TOOTH GERM

The Challenges of being a Dentist.... and a Mum!

2025-04-03T23:25:00.001+01:00

It's been over 2 years being back working a dentist after having my little girl... and I thought it might be getting easier...

What does my Week look like?

Currently, my working week does change from week to week depending on work commitments as well as available childcare! I've had to be adaptable to find something that works for my family, as well as where I work on top of being sustainable for me and not burning out!

I currently hold a few roles that include:

Consultant in Special Care Dentistry - this is an employed role where I technically work 3.5 days condensed into 3 days. I've been able to adapt my job plan to allow me to work longer days as well as swapping a Saturday once a month for a weekday, which helps with childcare
Clinical Director of a Dental Charity - this is a 1 day a week employed role, but since it is non-clinical I can split these hours up as to when I can with childcare, or occasionally I will need to go to an event or run a clinic.
Locum Domiciliary Dentist - this I do ad hoc, usually once a month when I can get childcare. As a locum I don't have a fixed commitment, but offer days as and when I can
Deputy Chair of a Managed Clinical Network - we have regular meetings as a MCN throughout the year which I do at lunchtimes and on my non-working days

The Challenges of being a Working Mum

1. Where am I going to get Childcare today?

Yes, my daughter is in nursery 3 days a week, but for other work commitments (not to mention if I try to plan any social events!), it can be juggling act of seeing who can look after my little one. We are very lucky to have a network of family around us (they do say it takes a village!) as well as a regular and reliable babysitter.

2. Will I get back in time for Pick-Up?

Gone are the days where running a little late in the afternoon or getting stuck in traffic on the commute home have no consequences: being late to pick-up my daughter from nursery in particular is a huge anxiety for me and means I need to leave work on time on the my pick up days!

3. Mum Guilt!

The rare times she says 'no Mama, stay at home!' when trying to take her to nursery, for leaving her overnight with others for work commitments, to asking family members to have her for a few hours. Until you're a parent, the mum, or parent guilt probably doesn't mean that much, but once you have responsibility for a little person, it creeps in every day! Guilty for not always being 100% present with her, guilty for being at work away from her, guilt you're not doing good enough for her.

4. I'm so TIRED!

There's no wonder most nights I am in bed by half 9! Even after a good nights sleep, a productive day, an efficient bedtime routine, being a working mum is the most tired I have ever been. Let alone if we have an unsettled night with her, or one of us are sick.

I think it's down to the constant 'to do' list in my head from the moment I wake up, to the moment I go to sleep. Getting 2 people ready in the mornings, drop-offs, full days at work, rushing home for pick-ups, evening routines with dinner, bathtime, and bed - then trying to squeeze a couple of hours of work or life admin in! It's go go go - no wonder I'm exhausted!

5. She's sick again!

Having a toddler in nursery is like having an infectious sponge living with you - soaking up every virus and illness humanly possible and bringing it home to share with the family!

Especially in winter, or when she was younger it felt like every month she'd have a snotty nose and you'd have the anxiety of phone calls from nursery asking you to come pick her up early. This would result in your guessed it, mum guilt - she's sick again how can I make her feel better, how are work going to react if I can't come in today because I need to look after her. And not only that, when the illness is passed on to us adults, it then incapacitates us for a few days (always worse than what she had it!)

How I Survive... ish

1. Asking for Help

Not just to relation to childcare for work, but also trying to find time for myself and to spend time with my partner. We moved closer to our family after we had our daughter, and I am so thankful we did to have our village of family and friends close by!

2. Resting

After busy weeks, I always try to have a calmer time, maybe booking some time off or scheduling working from home days in order to recover. I used to also spend most evenings after bedtimes on my laptop catching up with work, or doing some life admin - but now more often than not you'll find me catching up on my latest Netflix show, reading my book or just trying to relax with some quiet time.

3. Having Understanding Colleagues

Something I am very thankful for are my colleagues in my various roles and their understanding and kindness when it comes to being a working mum. Many are or have been working parents which is so helpful as they can understand the challenges and difficulties of the balance - particularly when things are not going to plan like when someone in the household is sick!

There have been some occasions when my daughter was smaller that I've even taken her into work or work events and everyone has always been so accommodating!

4. Enjoying Mother-Daughter and Family Time

I always schedule some time in the week for just me and my daughter as well as together as a family. I don't want to miss out on her growing up and whether we go out on a adventure or activity, sit at home and play or just go for a walk, I use this time to bond with her and our family.

5. Routine

Having a routine in the week and across the day can really help give me headspace, so I'm not constantly thinking what to do next or where am I going. Sometimes this isn't always possible, but children respond well to routines too and there's nothing more important in any parents life than a good sleep routine!! (in my opinion anyway).

Working mums and parents out there... what challenges do you face and how do you overcome them? Let me know in the comments below!

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Creating a Fear-Free Dental Experience for Children: Tips for New Practitioners

2024-10-28T11:19:00.004+00:00

I'm excited to share a Guest Blog on how to help manage paediatric patients in practice....

Image Source

Dental phobia is one of the most common fears. Over 50% of people admit to being scared of the dentist, and often this is a fear that starts when we’re children. For you, this means you sometimes need to take on the role of therapist before dentist.

But what can you do? If you’re new to the profession and are a little unsure of how to deal with nervous children, here are a few techniques to try and alleviate dental phobia in young patients.

Show No Nerves

Children often pick up fears from adults. While trying to deal with a nervous child may take you out of your comfort zone, showing any signs of this may cause your young patient to pick up on this behaviour and replicate it. Therefore, the best thing you can do is to appear relaxed, calm and extra welcoming.

To prepare yourself, it might be as simple as rehearsing the scenario with yourself in the mirror when at home. Alternatively, if you’ve got little ones in your family, spend time around them to increase your confidence around children if you lack confidence in this area.

Speak to Other Dentists

A nervous child is a problem that any experienced dentist has likely seen hundreds of times before, so there’s a good chance that they’ll know best when it comes to dealing with a frightened young patient.

As a new practitioner, it’s probably worth ringing around your network and speaking to senior dentists to see how they deal with the situation.

Positive Reinforcement

Rewarding good behaviour is one of the oldest tricks in the book when it comes to creating good habits or breaking bad ones. This is a technique that’s often applied to treating phobias too and works especially well with child phobias.

Rewarding a child patient every time they visit your practice will help them build up a positive perception of the dentist. Whether that’s a sticker, a healthy snack or even just some positive words could do the trick.

Gradually over time, this should help them subconsciously build up a better relationship with the dentist and shake off that dental phobia in time for their adult life.

Manage Expectations

Experiencing the unknown for the first time can instil fear in both children and adults. In this scenario, parents often choose to fill their child’s head with what they want to hear which can unfortunately lead to broken promises which can cause a more severe fear further down the line. As a result, it might be worth speaking with parents about managing their child’s expectations ahead of an appointment.

For example, telling a child that it won’t be painful before they receive a sharp injection isn’t going to build trust with them, and will likely make their fear worse the next time they visit the dentist.

This article was written in correspondence with trained and experienced dentists at Beyond Dental in Leamington Spa.

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8 Top Tips for Consultant Interviews in Dentistry

2024-10-12T14:25:00.001+01:00

I have gone through the process of Consultant interviews in Dentistry a few times and it is probably one of the most daunting interviews you can have... so here's just a few tips if you're going through the process.

1. Read the Personal Specification

Every Consultant job is different, so read all the information in the job advert, in particular the personal specification as that will lay out what is wanted from an applicant and what the post entails.

