using your member details.

And finally, Continuity of care – 80% patients treated by an NHS practice received respect. But while 70% think there is continuity of NHS service, that is not always the case. What about those people who are registered with an NHS practice but the status changes? “I have been registered at the same dental care practice for over 50 years and I have always regularly had checkups and treatment when necessary.

Q1 In what year was the #fixNHSdentistry campaign launched?

A 2015 B 2024 C 2012 D 2021

“I was notified by the practice in April this year that with effect from 1st August the practice was only offering private treatment plans. I have been unable to find a dentist in South Tyneside willing to accept as an NHS patient.” The poll also revealed that over two-thirds, 68%, of respondents mistakenly believe they have the right to register with an NHS dentist as they do with an NHS GP. When asked about their preference for

Q4 How many respondents said they wanted to register with an NHS dentist as a permanent patient?

A 83% B 72% C 54% D 65%

Q2 Healthwatch England’s 2024 survey found what number of respondents had failed to access NHS dental care during the previous two years?

A 25% B One in six C 40% D One in three Q3 How many of the survey respondents mistakenly believe they have the right to register with an NHS dentist as they do an NHS GP? A 68% B 53% C 37% D 46%

Q5 Which of the following is NOT among Healthwatch England’s key recommendations?

A Fundamental reform of NHS dentistry following public consultation B NHS dentistry to be funded according to the US health insurance model C DHCS to confirm how it plans to deliver 700k extra urgent NHS appointments D IT improvements to create centralised booking for urgent NHS appointments the

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UK PROFESSIONAL DENTAL TECHNOLOGIST As an integral part of the oral healthcare team in the UK, we: ● are individually registered with the GDC to be able to use the titles that relate to our role in the UK ● maintain our own lifelong learning through relevant continuous professional development (as provided free to the Dental Technologists Association [DTA] members) ● ensure that we are covered by specific indemnity insurance related to our dental laboratory custom-made dental device manufacturing work, and if necessary, related clinical work and/or extended roles

● work within the GDC Scope of Practice for our registered role, along with other extended areas as confirmed by further additional training ● are, as a current GDC registered dental technologist, able to sign-off custom-made dental devices under MHRA/MDR regulations, indicating that such appliances are fit for purpose as stated on the Statement of Manufacture ● maintain and develop our dental team networks to enhance patient care

The leading professional body for UK Dental Technologists PO Box 1318, Cheltenham, GL50 9EA Telephone: 01242 461 931 Email: info@dta-uk.org

www.dta-uk.org