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Green veg fights mouth cancer

Mouth cancer awareness campaigners, the British Dental Health Foundation, believe the study is further evidence of the link between poor diet and mouth cancer, one of risk factors for developing the disease.

Cruciferous vegetables are from the vegetable family Brassicaceae and include broccoli, cauliflower, cabbage, sprouts, watercress and radish.

The research1, which is presented in the Annals of Oncology, revealed that compared to men and women who ate no cruciferous vegetables, those who ate their greens vegetables at least once a week cut their risk of mouth cancer by almost a fifth (17%).
The benefits of cruciferous vegetables didn’t stop there. Results also showed the vegetables cut the risk of oesophageal cancer by more than a quarter (28%), colorectal and breast cancer by almost a fifth (17%) and kidney cancer by almost a third (32%).

Although the authors concluded the study provides ‘additional evidence’ on the benefits of cruciferous vegetables, chief executive of the British Dental Health Foundation, Dr Nigel Carter expressed a need for people to recognise the role poor diet plays when it comes to mouth cancer.

Dr Carter said: ‘Around a third of all cases of oral cancer are thought to be linked to an unhealthy diet. The Foundation recommends that people ensure they eat a healthy, balanced diet, with plenty of fruit and vegetables. There is also increasing evidence that suggests Omega 3, found in fish and eggs, can help lower risks of oral cancer, as can foods high in fibre such as brown rice, whole-wheat pasta, nuts and seeds.

‘The number of people being diagnosed with mouth, throat and food pipe cancer is continually rising. Researchers believe this is due to excessive smoking, drinking and an unhealthy diet among the young, while new research shows a dramatic rise in oral cancer as a result of the human papilloma virus and oral sex.

‘We must not forget tobacco is still the most likely cause of mouth cancer, linked to around three-quarters of all cases of a disease which kills one person every five hours in the UK. With new cases occurring all the time, too many people still remain unaware of the risk smoking poses. Encouraging people to quit smoking and pursue a healthy lifestyle would reduce the risk of developing oral cancer.”

The Foundation runs Mouth Cancer Action Month, supported by Denplan and Simplyhealth, throughout November under the tagline ‘If in doubt, get checked out’. The campaign aims to raise awareness of mouth cancer among the public, the risk factors associated with the disease and what the public should look out for. These include ulcers that do not heal within three weeks, red and white patches in the mouth and unusual lumps or swellings in the mouth.


1. C. Bosetti et al. Cruciferous vegetables and cancer risk in a network of case-control studies Ann Oncol (2012) 23(8): 2198-2203 first published online February 10, 2012 doi:10.1093/annonc/mdr604

The new law increases the percentage of hydrogen peroxide allowed in tooth whitening or bleaching products to 6%, subject to conditions, including first use by a dental practitioner or under their direct supervision.

The change follows as an amendment to the EU Directive 76/768/EEC concerning cosmetic products. The amending Council Directive 2011/84/EU was published in September 2011 requiring the UK government to amend the law. The Cosmetic Products (Safety) (Amendment) Regulations 2012 (The ‘regulations’) amend the previous regulations relating to tooth whitening.

The new regulations allow the use of hydrogen peroxide and other compounds or mixtures that release hydrogen peroxide, including carbamide peroxide and zinc peroxide to be used for tooth whitening. The maximum concentration that may be used for tooth whitening under the regulations is 6% present or released.

In very broad terms, a percentage expressed in terms of carbamide peroxide content will release one third of that level of hydrogen peroxide. So, the commonly used products containing 16% carbamide peroxide would be permitted under the revised regulations as they would be releasing less than 6% hydrogen peroxide.