This would also usually include a sample job plan, which will give you more information of what a week of working in that post looks like so that you can work out if that works for you e.g. if you are looking to do a particular activity such as theatre time, then you can see if that post includes that as part of the job plan.

Use this as a crib sheet to see if you firstly fit the criteria to apply in the first place, secondly to tailor your application to hit what they want and hopefully ultimately, guide you in preparation for an interview.

2. Speak to other Consultants for Advice

If you know other Consultants, I am sure they would be happy for you to contact them to ask for advice and preparation tips. Particularly if they work or have worked in the service you are applying to!

I would ask for any advice in preparation for the interview and also to get an idea of what it is like to work within that service if they already work in that service. They will give you pointers to help you prep, for example if they know that there is a hot topic going on in that service at the moment.

3. Reach out to the Panel

A very traditional interview will expect you to reach out to each panel member and meet them before the interview - think of it as a series of mini informal interviews before the real thing!

When someone first explained this to me, I didn't think they were serious... surely you're being interviewed by the panel at the time they've given you, why do you need to them also contact each panel member and seek them out before as well?! But many services are expecting this, particularly if you are new to the service and haven't met them before. I think the idea is that the panel can get to know who you are outside of the interview, to see how keen you are about the post itself as well as give you an opportunity to work out how you'd fit within the service.

I have had 3 Consultant interviews and this part was very different for each. One I did meet everyone via Teams, over the phone or in person before the interview, another I had already worked in the service so only met with people I didn't know on the panel and the other I wasn't even told who would be on the panel and therefore didn't meet anyone beforehand.

Panel members tend to be a large number of people compared to interviews you might have had in the past; I've had about 6-8 members on each interview I've had! That's a lot of people to meet beforehand! Some people might also ask you to send or bring your CV with you to a meeting. Panel members tend to be as follows, depending on the service:

Clinical Lead of the department
Clinical Director of the service
External Royal College representative
Service or Operations manager
Chief Executive or other senior manager within the trust (often outside of Dental)
Academic representative (particularly if the post you are applying for has a close relationship with a dental school)
Other Consultants currently working in the department
Senior Nurse or Nursing Manager

4. Go on a Preparation Course

As with many application processes within healthcare, there are courses to help you prepare for a Consultant interview. I think all I have come across are general Medical/Dental courses rather than specific to dentistry, but from what I have heard from people who have been on them, they have found them very helpful.

Going on a course isn't for everyone, but it can be a great way to simulate the process as well as learning more about what is expected of being an NHS Consultant. The best way to find local courses in your area is to contact Health Education England Professional Support Unit, or even find courses your local deanery might run co-hosted by NHS trusts.

5. Read about the Trust and its Values

Just like other job interviews, I would highly recommend doing some reading about the trust you are applying to work at and its values. There is often a question within the interview about how you demonstrate those values as an individual; how would you be able to answer this if you didn't know what the values are?!

You might also be able to glean information about what is going on in the trust at the moment, for example, are they developing certain services you can get involved in, do they have certain programmes or initiatives that you are interested in, do they have problems that you can show you can help with? If you are able to bring examples into your answers that show you know the trust and what is going on, this shows you've done your homework and understand what it is like to work there.

6. Prepare to present, if needed

Some interviews ask you to prepare a presentation as part of the interview format. Format of Consultant interviews again can vary but can include:

A presentation on a topic (either oral or PowerPoint), and topics are usually something about the issues facing the speciality or location you are working in, or plans for the future
A traditional question and answer interview with questions. The themes of the questions typically follow the roles of the people of the panel, for example:

Clinical situations e.g. what would you do if a patient presented with x, y, z
Questions about yourself and your motivations e.g. why do you want this job
Assessment of your communication - this can be a specific question or just a general assessment of how you answer questions
Academic questions e.g. experience in teaching, research etc
Management questions e.g. tell me about experience in management and leadership, what would you do if x, y, z, clinical governance based questions
An equality, diversity and inclusion question or something about the Trust values

So if you are asked to prepare a presentation, carefully use the guidance they give you to prepare something and practice!

7. Visit the Department

If you haven't worked in the department that you are applying for, I'd highly recommend going to visit the service so that you meet everyone in the department and see where you'll be expected to work.

Even if you have worked there, but haven't worked there in a while, it might be worth arranging a visit to touch base with the team and show your enthusiasm for the role.

When I applied for the role I currently hold, I was actually on maternity leave. Thankfully the team were very open to me visiting with my baby at the time, which made me feel like that was definitely a place I wanted to work because of how accommodating and friendly they were when I visited.

8. Book a coaching session with me!

Navigating this process is not easy! If you are looking for more one on one support, I do offer one on one coaching over Teams, so if you'd like some assistance in preparation please contact me.

Good luck with your interview! If you have any questions please leave them in the comments below, or get in touch.

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Infective Endocarditis and Antibiotic Cover in Dentistry

2024-08-30T22:25:00.000+01:00

A very common reason why I get referred patients is those who are at higher risk of Infective Endocarditis (IE) and need dental treatment, or have been admitted to hospital with this serious condition and require a dental check or a dental cause for the disease ruled out. So what is IE and how does it affect dental care?

What is Infective Endocarditis?

Infective Endocarditis (IE) is an infection of the inner lining (the endothelium) of the heart - most commonly the heart valves. It has a high mortality rate (40% at 5 years), and is therefore very serious. In 80% of cases, the cause is bacterial, but it can also be fungal or viral.

Some patients are at higher risk of IE, and we hear about it a lot within dentistry. This is because for bacterial causes of IE, caused by a bacteraemia (i.e. bacteria in the blood stream), the bacteraemia can be from a dental infection or dental treatment.

What happens in those patients who are at higher risk of IE, is that when the bacteria are circulating in the blood around the heart and the heart valves, they attach to the valves (which is much easier if the valves are damaged, artificial or their is turbulent blood flow in the area) and make plaques called vegetations which damage the valves.

Therefore some patients with certain conditions are in the special consideration group where the SDCEP guidance recommends antibiotic cover prior to invasive dental treatments. See the table below of patients who are at higher risk of IE, and those who require cover.

If cover is recommended, advice from a patient's cardiologist is prudent, but usual regimes to be taken 30-60 mins prior to procedure (which have be recently updated are:

2g amoxicillin (although it is acceptable and usual practice to prescribe 3g as the sachets of 2g are not readily available in the UK)
2g cephalexin if penicillin-allergic. This used to be 600mg clindamycin, but recent paper has updated recommendations to the SDCEP guidance.

Invasive dental treatment includes any of the following treatments:

Placement of matrix bands
Extractions
Root canal treatment prior to apical stop establishment
Subgingival scaling and root planing
Placement of rubber dam clamp
Subgingival restorations including extra-coronal restorations
Preformed metal crowns used in deciduous teeth
Full periodontal pocketing charting
Incision and drainage of dental abscesses
Surgery including a mucoperiosteal flap or incision
Placement of dental implants including TADs or mini-implants
Uncovering implant substructures

For patients who are not only in the special consideration group, but who are at higher risk of IE, it is very important to educate the patient about their risk and how they can lower it by ensuring they are maintaining their oral health. A bacteraemia can be caused from just chewing or brushing teeth in patients with periodontal disease! There are excellent patient information leaflets provided as part of the SDCEP guidance.

