18th Century teeth in the 21st Century

Today is World Oral Health Day. The main aim is to raise awareness of the impact that oral health can have on overall physical health and well being. Unfortunately for us, Britain seems to have given up on its dental health.

To be specific, successive governments appear to have decided that our dental health no longer has the same level of importance and slashed the availability of free dental care. Britain has one dentist for every 2000 people (WHO 2010) which sounds reasonable. However, seeing a dentist on the NHS has become something of a fabled miracle in many parts of the country.

 

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The NHS is happy to clean up your vomit if you get drunk every night, hold your hand if you inject yourself with too much heroin and help you cough up black phlegm if you spend your days chain smoking. If you don’t brush right though, the NHS is not necessarily your friend.

It is now almost impossible to find an NHS dentist. Even if you are lucky enough to secure one of the prized places, people are still charged up to 80 per cent of the cost of treatment. Being a child, being pregnant or being on social welfare and benefits are the main groups that are entitled to free treatment.

 

This has left us with a two-tier dental system. The upper tier pays to see a dentist privately and these patients have the unenviable privilege of paying the highest prices in Europe. The second tier scrambles for an NHS dentist and waits so long for partly subsidised treatment that their teeth can crumble or cause agony in the meantime. There is a third tier who have their own pliers and bits of string! Shockingly, more than one in 20 have said that they resort to DIY surgery.

 

Having bad teeth is not without consequences. For the young and middle aged, bad teeth can make it more difficult to find a good job or a successful relationship. It has been years since I’ve seen a TV presenter without a perfect set of white, straight teeth and as a country, we now spend £360 million on cosmetic dentistry a year.

For the elderly, poor dental health can leave them unable to eat properly or in pain. Gum disease also increases the risk of mouth cancer, and pancreatic cancer in men.

So how can we make sure we care for our teeth? Here are our top tips for a healthy smile:

 

  1. Brush your teeth twice a day with toothpaste that contains fluoride, this will prevent tooth decay, gum disease and bad breath. Brush your teeth for two minutes each time. Some electric toothbrushes now have timers and apps to help make sure we are covering all our teeth for long enough.
  2. Teach children at young age about healthy oral hygiene habits and supervise them until around the age of seven. The earlier this becomes part of their life, the more likely it is to become an engrained routine that will stay with them. Children should start seeing a dentist when their baby (milk) teeth first appear. Baby teeth are thinning and less able to withstand the bacteria that cause tooth decay. Decaying baby teeth can have a negative impact on adult teeth and needing extractions (removal of teeth) can lead to problematic adult teeth.
  3. Health diets which minimise sugars will minimise oral health problems. Fruit juices can be deliciously refreshing but can be high in sugars, try to get into a habit of reading your food labels.
  4. See your dentist! This might sound a bit obvious but just we get an MOT and service on our car by an expert mechanic, it’s also important to have an MOT on your mouth. Your dentist will advise you on how often you need to be seen, it can vary depending on your dental health.
  5. Flossing. Using floss or the small interdental brushes can get to the edges of the teeth that brushing can’t. Think about the last time you washed your car, you wouldn’t get wash the bonnet and the boot (trunk) and leave the doors dirty would you?

Healthy teeth used to be a marker of a modern first world society. If Britain doesn’t make changes soon, our lack of investment in dental care will leave us with 18th century teeth.

Your sense of self: the magic five.

Self Confidence.

Self Esteem.

Self Worth.

Self Belief.

Self Respect.

All priceless. All fragile. All unique.

Our sense of self is intricately tied to our personalities, experiences, belief systems and the bubble we find ourselves in. It can take a life time to build and a second to shatter.

 

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On the face of it, the five S’s may all seem similar concepts but each one is a like a snowflake – outwardly uniform but subtly different to the next.

In today’s society when we are so often judged on how well we do our job, how many exams we passed, how productive we are, what material possessions we have or don’t have, it can be easy to conflate our self-confidence by listing our many achievements. However to face and accept our flaws and weaknesses takes real strength. It’s our self-esteem that allows us to look at these facets of our character and not be lessened by them. A robust sense of self esteem enables to us own our flaws, learn from them, use them, grow from them.
Alexander Pope wrote An Essay on Criticism in 1709 and told us “To err is human, to forgive is devine”. Whether you have faith in a higher power is immaterial, and whilst Pope may have been talking about literary critics, his words ring true when considering self-esteem.

Mistakes, flaws and errors are part of what makes us human. Being able to forgive ourselves is part of our ongoing development. We need to acknowledge and accept these to be able to move forwards.

Valuing what we can offer our friends, our family, our colleagues, the wider community or, more importantly, ourselves helps to re-affirm our sense of worth and place in the world. We all have a place.

What we do with that place, to a greater or lesser extent, has much to do with our self-belief. Einstein said that insanity is doing the same thing over and over and expecting different results. If we never change what we put in to something, how can we ever expect a different result?

At a couple of stages in my professional life I have had attacks of “Imposter Syndrome”, a pervasive feeling that at some point I would be uncovered as a fraud. I lacked the confidence and belief in myself and my abilities. The first was immediately after medical school. For years as I rotated through my house officer (residency) jobs, I kept all my old med school notes and textbooks – just in case the university called to tell me they had made a mistake and I hadn’t actually passed my finals!