“Securing this change has been a long, frustrating process, and the time it has taken to achieve has been detrimental because the number of cowboy bleaching outlets has increased. Although overdue, this is a positive step that will, I hope, mean a new era for patient safety. To make that a reality, Trading Standards will need to wield its new power against non-dental professionals effectively, and the GDC will need to maintain its efforts to prosecute such individuals. Dentists can help by reporting breaches to both bodies. This change is not the end of the road of course; we must now re-focus on the issues of the use of higher strength products and whitening for patients aged under 18. But this is a significant step, and it should be recognised as such” Dr Stuart Johnston
Member of the BDA Principal Executive Committee and chair of the Council of European Dentists Tooth Whitening Products Working Group

Only for you
Under the regulations, only dental practitioners can purchase tooth-whitening products containing or releasing up to 6% hydrogen peroxide. This may lead to dental professionals being asked to provide tooth-whitening products to individuals who are not under their care. It could be construed as a breach of the regulations if a dentist (or a practice) sold tooth-whitening products containing or releasing more than 0.1% hydrogen peroxide to someone other than a patient undergoing tooth-whitening treatment.

First cycle
There is a risk that a patient who has not had appropriate instruction on loading a home tooth-whitening tray with the tooth-whitening product and who has not received instruction on fitting the tray could be at risk of swallowing excess material. The requirement that the first use of each cycle is by a dental practitioner (or under their direct supervision), helps to allay these concerns.

The regulations do not set out how long the trays must remain in the mouth for the first use. This will be a clinical judgement. Make sure you keep a detailed contemporaneous record of the instructions given at the first appointment.

The requirement that the first use of each cycle is by the dentist (or under their direct supervision) means that tooth-whitening products containing or releasing more than 0.1% hydrogen peroxide cannot be sold to patients at reception or by post.

Under supervision?
The regulations do not set out who can provide tooth whitening under the dentist’s direct supervision. However, the GDC’s Scope of Practice sets out that hygienists and therapists can provide tooth whitening under the prescription of a dentist, if they are trained and competent. So, hygienists and therapists can administer the first use of tooth whitening, if an equivalent level of safety is ensured.

Trained and competent
The regulations do set out that the treatment is under the ‘direct supervision’ of the dentist but do not define this. In Maintaining Standards, the GDC used the term ‘direct personal supervision’ to indicate when the dentist was to be on the premises.

Home use
After the first in-surgery application, the patient can be provided with the tooth-whitening product for home use. If the patient requires additional product for that course of treatment, the product should be dispensed by the dentist or hygienist/therapist.  

The change in the law means dental practices can advertise tooth-whitening procedures using products containing or releasing up to 6% hydrogen peroxide. However, some ‘power bleaching’ and other in-surgery bleaching techniques rely on the use of products that contain or release more than the permitted 6% levels of hydrogen peroxide. It would be unwise to state, suggest or imply that such techniques are being offered and information placed in the public domain, such as practice websites, should take great care to avoid any words or images that would suggest the availability of these services.

Medical devices directive
Some manufacturers in Europe are marketing tooth-whitening products containing or releasing more than 6% hydrogen peroxide as medical devices. Even if a tooth-whitening product is marketed as a medical device, it falls within the regulations and the EU Directive. This means it is not possible to circumvent the regulations by using a product with a CE mark.

Under 18s
The regulations and EU Directive state the product should not be used on patients aged under 18. This means it is only possible to test products containing or releasing up to 0.1% hydrogen peroxide on patients under 18. It has been suggested that tooth-whitening products could be classified as a medical devices and, as such, The Cosmetic Products (Safety) (Amendment) Regulations 2012 do not apply. However, even where a product is marked with a CE mark, the regulations do apply. This may create a dilemma for dentists who consider it would be in the best interests of a patient under 18 years of age to provide tooth whitening to an isolated non-vital tooth. If a dentist wishes to provide treatment, they are advised to have a discussion with the patient/parents and document all consultations. In providing treatment in breach of the regulations, dental professionals leave themselves vulnerable to a complaint.

Breach of the regulations
The Consumer Protection Act 1987 imposes a criminal liability on those breaching safety requirements, which include a breach of the Cosmetic Products (Safety) (Amendment) Regulations 2012. The maximum penalty for breaching the regulations is a sentence of imprisonment not exceeding six months. The local authority has a duty to enforce safety provisions within its area. A Trading Standards officer has a right of entry into a dental practice (at a reasonable hour and on production of credentials, if asked) under Section 29 (2) of the Consumer Protection Act 1987.

Reporting of adverse effects
The EU, as part of the agreement to change the Directive, demanded there should be reporting of adverse effects. If dental professionals are treating a patient who experiences an adverse effect, they are advised to keep a record of this.

