The new Council for Healthcare Regulatory Excellence will help to promote the interests of patients and to improve co-operation between the existing regulatory bodies – providing, in e?ect, a quality-control mechanism for their activities. The government and relevant professions will nominate individuals for this overarching council. The new council will not have the authority to intervene in the determination by the eight regulatory bodies of individual ?tness-to-practise cases unless these concern complaints about maladministration.... council for healthcare regulatory excellence
Over the past four decades the ?nancial outlay on NHS dental services has been around 5 per cent of total NHS funding. This contrasts with 10 per cent during the service’s early years, when the NHS was coping with decades of ‘dental neglect’. The population’s dental health has, however, been steadily improving: in 1968 more than one-third of people had no natural teeth; by the late 1990s the proportion had fallen to 13 per cent.
Dentistry is divided into several groupings.
General dental practitioners Concerned with primary dental care, the prevention, diagnosis and treatment of diseases of the gums and teeth – for example, caries (see TEETH, DISORDERS OF). They also deal with diffculties in biting and the effects of trauma, and are aware that oral disorders may re?ect disease elsewhere in the body. They will refer to the hospital dental services, patients who require treatment that cannot be satisfactorily carried out in a primary-care setting.
Most routine dental prevention and treatment is carried out in general dental practitioners’ surgeries, where the dentists also supervise the work of hygienists and dental auxiliaries. Appliances, such as dentures, crowns, bridges and orthodontic appliances are constructed by dental technicians working in dental laboratories.
There are around 18,800 dentists providing general dental services in the UK. These practitioners are free to accept or reject any potential patient and to practise where they wish. Those dentists treating patients under an NHS contract (a mixture of capitation fees and items of service payments) can also treat patients privately (for an appropriate fee). Some dentists opt for full-time private practice, and their numbers are increasing in the wake of changes in 1990 in the contracts of NHS general dental practitioners.
Community dental practitioner Part of the public-health team and largely concerned with monitoring dental health and treating the young and the handicapped.
In the hospitals and dental schools are those who are involved in only one of the specialities.
Around 2,800 dentists work in NHS hospitals and 1,900 in the NHS’s community services. In some parts of the UK, people wanting NHS treatment are having diffculties ?nding dentists willing to provide such care.
Restorative dentist Concerned with the repair of teeth damaged by trauma and caries, and the replacement of missing teeth.
Orthodontist Correction of jaws and teeth which are misaligned or irregular. This is done with appliances which may be removable or ?xed to the teeth which are then moved with springs or elastics.... dental surgeon
The Council is funded by doctors’ annual fees and is responsible to the Privy Council. Substantial reforms of the GMC’s structure and functions have been and are still being undertaken to ensure that it operates e?ectively in today’s rapidly evolving medical and social environment. In particular, the Council has strengthened its supervisory and disciplinary functions, and among many changes has proposed the regular revalidation of doctors’ professional abilities on a periodic basis. The Medical Register, maintained by the GMC, is intended to enable the public to identify whom it is safe to approach to obtain medical services. Entry on the Register shows that the doctor holds a recognised primary medical quali?cation and is committed to upholding the profession’s values. Under revalidation requirements being ?nalised, in addition to holding an initial quali?cation, doctors wishing to stay on the Register will have to show their continuing ?tness to practise according to the professional attributes laid down by the GMC.
Once revalidation is fully established, there will be four categories of doctor:
Those on the Register who successfully show their ?tness to practise on a regular basis.
Those whose registration is limited, suspended or removed as a result of the Council’s disciplinary procedures.
Those who do not wish to stay on the Register or retain any links with the GMC.
Those, placed on a supplementary list, who do not wish to stay on the main Register but who want to retain a formal link with the medical profession through the Council. Such doctors will not be able to practise or prescribe.... general medical council (gmc)
Founder groups: The National Institute of Medical Herbalists, College of Osteopaths, British Naturopathic and Osteopathic Association, The British Chiropractic Association, The Society of Homoeopaths, The British Acupuncture Association, The Traditional Acupuncture Society and the Register of Traditional Chinese Medicine.
Objects: to provide vital unified representation to contest adverse legislation; to promote the interests of those seeking alternative treatments; to maintain standards of competent primary health care; to protect the practice of alternative medicine if Common Law is encroached upon. The Council prefers to work in harmony with the orthodox profession in which sense it is complementary. Council’s first chairman: Simon Mills, FNIMH. Address: 10 Belgrave Square, London SW1X BPH. ... council for complementary and alternative medicine
“A good and proper diet in disease is worth a hundred medicines and no amount of medication can do good to a patient who does not observe a strict regimen of diet.” (Charaka Samhita 300AD)
A healthy diet helps maintain the immune system, builds up reserves and hastens recovery from illness.