If you are also treating these patients, even if you do cover their treatment with antibiotics, you should still warn them of potential signs of IE so they can quickly act if they do develop - i.e. go straight to A&E! Signs and symptoms of IE include:

Malaise
Fever
Chills
Fatigue
Aching joints
Night sweats
Shortness of breath
Swelling in the ankles, finger joints, legs or belly
Splint haemorrhages in the finger nails
Cough
Petechiae in the skin
Weight loss
Confusion

When we see patients in the hospital with IE, they will be having treatment for the condition, which can either be medical management (i.e. antimicrobials) or surgical management (repair or replacement of the valve or damaged lining). They will have had blood cultures to find out what the causative organism of the IE is. Streptococci can sometimes can be the causative organism from a dental origin.

If you are unsure whether a patient requires cover or what cover to give, it is best to contact their cardiologist for confirmation; they will be more useful usually than a GP.

There are various conflicting guidelines globally about antibiotic cover prior to dental procedures, most famously the NICE guideline that it is not routinely given prior. This is not that helpful in the day to day practice of a working dentist, therefore I would recommend reading this recent paper in the BDJ alongside SDCEP for guidance that is relevant in the UK.

Have to treated patients who are at risk of IE? Please leave your thoughts in the comments below.

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The NHS Access Crisis in Dentistry: Speaking at the London Assembly

2024-07-24T21:46:00.000+01:00

Last week I was invited to give oral evidence on a panel in front of the Health Committee for the London Assembly about the NHS dental access crisis...

Me at the London Assembly last week

What is the London Assembly?

The London Assembly holds the Mayor and his advisors to account by publicly examining policies and programmes through committee meetings, plenary sessions, site visits and investigations. The Mayor (currently Sadiq Khan) should respond to the motions of the Assembly and their recommendations.

The Mayor must also consult Assembly Members before producing his strategies and the multi-billion pound budget for the GLA (Great London Authority) Group.

As part of the assembly there are different committees - the one I was invited to was the Health Committee who have chosen to investigate NHS dentistry.

What are the Problems in London?

Many would think that the capital of England would not have issues with accessing NHS healthcare with it's wealth of workforce, hospitals and medical/dental schools. That certainly was the case when I first qualified in 2014 and moved down to London. My first job as an associate took several months to secure, even though I was going out of my way to get a role that would involve weekend work. There were countless job ads in BDJ jobs and when going for interviews, it was common to be part of a cohort of candidates in double digits.

Fast forward to the present day and things couldn't be more different. I am seeing this in my role in a tertiary care hospital: patients being admitted with life threatening dental sepsis because there weren't able to find an NHS dentist to treat their dental infection, long waiting lists of patients referred from other sectors of healthcare, patients who cannot have their life-saving heart operations because they are awaiting a dental check.

There is also huge variation across London. In some boroughs such as Tower Hamlets, the borough where I had my first ever job as a dentist, only 25% of adults and 33% of children have accessed a dentist in recent years. This is compared to 60 % of children seeing an NHS dentist in Hounslow.

The access crisis is affecting all sectors of NHS dentistry as general practice is the base level of the pyramid of dental care. Without an adequate service, the whole pyramid falls down.

What did I Call the Mayor of London to do to solve the issue?

I called on him to:

Put pressure on central government to pursue contract reform and get rid of the UDA
Influence ICBs to ringfence the dental budget so that clawback is used in dentistry and not absorbed into wider healthcare budgets
Implement a supervised toothbrushing programme in primary schools which is cost effective and reduces the burden of disease in children

To read more, I have also posted a blog on the BDA website here.

The London Assembly are also seeking responses from dental professionals, organisations and patients and would welcome your response here.

To watch the recording of the panel session see below.

So what do you think about the access to NHS Dentistry in London? Please leave your thoughts in the comments below.

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The Dental 'Recovery' Plan: What does it Actually Mean?

2024-05-24T22:07:00.000+01:00

At the beginning of February, the Government announced its Dental Recovery Plan in a bid to address the NHS dental access crisis (amid an election year!), but what's in the plan and what does it actually mean...

What's in the Plan?

A New patient premium - if you are seeing a new patient who hasn't accessed dental care in the past 2 years you will get a premium of £15 on top of your band 1 payment, or an additional £50 on top of your band 2 or 3 fee
Golden hellos of £20,000 for dentists to work in identified areas where access is poor
A new mobile dental van service for rural and coastal communities
An uplift in UDA value for some - the minimum UDA value is now set at £28
Plans to ringfence the dental budget i.e. if there is clawback, this money is reused for dentistry in other ways
Smile for Life initiatives in schools to promote good oral health at early ages
A greater use of skillmix with increased use of dental therapists and other DCPs in providing care
Roll out a national water fluoridation programme

What's NOT in the Plan?

The plan has lacked a lot of fine detail and it seems like as time goes on, elements of the plan will be more well defined and this is now all on the timeline of a July 4th election. So there is a risk with a new government which may be elected in the Summer, that the plan may be scrapped/adapted/repurposed.

But so far, here's some of the details not quite so obvious initially in the plan.

1. The new patient premium - this is reliant on providers passing the patient premium to their performers, and also isn't any additional UDA allowance - therefore technically practices will make up their UDA target faster. So some practices might have a risk of 'running out' of UDAs before their financial year is up. This could be good for those practices who previously found it difficult to hit their UDA targets. There is also the question about how do you assess whether a patient hasn't seen a dentist in 2 years... is that an NHS practice, does that exclude out of hours services, how will that be verified?

2. The Golden Hellos - this will be limited to the first 240 dentists who apply and will be staggered over 3 years. So in year 2 and 3 this amounts to an extra £5000 a year - when you consider the costs of moving this isn't a lot! And it also is just moving a recruitment crisis from one area of the country to another...

3. Mobile dental vans - there is currently a market engagement exercise ongoing about this that will confirm what the offering for this would be, but 13 coastal/rural ICBs of dental need have been identified and commissioners are already calling for options of 'non-van' solutions as there really aren't that many mobile dental units about...

4. Minimum UDA value - this only affects 700 of the 8000 practices that hold an NHS dental contract

The whole of the dental profession is eagerly awaiting the finer details of the plan, but from what is being heard we don't think that what has been announced is good enough. While change is welcome, the real call from the profession is to abolish the UDA and we've been calling for this pretty much as long as it has been in existence!

So what do you think of the Government's NHS Dental Recovery Plan. Please leave your thoughts in the comments below.

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Work Life Balance? My First Blog Post in Almost 6 months!

2024-04-06T16:45:00.000+01:00

I can't believe it's been almost 6 months since I have last blogged... that is the longest time ever between blog posts since A Tooth Germ came into existence!! I feel a bit ashamed and sad about that, but the past 6 months have been a blur of busyness, various clinical and non-clinical workloads piling up... plus my little one is now almost 2 years old and you know what people say about the terrible twos....

So why have I been so busy.....?

I've been a dental consultant for coming up to a year now, and while my team were very kind in letting me find my feet and settling in, I am well and truly past the honeymoon stage of a Consultant post! I am seeing the most complex patients I have ever seen in my career, in a challenging environment of long waiting lists and stretched NHS resources with healthcare staff strikes, increasing patient needs and a NHS dental access crisis. So no wonder I have barely time to breathe!

My role as a Consultant takes me out of the main dental hospital to community clinics and our district general hospital and I love these clinics seeing patients locally and setting up/building on spoke services. But this does mean when I am at work I juggle the workloads of my CDS patients, my district general patients and my dental hospital patients which takes some organisation.

On top of that my role at Dentaid the Dental Charity is becoming increasingly busy as our team is expanding and with our first partnership with an NHS ICB to deliver a huge number of clinics in a area where patients are facing difficulties in accessing care. And my role within the British Dental Association as Young Dentist Committee Chair means squeezing in meetings left right and centre with the access crisis becoming evermore prominently in the public eye and debated in parliament.

How do I get the balance?

