Mission Statement

The Besford Club was set up in 2010 by a small group of enthusiasts in the field of removable dentures. Its philosophy is based on that of John Besford (1942 –) who has proposed and tried to follow certain principles in his work and teaching.

To wit:

To retain their professional status, Club Members will at all times place the interests and wellbeing of patients above their own.
As an aid to achieving this, Members will subject their alternative treatment options to the following tests before presenting them to a patient: a) are the treatment plans what I would recommend if the patient were one of my nearest and dearest (‘the daughter test’)? b) do these plans represent the minimum needed to solve the patient’s current problems and prevent others (rather than the most he/she can be persuaded to put up with and pay for)?
Being deprived of teeth is disabling and for many sufferers considered a matter of shame, giving rise to feelings of loss of control/autonomy, loss of attractiveness, deterioration, aging and other negative feelings. Club Members try to minimise patients’ distress by never causing them to leave the dental operatory without visible tooth/gum replacements which look sufficiently natural as to escape detection and attention (unless the patient specifically requests an unnatural appearance). During treatment, dentures are kept accessible to patients when not in their mouth.
In order to restore some autonomy, Members encourage and train patients to assume the status of ‘captain of the dental crew’, having the right to determine the course of dental treatment, providing it is not harmful, and to take an active role in guiding it. (Members decline to carry out any harmful treatment which the patient requests, especially when on the basis that ‘if I don’t do it, someone else will’.)
During the initial consultation, the clinician compiles a numbered list of each patient’s stated and recorded wishes. After suitable clinical investigations, the patient’s numbered objectives are discussed in terms of whether they can be achieved totally, partly or not at all. Those that are achievable are integrated with other oral health needs so as to arrive at alternative plans of action or inaction, which are in effect co-productions between patient and clinician.
In setting out the plans, the clinician takes care not to exaggerate the benefits of each plan or minimise the risks and costs. The patient is given ample time to consider these alternative plans and their costs (time, money, effort, etc.), and is not rushed into quick decisions. Where extensive or complex non-emergency treatment may be indicated (for example precision attachment or implant-stabilised restorations), Members are willing to seek ‘second opinions’ from other clinicians expert in those fields, including other Members. Accepted treatment plans are therefore the result of fully informed consent.
Each member, clinician or technician, accepts the proactive responsibility for considering the patient’s future dental and other health requirements, not just the job in hand. (The design of partial dentures and bridges for hygiene and adaptability to further tooth loss are examples of this.)
As part of that proactive responsibility, members make a point of identifying, in dentitions already depleted, teeth which are strategically important for stabilising existing or future prostheses, and drawing to the patient’s attention the advantages of maintaining those particular teeth by cleaning and other measures.
Time and money permitting, Club Members adhere to the view that rehearsal with provisional restorations, interim appliances, test impressions of tooth preparations, etc., before construction of the definitive restorations will give the patient greater control and the clinician and technician a significantly greater chance of achieving high standards of durability, comfort and appearance, than going ‘straight to finish’ and hoping ‘it will be alright on the night’.
During and at the end of treatment, the patient’s modified and finalised wish list is consulted to check that all of the requirements agreed to at the outset have been met or, if not all, that the reasons for this are understood and accepted by the patient.

John Besford • December 2011

spontaneous beginning.