A good general diet includes foods low in fat, salt and high in fibre. All white sugar and white sugar products (chocolates, sweets, etc) should be replaced with natural sugars (honey, dates, figs, molasses, raisins etc). It should contain plenty of raw fresh fruit and vegetables; best prepared in a juice-press.
Vegetables should be conservatively cooked in very little water with little salt in a covered vessel. At least one mixed raw vegetable salad should be taken daily. Bread can be replaced by jacket potato, Soya- bean flour products or ripe bananas. Puddings, pastry and suety meals should be avoided.
Lean meat should be restricted to two or three parts a week with liberal inclusion of oily fish. Tofu, a Soya bean product, is an excellent alternative to meat. Three or four eggs, only, should be taken weekly.
Dairy produce (milk, butter, cream) contain cholesterol which thickens the blood, blocks arteries and increases resistance against the heart and major blood vessels, and should be taken sparingly.
Accept: Garlic, Onions, Lecithin, Muesli or Oatmeal porridge for breakfast or at other times during the day, yoghurt, honey.
Reject: fried foods, biscuits, confectionery.
Salt: replace with powdered Garlic, Celery or Kelp.
Alcohol: replace with fresh fruit or raw vegetable juices. Coffee is a risk factor raising cholesterol concentration; Dandelion coffee, Rutin or any one of many herbal teas available offer alternatives.
Avoid over-eating and meals when tired. Foods should be well masticated without liquid drinks; dry- feed. Plenty of liquid drinks, water etc should be taken between meals.
Supplements: Vitamin C 200mg, Vitamin E 200iu, morning and evening. Evening Primrose oil. Efamol produce a combined Evening Primrose and Fish oil capsule.
Dietary fibre can prevent certain colonic diseases. Treatment of disease by diet is preferred to drugs because it has the advantage of being free from side-effects. ... diet - general
Most GPs work in groups of self-employed individuals, who contract their services to the local Primary Care Trust (PCT) – see below. Those in full partnership are called principals, but an increasing number now work as non-principals – that is, they are employees rather than partners in a practice. Alternatively, they might be salaried employees of a PCT. The average number of patients looked after by a full-time GP is 1,800 and the average duration of consultation about 10 minutes. GPs need to be able to deal with all common medical conditions and be able to recognise conditions that require specialist help, especially those requiring urgent action.
Until the new General Medical Services Contract was introduced in 2004, GPs had to take individual responsibility for providing ‘all necessary medical services’ at all times to their patient list. Now, practices rather than individuals share this responsibility. Moreover, the contract now applies only to the hours between
8.00 a.m. and 6.30 p.m., Mondays to Fridays; out-of-hours primary care has become the responsibility of PCTs. GPs still have an obligation to visit patients at home on weekdays in case of medical need, but home-visiting as a proportion of GP work has declined steadily since the NHS began. By contrast, the amount of time spent attending to preventive care and organisational issues has steadily increased. The 2004 contract for the ?rst time introduced payment for speci?c indicators of good clinical care in a limited range of conditions.
A telephone advice service, NHS Direct, was launched in 2000 to give an opportunity for patients to ‘consult’ a trained nurse who guides the caller on whether the symptoms indicate that self-care, a visit to a GP or a hospital Accident & Emergency department, or an ambulance callout is required. The aim of this service is to give the patient prompt advice and to reduce misuse of the skills of GPs, ambulance sta? and hospital facilities.
Training of GPs Training for NHS general practice after quali?cation and registration as a doctor requires a minimum of two years’ post-registration work in hospital jobs covering a variety of areas, including PAEDIATRICS, OBSTETRICS, care of the elderly and PSYCHIATRY. This is followed by a year or more working as a ‘registrar’ in general practice. This ?nal year exposes registrars to life as a GP, where they start to look after their own patients, while still closely supervised by a GP who has him- or herself been trained in educational techniques. Successful completion of ‘summative assessment’ – regular assessments during training – quali?es registrars to become GPs in their own right, and many newly quali?ed GPs also sit the membership exam set by the Royal College of General Practitioners (see APPENDIX 8: PROFESSIONAL ORGANISATIONS).
A growing number of GP practices o?er educational attachments to medical students. These attachments provide experience of the range of medical and social problems commonly found in the community, while also o?ering them allocated time to learn clinical skills away from the more specialist environment of the hospital.