I often get asked on social media and when speaking at events, how do I fit it all in?! I used to really see that as a compliment and I do still value having a portfolio career and fingers in a few pies, but the past few months have seen me reflecting on what I am currently doing.

I have been a dentist for almost 10 years and have built up various experiences across sectors. I now think it is time to really decide what I enjoy doing and refocusing on what I really enjoy. Particularly now I have a family, there is only so many hours in the week and I don't want to work myself to death.

I think it is hard for mothers and working parents to really say they have a balance between work and personal life. I enjoy going to work as I feel like 'me' not just 'a mum', and even when I am at home with my little one I find myself thinking how can I squeeze a few emails in or a meeting. The result is yes productivity and getting stuff done, but at the end of the day I cannot tell you how tired I feel! So that is why an evening blog post has been pushed down to the bottom of the priority list for the past few months.

The Future of A Tooth Germ

So is there a future for this blog? I am so proud of what I've achieved with over 9 years of typing away on this site. I still feel that glow when someone says to me they read my blog, particularly when they say it's really helped them with an aspect of their career.

And so I will continue to make space to blog and post on here. It might to be as often as 5 years ago and I might change direction a little, but A Tooth Germ is here to stay! And of course I will continue to offer my platform to those who wish to write something themselves. I have always meant my blog to share ideas and education across Dentistry and support those coming through their careers - and even though I'm almost 10 years a dentist and a Consultant, I would still consider myself to be a Tooth Germ....

Thank you for those loyal readers who got to the end of this... let me know what you think I should continue to post about in the comments below!

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Top Tips when Managing People with Substance Misuse in Dentistry

2023-11-22T21:55:00.003+00:00

Some patients might reveal to you either a past or current use of substances such as recreational drugs or alcohol... but how does that affect dental care?

Which Substances can be Misused?

Cannabis - the most commonly abused drug in the UK
Cocaine - the second most commonly abused drug in the UK
Alcohol
Heroin/opiates
Nitrous Oxide
MDMA
Ketamine
Spice
Poppers
Over the counter medication e.g.opioids, benzodiazepines

What are the Oral Manifestations of Substance Misuse?

Oral manifestations of substance misuse can be very specific to the substance, or more general or as a consequence of the effect of the substance. For example, some substances cause sugar cravings or binges, which increases the risk of caries.

Some oral manifestations are:

Caries
Periodontal disease
Xerostomia
Oral cancer/precancerous lesions
Soft tissue perforations (cocaine use)
MRONJ/osteomyelitis
Cluster headaches
Tooth surface loss (attritive from grinding, erosive from vomiting/alcohol use)
Oral ulceration
Burns (poppers)
Bleeding (alcohol)
Halitosis (alcohol)
Traumatic injuries (from accidents during intoxication)

Top Tips when Managing these Patients

1. Treat patients in the context of their lives right now

If the person is at a chaotic or unstable point in their life; perhaps their addiction is not under control, they don't have a stable place to live, or their mental health is really unstable, perhaps they only want to engage with emergency or ad hoc dentistry. Treat their expressed need so they are pain free and comfortable, and when they are ready to engage for comprehensive care, you will have gained their trust.

2. Tailor prevention messages

Are you able to adapt your prevention messages so they are relevant to the patient? If they are on methadone, advise them to rinse their mouth out or use sugar free gum afterwards to counteract the dry mouth effects. Can you prescribe high fluoride mouthwash for your patient to use if they frequently vomit after using alcohol

3. Work collaboratively

Make every contact count - if you can work together with Drug & Alcohol teams in terms of pathways, but also if you need support chaperoning patients or getting further information e.g. blood tests, advising sugar-free methadone.

4. Assess capacity

Just because a patient turns up to an appointment having consumed drugs or alcohol, doesn't automatically mean they lack capacity to consent. For many, they require their substance to be able to function and if you refused to see them after they've had a substance, you'll never actually get to treat them. Assess their capacity using the Mental Capacity Act's Code of Practice - even if they don't have capacity for treatment, are you able to do something to engage them like perform a check-up or give prevention advice?

5. Be wary of drug interactions with local anaesthetics and sedative agents

If patients have recently taken certain stimulants (cocaine, MDMA) there is a risk of interaction with adrenaline-containing local anaesthetics (hypertension, convulsions), so defer treatment.

Many substances, such as cannabis, stimulants, opioids, interact with midazolam sedation or make sedation unpredictable. Be cautious and offer alternatives (e.g inhalation sedation) if possible.

6. Listen to patient's pain!

Patient's pain thresholds might be very low if they are detoxing or have been switched to drug replacement therapy. They can be very sensitive to pain (for example even when delivering local anaesthetic), they might complain of toothache when coming off their substance as it had been masking their pain or they might require more than normal doses of local anaesthetic

7. Be aware of bleeding

Many of these patients will bleed and therefore you need to assess their risk when planning extractions. There is a high incidence of blood bourne viruses in IV drug users so they might have liver damage from hepatitis, or chronic alcohol excess will have caused cirrhosis of the liver.

Liaise with their medical teams for recent blood tests and ask the patients more about their bleeding. Do they bruise easily? For blood tests, Liver Function Tests (LFTs) will show deranged liver enzymes which are related to clotting factors, but I find that quantifying bleeding risk is more easily assessed by a INR, which will tell you how much longer it takes for a person to stop bleeding. Also consider local haemostatic measures, staging extractions and careful post operative advice. When in doubt, ask for advice from an oral surgeon or Special Care dentist.

To read more about drug misuse in dentistry, read one of my latest articles in Dental Update here.

If you have any questions about managing these patients, please leave comments below.

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5 Tops Tips when Treating People with Physical Disabilities in Dental Practice

2023-11-01T11:39:00.001+00:00

For patients who have physical disabilities, accessing a dentist can be a big struggle. So what can you do to help facilitate care for these patients?

An example of a wheelchair recliner - with me in it!

1 in 4 people in the UK have a disability. There are various forms of disability from learning disability, hidden disabilities, sensory disability and physical disabilities. Physical disabilities can be progressive, temporary or fairly stable depending on the individual.

Examples of physical disabilities include:

People who require assistance in walking e.g. walking sticks, walkers
People who cannot walk or self-mobilise and require the use of wheelchairs
People who cannot mobilise at all, often confined to their beds or require hoisting into a wheelchair
People with dexterity issues for example arthritis in their hands, tremors, reduced grip strength

These can be because of conditions such as cerebral palsy, multiple sclerosis, Parkinson's disease, epilepsy, spinal cord injuries, amputations etc.

Physical disabilities can be congenital e.g spina bifida, cerebral palsy, or acquired such as amputations, arthritis.

They can be be musculoskeletal affecting joints bones and muscles (musclar dystrophy, arthritis), where the disease leads to inability to perform movement of body parts due to deformities, diseases or degeneration of muscles or bones. Alternatively, they can be neuromusculoskeletal where the inability to move affected body parts is because of disease, degeneration or disorder of the nervous system (cerebral palsy, stroke).

How do Physical Disabilities affect Dental Care?

People with physical disabilities could have poorer oral health and difficulties accessing dental care compared to the general population. This can be because:

They find it difficult to get out of house. They might rely on carers or relatives to support them to mobilise or take them to appointments. They might require transport services to bring them to clinics, or a crew to get them out their house if there are obstacles for example stairs.
They might struggle travelling to appointments. If they rely on public transport they might find it difficult accessing these services, or they have to allow extra time. They might be uncomfortable travelling long distances for example, sores from being in the same position in a wheelchair.
Clinics might be inaccessible. For example, if there are steps or the clinic is up stairs without a lift. Doors and corridors might not be wide enough to accommodate a wheelchair. There might not be easy access or disabled parking available.
Patients might struggle to get into the dental chair or cannot transfer without a hoist
Oral hygiene can be challenging if patients cannot brush effectively

Top Tips in Managing these Patients

1. Complete Disability Awareness Training as a Team

It is so important that not just the clinical members of a team complete disability awareness, but also reception and admin staff.

