September 17, 2026

Good morning.

A new NHS England update has brought 3 practical issues into focus this week: endocarditis prophylaxis, controlled drugs and amalgam.

In addition, one route for overseas recruitment has almost disappeared, while a new MIH trial puts restorative material choice under the spotlight.

Let's get into it.

THE DRILL

This is one of those areas where plenty of dentists still hesitate.

NHS England has just pointed dental teams back to the updated UK-endorsed guidance on antibiotic prophylaxis against infective endocarditis.

The practical version:

For patients at high risk of infective endocarditis, antibiotic prophylaxis should be offered before extractions and oral surgery.

For other procedures involving the gingival or periapical tissues, prophylaxis may still be considered but it becomes a shared decision with the patient, weighing the potential benefits and harms.

For patients at moderate risk, prophylaxis isn't recommended.

So “NICE says we never give antibiotics” is too simplistic.

Equally, a cardiac history doesn't automatically mean cover.

Worth five minutes with the updated guidance before the next patient arrives clutching an old antibiotic card from 2009.

New Home Office figures show six sponsored entry-clearance visa grants for dental nurses across Q4 2025 to Q2 2026.

In the preceding three quarters, there were 122.

That's roughly a 95% fall following the July 2025 Skilled Worker rule changes.

Important distinction: this isn't a 95% fall in Britain's dental-nurse workforce.

It's a 95% fall in grants through this overseas recruitment route.

For practices that previously used international recruitment to fill vacancies, though, the route has effectively narrowed to a trickle.

QUESTION OF THE WEEK

A child has an MIH-affected molar with post-eruptive breakdown.

Researchers restored affected teeth using either glass ionomer cement or resin composite and followed them for 12 months.

Which performed better?

A) Glass ionomer

B) Resin composite

C) No clear difference

Have a think. Answer near the bottom.

WHAT THEY DON’T TEACH YOU

The GDC says crowns accounted for 12% of allegations in fitness-to-practise cases involving single-patient complaints in 2025.

Its latest case-based review keeps returning to familiar fundamentals:

Assessment, diagnosis, planning, competence, consent and managing expectations.

Particularly when multiple teeth are involved.

The lesson isn't “don't do crowns.”

It's that the more irreversible the treatment becomes, the less room there is for fuzzy planning or an unclear conversation about what the final result can realistically achieve.

And if your website says you “specialise” in something, make sure the wording accurately reflects your training and GDC specialist status.

BREAK THE ICE

Try:

“Before we begin do you prefer knowing exactly what I'm doing as we go, or would you rather I keep the commentary to a minimum?”

Simple question.

Much better than discovering 20 minutes later that you've been reassuring them in exactly the wrong way.

THE ANSWER

The randomised trial included 72 restorations in MIH-affected molars.

At 12 months, survival was 91.7% with glass ionomer and 88.9% with resin composite. The difference wasn't statistically significant.

But the more interesting finding was what happened around the restorations.

Continuing post-eruptive breakdown of the remaining hypomineralised enamel contributed substantially to failure.

So the useful takeaway may be less about choosing a winning material and more about remembering that the restoration isn't the only thing you're managing the surrounding tooth remains vulnerable.

Small study. Twelve-month follow-up. Useful signal, not the final word.

THE LAST RINSE

The fastest way to discover a patient's second chief complaint is to say:

“Right, that's everything for today.”

“Actually, while I'm here…”