In addition to teaching commitments, many GPs are also choosing to spend one or two sessions away from their practices each week, doing other kinds of work. Most will work in, for example, at least one of the following: a hospital specialist clinic; a hospice; occupational medicine (see under OCCUPATIONAL HEALTH, MEDICINE AND DISEASES); family-planning clinics; the police or prison services. Some also become involved in medical administration, representative medicopolitics or journalism. To help them keep up to date with advances and changes in medicine, GPs are required to produce personal-development plans that outline any educational activities they have completed or intend to pursue during the forthcoming year.
NHS GPs are allowed to see private patients, though this activity is not widespread (see PRIVATE HEALTH CARE).
Primary Care Trusts (PCTs) Groups of GPs (whether working alone, or in partnership with others) are now obliged by the NHS to link communally with a number of other GPs in the locality, to form Primary Care Trusts (PCTs). Most have a membership of about 30 GPs, working within a de?ned geographical area, in addition to the community nurses and practice counsellors working in the same area; links are also made to local council social services so that health and social needs are addressed together. Some PCTs also run ambulance services.
One of the roles of PCTs is to develop primary-care services that are appropriate to the needs of the local population, while also occupying a powerful position to in?uence the scope and quality of secondary-care services. They are also designed to ensure equity of resources between di?erent GP surgeries, so that all patients living in the locality have access to a high quality and uniform standard of service.
One way in which this is beginning to happen is through the introduction of more overt CLINICAL GOVERNANCE. PCTs devise and help their member practices to conduct CLINICAL AUDIT programmes and also encourage them to participate in prescribing incentive schemes. In return, practices receive payment for this work, and the funds are used to improve the services they o?er their patients.... general practitioner (gp)
Alternatives. Black Cohosh, Cactus, Chamomile, Lady’s Slipper, Ginseng, Hops, Jamaica Dogwood, White Willow, Wild Lettuce, Valerian.
Chamomile tea (mild analgesic).
Tablets/capsules. Any of the above.
Formula. Ginseng 4; Black Cohosh 2; Skullcap 2; Mistletoe 1; Motherwort 1. Dose: Liquid Extracts: 1 teaspoon. Tinctures: 2 teaspoons. Powders: 500mg (two 00 capsules or one-third teaspoon). Thrice daily. Children: see: DOSAGE. Cayenne pepper (Capsicum) sometimes successful.
Topical. Poultice: Chamomile, Hops, Linseed or Bran. Acute cases (cold), chronic cases (hot). Grated or bruised Horseradish root. Evening Primrose oil. Hot Cider vinegar, Tincture Arnica or Hypericum. Aromatherapy. 2 drops each: Juniper, Lavender, Chamomile to 2 teaspoons vegetable oil. Light massage. Diet. High protein. Calcium-rich foods.
Supplements. Vitamin B-complex, B6, B12, Niacin, Magnesium, Dolomite, Zinc.
See: FACIAL and INTERCOSTAL NEURALGIA; DYSMENORRHOEA (neuralgia of the womb). ANTISPASMODICS. ... neuralgia, general
The affected tooth aches or throbs, and biting or chewing is usually extremely painful. The gum around the tooth is tender and may be red and swollen. An untreated abscess eventually erodes a sinus (channel) through the jawbone to the gum surface, where it forms a swelling known as a gumboil. As the abscess spreads, the glands in the neck and the side of the face may become swollen, and fever may develop. Treatment may consist of draining the abscess, followed by root-canal treatment of the affected tooth, but in some cases extraction of the tooth is necessary. Antibiotics are prescribed if the infection has spread beyond the tooth.
An abscess in a periodontal pocket can usually be treated by the dentist scraping away infected material.... abscess, dental
For minor procedures, a local anaesthetic (see anaesthesia, local) is injected either into the gum at the site being treated or into the nerve a short distance away (called a peripheral nerve block).
In addition, topical anaesthetics are often used on the gums.
For more complicated procedures, such as periodontal (gum) surgery and multiple tooth extractions, general anaesthesia is carried out (see anaesthesia, general).... anaesthesia, dental
General anaesthetics have become much safer, and serious complications are rare.
However, severe pre-existing diseases such as lung or heart disorders increase the risks.
Minor after effects such as nausea and vomiting are usually controlled effectively with antiemetic drugs.... anaesthesia, general
The surface of the affected tooth is painted with oxidizing agents and then exposed to ultraviolet light.... bleaching, dental
It is sometimes used as an alternative to crowning (see crown, dental) and may also be used as a preventive technique to protect the teeth.... bonding, dental
at the tooth’s core. Advanced decay causes toothache and bad breath.