This is because as soon as a patient contacts your practice or clinic, they might require reasonable adjustments according to the Equality Act to access care. This might mean accommodating them at the surgery at a certain time e.g. later on in the day if they have carers to assist them in the morning.

To read more about disability awareness in dentistry, read this blog here.

2. Think about your Clinic Environment

Are there simple adjustments you can do to increase accessibility at the surgery or clinic? For example:

Installing handrails for steps
Painting edges of steps in a different colour to make them visible
Installing ramps if possible
Ensuring there is a disabled parking space if possible
Removing obstacles which narrow corridors or spaces
Having a lower reception desk for those who are in wheelchairs
If you are replacing a dental chair, having a break-leg design can be easier for patients to get in and out of

3. Do you actually HAVE to transfer patients from their Wheelchairs?

If patients cannot or find it difficult to transfer from their wheelchairs to the dental chair, if appropriate, sometimes you can see them in their wheelchairs.

Some wheelchairs recline back which can really help with your access. Certainly for examination and possibly simple treatment you could think about treating them in their chairs. Be careful of yours and your nurse's posture though - you don't want to injure yourself!

4. Complete Manual Handling Training

If patients need some help transferring, only do so if you are confident and have completed manual handling training to ensure you and the patient are safe. Always ask patients permission if you think they need some help.

5. Adapt Oral Hygiene Advice

Some patients might struggle with brushing and other oral hygiene, so listen to patients and what they find difficult to help guide them. Examples of adaptations might be:

Brushing later on in the day for patients with arthritis who have 'morning stiffness'
Having thicker handled toothbrushes to help with grip. You can buy toothbrush sleeves, adapt with a tennis ball or even make a putty handle to attach to their current toothbrush - see below
Recommend an electric toothbrush or Dr Barman's 3 sided toothbrush if they get tired
Engage with a carer to relative to assist with oral hygiene
For interdental aids, using the long handled interdental Tepe brushes

Toothbrush adaptations. From left to right: Collis curve toothbrush, Tennis ball to adapt handle, putty to adapt handle & Dr Barman's 3 sided toothbrush

What about those with Severe Disabilities?

For those who cannot transfer from their wheelchairs or where it is very challenging to treat them due to physical disabilities, or those who require stretchers, referral to Special Care Dentistry might be required.

They will be able to offer adaptations, for example:

Patient transport to assist bringing them to clinic
Domiciliary visits for those who really struggle to get out their residence
Wheelchair recliners so the patient doesn't need to be transferred from their chair for treatment - see the top photo
Hoists
Access to stretcher lists

Treating patients with physical disabilities does sometimes take patience, out of the box thinking and really listening to patient needs - but all healthcare professionals have a legal and ethical requirement to make reasonable adjustments when seeing these patients.

If you have any questions about managing these patients, please leave comments below.

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Top Tips for Managing People who Experience Homelessness & Social Exclusion in Primary Care

2023-10-13T21:54:00.002+01:00

I am super proud of one of my latest articles to be published in the British Dental Journal, with top tips for dental teams who work in primary care when caring for people who experience homelessness and social exclusion...

While there are some patients who experience homelessness who need intervention and care from community dental teams or special care dentistry in hospital settings, the vast majority of this group can be treated in primary dental care settings by general dental practitioners.

There are challenges when caring for this group, for example:

High fail to attend rates and difficulty in engaging patients. This is multi factorial (for example, it might be difficult to communicate appointments with them, they might have varying priorities which trump attending a dental appointment, they might struggle to travel to a dental practice etc), but can be very challenging particularly in UDA based setting
Complex mental health and medical needs which affect dental treatment - such as bleeding issues from chronic alcohol use, unpredictable behaviour, consent concerns

Moreover, the oral health of this group is poor and many have chronic dental issues such as pain and poor self-esteem due to their smiles.

My top tips in this article cover:

How to clarify payments and exemption from dental charges - for example, completion of HC1 forms
How to obtain reliable contact details to communicate appointments and follow-ups - often using an advocate who is able to support the patient with their health needs
How to combat missed appointments and reduce failed appointments
Strategies to manage patients complex needs including their medical issues, mental health problems and addictions
How to tailor prevention advice so it is meaningful and attainable for this patient group
How to treatment plan these patients
What is trauma-informed care and resources to train the entire dental team
How to improve access the NHS dental care for this group

To read the article in full, please click here.

If you have any questions about the article or how to care for these patients in your service, please leave comments below.

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How do I refer to Special Care Dentistry?

2023-09-10T20:45:00.002+01:00

I am writing this as I have recently been approached by clinicians and patients alike about how to access Special Care Dentistry... so here's generally how it works.

What Level of Care is the Patient?

Levels of care are referred to with most of the Commissioning Guidelines published by NHS England. They refer to the complexity of the patient, and whether they can be seen by a general dentist, one with enhanced skills (dentists with special interests for example), or Specialist/Consultant care.

For Special Care Dentistry, these are defined as:

Level 1 - Patient to be seen in General or High Street Dental Practice

This can be as part of shared care from level 2 or 3, or on instruction from a specialist service or practitioner providing a treatment plan.

This could be a patient who might just minimal reasonable adjustments to access the care they need, for example, a longer appointment, anxious patients who tolerate treatment with behaviour management techniques, patients with stable medical conditions who are suitable to be seen in primary care.

Clinical teams will be able to see these patients from the education they receive as part of dental undergraduate and foundation training.

Level 2 - Patient to be seen in the Community Dental Services (CDS), by clinicians with enhanced skills in Special Care Dentistry

This can also be a part from shared care, but patients require additional skills to manage their additional needs. This could be cause they require sedation, domiciliary care or additional equipment such as wheelchair recliners/hoists or bariatric dental cares to access dental care.

They also might require additional support in communication (e.g. use of Makaton, Sign language, communication aids), lack capacity to consent (therefore needing Best Interest's Decisions), more unstable medical problems or rely on others to provide their oral care.

Level 3a/b - Patient to be seen in the CDS or hospital dental services by a Specialist or Consultant in Special Care Dentistry

This level of care is for the most complex patients, where Specialist (3a) or Consultant (3b) lead care is required.

This might be because they have severe and complex medical issues (ASA III and above), require multi-disciplinary care (for example as part of an MDT prior to certain medical treatments), patients with challenging or unpredictable behaviours, those who require a general anaesthetic for their treatment or advanced sedation techniques or require clinical holding.

Once you understand what level of care is required for your patient, you then need to work out what your local referral pathways are like.

How do I Refer?

On the whole, level 1 patients are expected to be seen in General Dental Services, which are open access and do not need referrals - although the NHS dental access crisis is making it hard to find a dentist in some areas of the country.

For level 2 care, this will require a referral to the local Community Dental Services, and similarly for level 3 care this might require again a CDS referral, but might be a referral to local dental hospital if there is one in the area.

Local pathways and methods of referral are lead by the local NHS England dental commissioning team in conjunction with the relevant Managed Clinical Network. Some areas have a central referral system, some you refer to each service via a separate referral process.

Referrals to the CDS and hospital dental services can be made by general dentists but also many will accept referrals from other health and social care professionals e.g. GPs, care home managers, social workers, nursing teams. In some more rare cases, some services do accept self-referrals, but these might be for certain elements of their service only (for example if they have a clinic for people who experience homelessness).