Indemnity and assistance
The proposed relaxation in the regulations to permit the use of higher strength products will significantly improve the unsatisfactory ethical and legal dilemmas that have been faced by dental practitioners, but some unwelcome anomalies remain and Dental Protection will make representations in this regard.

The regulations set out that products containing or releasing up to 6% hydrogen peroxide can be used, subject to conditions:
•    To only be sold to dental practitioners
•    For each cycle of use, first use by a dental practitioner or
•    Under their direct supervision, if an equivalent level of safety is to be ensured
•    Afterwards to be provided to the consumer to complete the cycle of use
•    Not to be used on a person under 18 years of age.

Members of Dental Protection are welcome to discuss this or any other issues. Call the helpline (0845 609 4000) or email

MP Alison Seabeck held an adjournment debate on oral health in the House of Commons earlier this week, bringing to attention the rising costs of oral health care.

During her speech, the Labour MP referred to the Smiling Britain event, that last month brought together key oral health experts to discuss the European Platform for Better Oral Health report.

She focused on the Platform’s key message of preventative care and highlighted that the new dental contracts, currently being piloted in the UK, aimed to incentivise dentists to focus on preventive measures.   

The Labour MP for Plymouth, Moor View, paid tribute to the UK’s progress compared to ‘European neigbours’ but acknowledged ‘there is certainly still room for improvement’ and warned that the cost of dental treatment remained an issue for many families.

Government health minster Dr Dan Poulter agreed there was no room for complacency and championed the new dental contracts.

He said: ‘Notwithstanding the fact that we have made good progress historically, and that the European platform on oral health report highlighted the good things we do in this country, we must never be complacent.

‘We must continue to ensure that we drive further improvements and reduce the inequalities in access and in oral health that still exist and are very real in some parts of the country.’

He said: ‘Elements of the new dental contract are being tested in 70 practices at the moment, and we are rolling them out to an additional 20 to 25 practices as part of the pilot to make sure that that contract is fit for purpose.

The health minister also highlighted the 43% rise in fluoride varnish applications for adults and 64% rise for children and explained: ‘The fundamental focus is on moving away from a reactive service to a preventive care service.

‘That will both improve oral health by reducing the incidence of cancer, and give children the best start in life by engendering good dental health habits through the involvement of hygienists and other practitioners. Our aim is to move dental care on to a more stable footing.’

In her address, Alison paid tribute to the Peninsula Dental School, local to her constituency, saying: ‘I am proud that we have the Peninsula dental school in Plymouth. The groundbreaking training offered by Peninsula in Plymouth closely links the trainee dentists and technicians to local communities that have historically had very low levels of contact with dentists, and it is making a difference.’

She urged the government to consider investing time and efforts into simple oral health promotion, saying: ‘Brushing, flossing, using mouthwash and chewing sugar-free gum could all be more effectively promoted to help to keep dental costs down in Britain, and the sharing of good practice should be encouraged.’

‘I know that companies such as Wrigley run their own campaigns linked to their products and support wider campaigns such as Keeping Britain Smiling, but, given the massive cost to the NHS of poor dental health and linked ill health, the government also have a role to play.’

Celebrating the role of dental hygienists, she added: ‘The wider use of expert dental hygienists to monitor and advise patients as well as to carry out treatments could have a significant benefit, although there will be some dental practices – these issues have been raised – that are not currently suitable and do not have enough space to accommodate the additional clinics.’

To help raise money for the charity, CRISIS, dentist, Dr Nilesh Parmar, is holding an exclusive ‘Ice White Xmas Party’ charity event on Saturday 1 December  in London.

CRISIS, the national charity for homeless people, is dedicated to ending homelessness by delivering life-changing services and campaigning for change.  

Nilesh said: ‘I’m very committed to working closely with charities, and, this year, my aim is to bring together family, friends and colleagues to raise lots of money for the worthwhile charity CRISIS, at a time of year when the homeless need it most.’

Sponsored by Astra Tech (Dentsply Implants), Digimax, Enlighten and Manan Ltd, the fun-filled charity event will also host a raffle, which will see guests win some fantastic, generously donated, prizes.