Treatment consists of drilling away the area of decay and filling the cavity (see filling, dental). In advanced decay, it may be necessary to remove the infected pulp (see extraction, dental).
Water fluoridation and the use of fluoride toothpaste helps prevent caries.
The risk of caries is also reduced by cutting sugar consumption, practising good oral hygiene, and visiting the dentist regularly.... caries, dental
A crown may be fitted by filing the natural tooth to form a peg and cementing the crown over the top. If the tooth is... crown, dental
Dental curettage is one method used to remove the lining of periodontal pockets and diseased tissue from root surfaces in periodontitis.... curettage, dental
(See also caries, dental.)... decalcification, dental
During a routine dental examination, the dentist uses a metal instrument to
probe for dental cavities, chipped teeth, or fillings. Dental X-rays are sometimes carried out to check for problems that may not be visible. Dentists also check how well the upper and lower teeth come together. Regular examinations in children enable the monitoring of the replacement of primary teeth by permanent, or secondary, teeth. Referral for orthodontic treatment may be made. dental extraction See tooth extraction. dental X-ray An image of the teeth and jaws that provides information for detecting, diagnosing, and treating conditions that can threaten oral and general health. There are 3 types of dental X-ray: periapical X-ray, bite-wing X-ray, and panoramic X-ray.
Periapical X-rays are taken using X-ray film held behind the teeth. They give detailed images of whole teeth and the surrounding tissues. They show unerupted or impacted teeth, root fractures, abscesses, cysts, and tumours, and can help diagnose some skeletal diseases. Bite-wing X-rays show the crowns of the teeth and can detect areas of decay and changes in bone due to periodontal disease. Panoramic X-rays show all the teeth and surrounding structures on one large film. They can show unerupted or impacted teeth, cysts, jaw fractures, or tumours. The amount of radiation received from dental X-rays is extremely small. However, dental X-rays should be avoided during pregnancy.... dental examination
outer surfaces of the front teeth is most frequently caused by excessive intake of fruit juices and carbonated drinks. Erosion of the inner surfaces of the molars may be a result of the regurgitation of stomach acid, as occurs in people suffering from acid reflux or bulimia. (See also caries, dental.)... erosion, dental
For most extractions, local anaesthesia is used (see anaesthesia, dental). Teeth are usually extracted with dental forceps, which grasp the root of the tooth. In difficult extractions, some gum and bone may also need to be removed from around the tooth.... extraction, dental
using soft nylon or silk thread or tape.
Dental floss may be waxed or unwaxed.
Flossing should be carried out as an adjunct to toothbrushing.... flossing, dental
Fractures may involve the crown or the root of a tooth, or both.
Fractures of the enamel can usually be repaired by bonding (see bonding, dental); in some cases, a replacement crown may be fitted (see crown, dental).
Pulpotomy may be performed if the pulp of a tooth is damaged.
Fractures of the root may be treated by splinting (see splinting, dental), root-canal treatment, or removing the tooth (see extraction, dental).... fracture, dental
Impacted wisdom teeth are common, and, if symptomless, may not need to be removed.
In some cases, however, symptoms necessitate their removal.... impaction, dental
A quick-setting material, such as alginate, is placed in a mould over the teeth.
The mould is removed, and plaster of Paris is poured into it to obtain a model of the area.
This model is then used as a base on which to build a denture, bridge, or dental inlay.
Dental impressions are also used in orthodontics to study the position of the teeth and to make orthodontic appliances to correct irregularities.... impression, dental
An inlay may be needed for the back teeth or to protect a weakened tooth.... inlay, dental
Overcrowded teeth may lead to malocclusion or may prevent certain teeth from erupting through the gum (see impaction, dental). They can be difficult to clean, increasing the risk of dental decay (see caries, dental) and periodontal disease.
Teeth may need to be extracted to allow room for others. Usually an orthodontic appliance is fitted to the remaining teeth to position them correctly.... overcrowding, dental
It is the chief cause of tooth decay (see caries, dental) and gingivitis, and forms the basis of a hard deposit (see calculus, dental).
Some of the microorganisms in plaque, particularly STREPTOCOCCUS MUTANS, break down sugar in the remains of carbohydrate food that sticks to the mucus, creating an acid that can erode tooth enamel.... plaque, dental
protease inhibitors A type of antiviral drug used to delay the progression of HIV infection (see AIDS).... prosthetics, dental
Internal resorption is rare, occurring in about 1 percent of adults.... resorption, dental
GMC website: includes the Council’s guide to Good Medical Practice... general medical council