To find out your local pathways, please consult your local dental network, but many CDS or hospital services will also have information available on their websites with referral processes. Many also will accept online referrals as well as paper based ones.

What Information should I include?

If there is a central referral system or referral template form for the service you are referring to, please do use that, but if you are writing a referral letter, please do make sure you include the following information as a minimum:

Patient information and contact details (DoB, gender, address, telephone etc)
GP information and other medical/social care professionals involved in their care if relevant
What treatment has been attempted/managed in the past
What treatment is needed
Medical history (medical conditions, medications and allergies)
Why they are being referred if referring onwards from level 1 or 2 care upwards
Any special considerations with transport/access/communication e.g. wheelchair access, transport required, interpreters, next of kin or lasting power of attorney details
Whether urgent or routine

Are there Private Options?

Private Special Care Dentistry activity hasn't really been captured before and is likely to be one of the smallest fields in private dentistry in the UK. Many of our patients either cannot afford to access private dental care, or in fact it is not appropriate (for example, if they need to be managed in secondary care).

There are some practices who do offer private dental care and will see patients who fall under the remit of Special Care Dentistry - particularly for those patients who require sedation to have their dental treatment. There are also some providers who offer private General Anaesthetics but these are fairly rare.

Private services are usually heard about by word of mouth, so getting in touch with local services and contacts would be the best way to find services or practices in your locality.

Please do network locally to find out services in your own region.

Do leave in the comments if you are unsure of the services in your area.

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Integrated Care Systems... What do they mean for Dentistry?

2023-07-06T21:01:00.000+01:00

Some more three letter acronyms you might have heard being used more in dentistry... Integrated Care Systems (ICSs) and Integrated Care Boards (ICBs). But what are they and what is their relevance in dentistry?

What is an Integrated Care System?

ICSs are partnerships that bring together NHS organisations, local authorities and others in an area to take collective responsibility for the planning of services to improve health in their area. There are 42 ICSs across England.

Following the Health and Care Act in 2022, ICSs were formalised as legal entities and they have 2 components:

1. Integrated Care Boards (ICBS) - they are responsible for planning and funding most NHS services in the area

2. Integrated Care Partnerships (ICPs) - they are committees that bring together partners including local government, the voluntary, community and social enterprise sector (VCSE), NHS organisations and others to develop a health and care strategy for the area.

The aims of ICSs include:

Improving outcomes in population health
Tackling inequalities in outcomes, experience and access
Enhancing productivity and value for money
Helping the NHS support broader social and economic development

What does this mean for Dentistry?

ICSs have taken on most commissioning responsibilities for the NHS including from Clinical Care Groups (CCGs) and NHS England and Improvement. Prior to April 2023, NHS dentistry was commissioned directly by NHS England, but now it will be the ICSs responsibility through their ICB.

The new systems are working towards a new model of commissioning, where systems talk to each other in an area and the focus is on collaboration, not competition. The people who worked within NHS dental commissioning within NHS England are now under the ICB and there might be changes while the new structure settles and an ICB in an area takes time to understand their role, the needs of their population and what is currently going on, but this doesn't mean that things will change overnight.

This will open up opportunities to ensure oral health is heard among healthcare... something that doesn't happen very well at the moment. ICBs will be able to hear how access to dental care or oral health problems impact wider health and social care issues; for example, if there is lack of accessible out of hours dental care, when patients turn up to A&E departments with dental pain, increasing pressures in secondary care and A&E waiting times, the ICB will not only recognise this impact, but be accountable for it and be able to address it (hopefully!).

In the short term, it means that new people and new systems need to be connected in the current networks of dental providers - but they won't just be responsible for dentistry but for all matter of other NHS care from acute care, mental health, optometry, pharmacy the list goes on. So many balls to juggle for ICB leads, so many services, organisations and health needs to get their head around.

It is up to us as dental professionals and the organisations that represent us (such as the BDA, LDNs, LDCs etc.) to actively engage with our local ICBs to ensure that dental care is really put on the map and find innovative and impactful ways to work together within the new system.

If you want to learn more about ICSs, check out this BMA article.

What's your experience engaging with ICSs so far? Please let me know in the comments.

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Models of Dental Care for People Experiencing Homelessness in the UK

2023-06-13T23:04:00.004+01:00

My latest publication is the one I am probably most proud of.... it's an adapted version of my Masters thesis looking at the models of dental care available in the UK for people who experience homelessness...

This piece of work has been over 3 years in the making... from the original literature searches in 2020, to submission for my MSc and now to amending for publication in the British Dental Journal! When I started off, formulating my research question this moment seemed very VERY far off!

I would not have been able to have completed this project and my MSc without the support of Dentaid, but also my MSc supervisors. Research is very fulfilling, but can also be super daunting and there are moments when you get yourself stuck down a rabbit hole of reading and going round in circles around a problem. But writing this up has been one of the most fun I have had in my career so far.

In my paper, I highlight the models that have been used and evaluated in the UK when delivering dental care for people who experience homelessness. Patterns include:

Using mobile dental services - such as mobile dental vans or even domiciliary care
Outreach to promote inreach, signposting to services and deliver oral health promotion
Multi-disciplinary working with other medical and social care services such as co-location, referrals and partnership working

To read my paper in full, click here.

Do you have any feedback or comments about the paper? Or on completing a thesis whether for a diploma, masters or pHD? Please leave them in the comments below.

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10 Top Tips for Poster Presentations in Dentistry

2023-05-28T11:03:00.003+01:00

Over the years and throughout my years of postgraduate training in dentistry, I have published and presented many posters at conferences and events. I remember the first poster I ever did I had no idea how to go about it... so here are my top tips if you're considering presenting a poster...

My latest poster presented at the Pathways from Homelessness Conference

1. Decide where you are going to present

Have a look at different meetings, conferences and events for opportunities to submit posters and present them. Most specialist societies will have sections for poster (and also sometimes oral) presentations. Many will have specific criteria you need to follow, for example not just submission dates, but abstract length, topics, landscape or portrait etc.

Some meetings will be very competitive and only accept a certain number of posters, some will accept all poster submissions that hit their essential criteria so do your research. Don't forget other places where you might have poster opportunities such as BDA events, local meetings in your hospital or trust, student events or conferences, or trainee days (such as DCT or ST study days).

2. Decide what your poster will be about

Depending on where you are presenting as mentioned above, there may be stipulations about what posters can be about; on the whole it will be one of the following:

Case reports or case series
Research
Topic review
Audit or quality improvement project
Service evaluations

3. Collaborate

You don't have to work by yourself! Posters can have multiple authors, or you can ask advice and support from your colleagues, supervisors or mentors. Do make sure you either mention them as co-authors or in the acknowledgements!

4. Get examples

Many conferences will have abstracts or previous posters on their websites you can have a look at, but also ask colleagues or mentors for examples so you can get the gist of layout, how to structure and content of your poster.

You can see examples of some of my previous posters here, here and here (this one was one a won a prize for!).

5. Work out if it's a digital poster, or a physical one?

This information should be available on the website or information from the organising team of the conference or meeting you are planning to submit your poster to. Digital posters mean you don't have to print off anything but the conference organisers will display your poster either online or via television screens. Make sure you correctly format your poster to their requirements so they can display or circualate them (for example, sharing the poster in powerpoint or PDF formats).

If you need to print off your poster... well that does throw up a few additional considerations I will cover below...