The second time was shortly after I qualified as a GP. I worried all the time that I would be “found out” and that I wasn’t really “good enough” to do my job. Thankfully with time, supportive colleagues and a helpful husband, I learned to settle in my work. I still have moments when doubt starts to creep in, but using strategies I have developed over time to refocus my self-belief and confidence, I can pick myself back up.

Having a goal – whether it be in your work, your home life, weight loss or fitness goals – and the effort and drive it takes to reach it – all relies on your self-belief. That intense faith you place in yourself that you will reach your target. This one (as they all are) is tricky. It’s vulnerable to knocks along the way and this can lead you to deviate from your goals.

An analogy I often use with patients when we talk about goal setting is to imagine climbing a mountain. When you are in the foothills looking at the summit, it can seem an awful long way up. It’s easy to think of at least ten reasons not to start the journey – it’s a long way, it’ll be hard, I’m not prepared… But if you think of that same journey as a series of shorter journeys, perhaps from the foothills to base camp. From base camp to the next rest stop, and then to the next and so on until you reach the summit. Then at each rest stop allowing time to gather yourself and evaluate your progress. Whilst the journey might still seem a challenge, breaking it down to smaller chunks makes it more manageable.

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A buzz phrase in medicine, and education generally, is SMART. A tool for setting goals, it tells us that goals should be:

Specific (what are you going to achieve)

Measurable (how will you know when you achieve it)

Achievable (is it within your ability – if your idea of art is drawing is limited to stick people it might not be achievable to think you’ll open at the Tate Modern or MOMA in twelve months time)

Realistic (perhaps you are a great artist but accept it might take ten years for an opening in prestigious galleries) and

Time Specific (when are you going to achieve it by)

Either way to get to our goal takes self-confidence to learn our strengths, self-esteem to accept our weaknesses, self -worth to believe we have value and the right to dream and self-belief to push on and achieve it.

Which leaves the toughest one of all, self-respect.

Underpinning all of these is the respect we have for ourselves. Our esteem, worth, belief and confidence are, in general, internal concepts. They are what we think. Our respect is generally what we do to ourselves in the physical sense. Self-respect doesn’t care what happened in the past, it’s about what you are doing right now.

If the other four S’s are talking the talk, your self-respect is walking the walk.

No one, in any shape or sphere can or should take your self-respect. The only person who has any right to your self-respect is you. If you have a bad day, or week, or even a bad month your esteem, confidence, worth or belief might take a beating, but it’s your self-respect that will build you back up.

Self-respect is lifetime work. There will always be critical voices and adverse life events ready to knock you. However if you can ensure you respect you for you, you’ll make it through. Imagine your self-respect as a small seed, planted in the ground. To grow, it needs to be nourished and fed to flourish, ignore it and it will risk withering and decaying.

Having respect for yourself means taking care of your body, your mind and your actions. Be proud of you. Don’t settle for something that is less than you deserve. Forgive yourself, we have all done things we are not proud of, but berating yourself for these for the rest of your life won’t get you anywhere. Surround yourself with positive people and influences. Take care of your body – you only get the one. Don’t compare yourselves to others. Theodore Roosevelt told us that “Comparison is the thief of joy”. Treat others with respect but do not allow others to disrespect you.

“Self-respect cannot be hunted. It cannot be purchased. It is never for sale. It cannot be fabricated out of public relations. It comes to us when we are alone, in quiet moments, in quiet places, when we suddenly realize that, knowing the good, we have done it; knowing the beautiful, we have served it; knowing the truth, we have spoken it” Alfred Whitney Grisworld

 

–Alex

 

 

World Glaucoma Week: Shining a light on glaucoma

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By 2020, the number of people in the world with glaucoma is expected to reach 76.0 million. That is more than the entire population of the UK. Glaucoma is one of the leading causes of blindness in the world. Fortunately, it is highly treatable with the right medications and intervention if detected early.

This week is the 7th World Glaucoma Week. This was launched back in 2010 and the aim has been to increase awareness of the disease. The key to managing glaucoma is early diagnosis. Glaucoma generally involves high intraocular pressure (high pressure within the eye) which causes damage to the optic nerve. This is the main nerve that helps us to see.

Your optician can check the pressure in your eye with a simple painless test. By looking in your eyes they can also look for signs of damage to the optic nerve caused by glaucoma. As with high blood pressure which damages our blood vessels, the aim is to keep the pressure down. Early detection allows use of appropriate eye drops which reduce the eye pressure and minimise/stop damage to the optic nerve.

This year, the particular aims are to get national health authorities across the world (such as the NHS) to design strategies to combat glaucoma blindness. Educational materials about glaucoma should be delivered to those people at risk via all mediums including social networks. Resources should be focussed on those patients least likely to access eye care.

Thousands offer their time for free to support World Glaucoma Week and much has been achieved by the previous years. The aim is now to build on this work and reduce the effects of this potentially blinding disease. You can find out more on at the  World Glaucoma Week website.

–Nitin