Prizes up for grabs include an iPhone5, spa day, luxury driving experience day, a personal training session, teeth whitening treatment and a week’s stay in an apartment in Puerto Banus, Spain.  And, if that’s not enough to get you entering, all proceedings from the raffle will go to CRISIS.

Guests attending the event at Holborn House will also enjoy a champagne reception accompanied by canapés and live entertainment. Tickets to this exclusive event are available by invitation only, so to receive your invitation, email

Donations are greatly appreciated, and can be made on the night, or via the Just Giving website

Part 2: Performers
By the time you reach the level of Performer, your career will be well on track and your earnings will have increased significantly. Your personal and professional commitments are likely to have changed considerably since you qualified, and you may now be looking to start a family or buy a practice.

Income protection
You are your biggest financial asset and, with the average salary of a performer being more than £65,000, it’s important to make sure both you and your earnings are adequately protected.

Income protection is important because it will provide you with an income if you are unable to work due to an illness or accident, typically up to 50% of your pre-incapacity earnings.

As your salary will have increased significantly since you were a foundation dentist, any plans you currently have in place may not be enough to cover your new circumstances.

Locum Insurance
It is often assumed that if a performer is unable to work, hiring a locum is the responsibility of the Principal. However, each Performer needs to be aware that responsibility for finding, referencing and hiring a locum now rests with them. Unless an alternative legally binding agreement is in place, the Principal can hire a locum and recover the costs from the Performer.

Without insurance, the cost of a locum – which can run to hundreds of pounds per day – could be deducted from the earnings of the person they are covering for.

Starting a family
At this time of life, settling down and starting a family may be on the agenda. But aside from the added expense of having a child, there is also the loss of income to contend with that comes from taking maternity leave.

Statutory Maternity Pay is paid for a maximum period of 39 weeks. For the first six weeks it is paid at 90% of your average gross weekly earnings with no upper limit, and for the remaining 33 weeks the lower of either £135.45 or 90% of your average gross weekly earnings. It is also worth checking your contract with the practice, to see if you are liable for locum cover for the time you are off work.

Looking further ahead, if you decide to send your children to private school or help them with university costs then you will be faced with even more expense. Based on current fees it could cost more than £175,000* to put a child through private education from age 5 to 18, while, the average debt on graduation for university students starting this autumn could be £53,400**.

With sums like this, it’s important to review your savings and investments portfolios to ensure they will cover the predicted costs.

Investing for the future
No matter what your goals are, when you’re saving it’s important to make your money work hard.

If you opt for shares, or equity based investments, you should be prepared to leave your money invested for at least five years. There are a variety of options available when investing in the stock market, ranging from stocks and shares ISAs to investment bonds, and it is sensible to talk to a financial adviser who will explain these and discuss which options are best for you

Buying a property
When you’re buying a home, getting the right mortgage to suit you is vital.

You will need to decide whether to opt for a fixed rate mortgage, which has a set level of interest for a specific period of time, or a variable rate. You will then need to consider how you will repay it. With a repayment mortgage, you will eventually pay off the full amount borrowed plus interest. Interest only mortgage payments are lower, but at the end of the mortgage term you will still owe the amount you originally borrowed, and lenders will insist you have the means to pay this off.

Preparing for retirement
Even though retirement will still seem a long way off when you’re in your 20s and 30s, it’s still important to think about your retirement.

As you will know, there are major changes planned to public sector pensions. While the final details have yet to be confirmed, if you are a member of the NHS Pension Scheme, it is likely that you will have to work longer and pay more for potentially lower benefits. You may need to make additional payments or alternative investments to ensure you achieve the level of retirement income you desire. However, it is still likely to be a very good scheme.

If you are concerned about how the changes will affect you, discuss your options with a financial adviser who has a detailed understanding of the NHS Pension Scheme.

* 2012 Independent Schools Council Survey

** Student Debt Survey

The above information does not constitute financial advice.  If you would like more information or need specialist financial advice call Wesleyan Medical Sickness, which specialises in financial services and products for dentists, on 0800 980 5462 or visit the website at

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