6. Give plenty of time to print your poster

Allow enough time to finalise your poster and get it printed. There is nothing worse than running around the day before a conference trying to find somewhere to do same day printing of an A0 sized poster! Trust me I've done it!

Depending on what your printing services are like in your area, give yourself at least a few days as some services will need a day or so to print off, although there are online printing services but again will take a few days to deliver the poster (if you trust the post or delivery service to get it to you!).

One of the best tips for poster printing is that if your trust or you belong to a teaching hospital with access to a library, many of these will print off the poster for you, at a decent price and are used to doing these. Some trusts even will do a lot of the formatting etc for you and make your life easier! So research what you might have access to. Also remember to take blu tak/pins/stickies to hang your poster if needed.

7. Format your poster properly

Make sure when your poster is displayed that everything is how you've planned it - this can be easier to test out digitally than if you need to print the poster off, but some printing services will allow you to preview what the final product will look like.

For formatting on powerpoint, make sure you make the slide the correct size (A0, A1 etc) on formatting. If you click on any of my examples above, they are all formatting to size A0 so please do feel free to adapt! Also make sure your poster is landscape/portrait as the organisers recommend. I would say the majority of posters I have presented are usually portrait... but not all!

8. Make it eye-catching

The worse thing at poster exhibitions are conferences, in my opinion, is having a room of posters that are just text! Imagine like 20 posters, size A0, with just text on them! Use graphs, figures, tables, pictures and nice design features like big headings or colours so they are easy to read and grab peoples' attention.

And if you are working for a specific trust of organisation, ask their communications or designs team if they have templates you can use. They might also have guidelines, like the use of their trust logo or which colours to use - so check those out before you start.

9. Proof read

I don't know what it is about creating a big A0 sized poster, but it seems ten times easier to make typos on these sort of things! Make sure you proof read all text (including bits like references of your affiliations) as otherwise your mistake will be out there on display for the whole world to see! Always a good idea to also ask a second pair of eyes to have a look!

10. Be ready to present your poster

At some conferences, not only do you have to display your poster and the work you have done for everyone to see... but some will ask you to stand by your poster to present it during the exhibitions. I've had varying experiences of this; from standing up in front of half the conference delegates and presenting for 5 minutes, to just chatting through my poster as people go by, to submitting a precorded audio file or zoom of me presenting the poster which was posted as a link alongside my poster online.

For poster judging (as don't forget, many conferences will have prizes for the best posters!), judges sometimes want you to present the poster or they might ask questions about it. So be prepared!

I hope my tips help any of you who might be thinking of submitting a poster somewhere! They can look great on your CV and are essential as part of most of the postgraduate dental recruitment processes (like speciality training) - but also a chance of winning prizes for your great work! So keep an eye out for opportunities and get submitting!

Have you presented a poster before? Do you have any more top tips? Please leave them in the comments below.

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What is DNACPR and Why is it Relevant in Dentistry?

2023-05-21T11:00:00.003+01:00

A few years ago, I presented at the British Society of Gerodontology about DNACPRs and their relevance to dentistry. Better late than never, I've decided to summarise what every dentists needs to know about these orders in this blog!

Example of a DNACPR form

What is a DNACPR or DNAR?

DNACPR stands for do not attempt cardiopulmonary resuscitation and is sometimes called DNAR (do not attempt resuscitation) or DNR. It means if a person's heart stops (cardiac arrest) or they stop breathing (respiratory arrest), that healthcare teams will not try to restart them.

This order is usually made by the patient if they have capacity, or their healthcare team if they don't (for example they have dementia, learning disabilities or are unconscious), but doctors can instate DNACPRs in patients who have capacity who might not want to make a decision as well. There is a standardised form teams fill in (see picture above), although it might look differently in some trusts, and many trusts have implemented a ReSPECT form which involves more than just DNACPR status but other emergency care planning wishes. See video below.

Patients and medical teams might choose to have or give a DNACPR if they believe that it wouldn't be in a person's best interest to prolong their life or cause further suffering at the end of someone's life. CPR success rates even with a person who was healthy prior to an arrest are not that high, with only 1 in 10 people surviving an out of hospital arrest and many who survive with have a life long disability as a result.

Why is it Relevant in Dentistry?

In some settings, dentists and their teams will come across patients who have DNACPR orders - for example in domiciliary settings, in hospital or even in general practice when caring for older or unwell populations.

It is important to have an understanding of whether your patients has a DNACPR and how that might impact your care. A DNACPR order only means that CPR is withheld, but other medical emergencies and treatment should be offered as normal. DNACPRs can also only be in place for short periods of time - for example an acute illness in hospital, but some patients with chronic or progressive conditions may have long standing orders so ensure you are familiar with your own patient's situation and ask for copies of documentation.

What do you do if your Patient has a DNACPR?

If one or your patients has a DNACPR get as much information as possible about their medical and social histories - is this a long standing DNACPR, how safe it is for you to treat them in your environment (for example if you're in primary care), actually how much dentistry does this person need? For example, if they are clearly very unwell or end of life care, considering palliative dentistry rather than lots of extractions/rehabilitation.

You should have a discussion with the patient and their carers/family about what is they were to have an arrest during dental treatment and should the order be suspended or not - the likelihood is that for the majority of dentistry, it is unlikely that you would be put in a situation where you'd need to consider giving CPR or not; however, in some instances, such as considering a general anaesthetic for dental treatment, this situation would need to be discussed. It is likely this would be lead by an anaesthetic team, but the dental team should be aware that the conversation surrounding the DNACPR needs to be had.

Ultimately, a DNACPR is not legally binding. So if you are ever unsure as a clinician, it would be safer to begin CPR and once further help has arrived such as paramedics or crash teams, the decision whether to withdraw the CPR can be made by them. Only if a patient has made an Advanced Decision to Refuse Treatment, is then a DNACPR legally binding.

Although an emotive topic, these orders and advanced life decisions are important to be aware of in a dental setting so do not be afraid to ask the question! We even have the question on our medical history forms - but it is also important to follow this up and ask for documentation.

Have you had any training or discussions surrounding DNACPR orders? Please leave them in the comments below.

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Guest Blog Post with Daisy Ridsdill Smith: DFT Reflections

2023-05-03T16:24:00.001+01:00

It's been a while since I've a guest blog feature on A Tooth Germ, but I am so pleased to publish Daisy's insightful reflections of her experience of Dental Foundation Training so far...

Daisy, a DFT based in Suffolk

I am currently 8 months into my foundation year. I moved back to my hometown in Suffolk. Funnily enough I have ended up in the practice where I did my work experience when I was 16 years old. From being a shy shadower in the corner of the room to being the dentist who is responsible for helping people make decisions. It’s a full circle that does help me recognise how far we go as dental professionals through our training at university.

It has been very gratifying to have noticed the improvement in my confidence, clinical skills and communication during these last 8 months. In September I felt shy giving OHE and muddled up the dates on toothpaste prescriptions. Last week I caught myself singing song lyrics from ‘Moana’ to a 6-year-old crying in the chair and successfully getting them through the visit. I genuinely look forward to going to work every week and the dental team I work with are so kind and supportive making it even more enjoyable.

Dentistry comes with challenges, which I feel is exacerbated by the problems faced with NHS dentistry. Where I am working is often described as a dental desert. The books are very full and sometimes it can feel like you are firefighting – which can feel stressful at times. Especially since the transition from dental student to FD is also a learning curve. Initially I would often doubt my decisions and even now 8 months in I need to ask for advice and opinions from my supervisors. Some days can be exhausting (mentally & emotionally). You can take on patient’s problems home with yourself. I often catch myself over-thinking a situation in a day – for which reaching out to fellow DFTs, colleagues, friends and family for life advice has been invaluable. I have found it very helpful to remind myself at the end of the week that 1) you will have helped so many people (even if it doesn’t feel like it!) and 2) everyday we are learning and improving that tiny bit more.

My advice to anyone about to undertake DFT

1. Ask for advice, - both from supervisors and colleagues!

As well as taking feedback onboard. This year is meant for developing you as a clinician so embrace it. I recently gained some tips from another FD working in community for managing nervous children: for example, giving the handheld mirror to the patient for them to hold so they can see what you are doing and have more control.

2) Giving oral hygiene advice is great!

The BSPD recommend 3 minutes of giving OHE every visit for children. If this is a patients only access to the dentist, they may pick something up? Those 3 minutes can easily be slotted while you’re waiting for x-rays to develop or while the surgery is being prepared for the next patient. I like to think of Tesco’s slogan ‘Every Little Helps’ and that they then leave the dentist and share what they have learnt with their friends and it can help educate the community in a domino effect.

3) Be open and honest with your patients.

When mistakes happen, stay calm and communicate appropriately with the patient and the dental team. I once started to remove the wrong amalgam restoration at the end of the busy day. I kept my cool and told the patient there and then. I was on the verge of crying when I got home that day but was proud of myself for managing the situation professionally. I thought about ways to mitigate this risk and now make sure me and my nurse verbally identify which tooth we are working on before we start a procedure.

4) Enjoy the year

We are in such a privileged position as dentists. We really do have the power to directly improve someone’s quality of life. Two of my favourite things are getting a patient out of pain or giving someone their front teeth back.

Thanks so much Daisy for those tips and for sharing your experiences! If you'd like to feature on my blog, drop me a message via the contacts tab!

What's your experiences of DFT? What advice would you give? Please leave them in the comments below.

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What is DCT Equivalence?

2023-04-23T11:10:00.002+01:00

COPDEND and their stakeholders brought in a new process last year called DCT equivalence... but what is it and who should apply?

What is DCT Equivalence?

This process to facilitate applications for people wishing to do speciality training, but may not have 'ticked the boxes' of two years of DCT posts, but who have the necessarily and equivalent skills to apply. The idea, echoing the recommendations of the Advancing Dental Care report, is to promote more flexible routes to specialist training - for example encouraging people in salaried hospital jobs, community roles or those working at enhanced levels in general dental practice to become specialists.

Until this change, applicants for all specialist training pathways needed to demonstrate 2 years of DCT training i.e. complete a DCT1 and a DCT2 post. But it was argued that many other routes will give the necessary competencies of a DCT2 level applicant and hence why this formalisation of recognition of skills has been introduced.

Once you are given a DCT equivalence you can therefore use this to apply for specialty training and hit the essential requirement to having the competencies of a DCT2 on commencement of a specialist training post.

How do I Apply?

The applications are annually released around August time and applications are streamlined and assessed centrally. They will be open for around a month, with outcomes again around a month later. Please check specific dates on the COPDEND or NES website.

In order to apply you will need to have completed DCT1, have 36 months as a minimum working as a dentist and could then use evidence from the following (this is not exhaustive) posts to show equivalence:

Specialty Dentist/Doctor or Salaried posts in hospital
Community Dental Officer or PDS dentist
Salaried dentist or self-employed dentist working in GDS providing more complex care (e.g. completing post grad qualifications, Level 2 service provision, sedation, domiciliary care)
Posts such as fellowships with split roles between clinical and non-clinical work

In order to apply you will need to submit evidence to be assessed. Evidence can be any of the following:

CV
Post grad qualifications e.g. MFDS
Clinical logbook
CPD log and certificates
Personal Development Plan
Quality Improvement projects
Structured Learning Events (SLE)
Multi-source feedback (MSF)
Reflections
Patient Surveys
Teaching evidence
Leadership and Management evidence
Presentations
Publications

For more information including FAQs, dates and links to apply please see the COPDEND or NES websites.

Have to considering applying for DCT equivalence? What was your experience of it? Please leave them in the comments below.

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My Experience of Working as Dentist whilst Pregnant

2023-04-16T11:17:00.003+01:00

My baby may now be over half a year old, but I remember the challenges of working when she hadn't even entered the world! Working clinically was a big challenge for me which I hadn't really anticipated...

Pregnant and in Theatres

This topic is a personal one and I should firstly say that every women and every pregnancy is different. It can also be a sensitive topic to talk about, so plucking up the courage to write this blog post has taken a while. I am mindful of all the people who have difficult fertility, pregnancy and motherhood journeys. Certainly I really did not appreciate what a feat falling pregnancy, carrying a baby for 9 months (although it was 8 for me in the end!), giving birth and surviving motherhood is until I have experienced it myself.

I want to share my experiences and journey as I feel like it is something women and parents don't usually do, especially in dentistry. Our profession is increasingly a female majority where many will want to pursue having a family. Supporting and championing this is something I really care about - flexibility in their career, empowering women to grow both their personal and professional lives is something everyone should do in dentistry whether male, female or otherwise.

I am grateful throughout my pregnancy and now maternity leave that my employers and colleagues have been amazingly supportive. I want to encourage all sectors to foster this positivity and support. The first step in this is the understand what adjustments might be needed for pregnant people... so here is my own personal journey of the pregnancy I have just gone through.

The First Trimester

Notwithstanding the excitement and also fear that came with finding out I was pregnant, was the confusion and uncertainty of when I should start telling people. Early on, similar to many women, I only wanted to tell a close circle of people - however particularly since I work with a certain patient group including the use of inhalation sedation, I felt that I had to tell my employer. I did this earlier than I legally had to as there are requirements to maternity leave in the UK of when you need to tell your employer. Please see your own contract of employment to verify this for your own personal situation.

In Special Care Dentistry and the Community Dental Service as soon as a clinician's diary is blocked or dental nurse switched on the rota to avoid the use of nitrous oxide sedation, it almost like an unofficial pregnancy announcement! There are no specific guidelines that mandate this, but it is recognised that certainly in the first trimester inhalation sedation should be avoided due to risk of miscarriage. The choice whether to perform inhalation sedation is a personal one too and the opinion of the women should be taken into consideration - I did not want to take the risk myself, although I did do a few ad hoc sedations later on in my pregnancy.

I did a risk assessment with my line manager and I spoke with our occupational health for any adjustments that I might need during my pregnancy, such as:

Avoiding some treatments (such as IHS as mentioned above)
Care with manual handling and patient assistance - for example I routinely use a hoist to get my patients into the dental chair. It was agreed that I wouldn't do this myself anymore, but my nurse/another team member would lead on this
Risk assessing individual patients - for example, I do see some patients who have challenging or unpredictable behaviour. We agreed if possible, other dentists should see these patients or I should see them jointly alongside another clinician
Appointment lengths and breaks - build in longer appointments if needed and breaks if I needed to rest
Time off for my maternity and antenatal appointments (which is a legal requirement)

People often say the first trimester is the worst - the morning sickness (which isn't just limited to the morning by the way) and the fatigue. Personally the sickness continued throughout my pregnancy which was a challenge when seeing patients. I also now completely understand first hand why pregnant patients get free NHS dental care.... I am pretty sure my oral health was the worse it has ever been when I was pregnant. I couldn't brush my teeth without vomiting, the frequency of sickness, the bleeding gums, and the grazing and snacking that happens to quell the nausea... I was scared that on the bitewings taken at my most recent check up there would be a sea of interproximal caries! (miraculously all was actually well!).

I also had other symptoms that made working hard. I had about 2 weeks of sciatica which made it hard to sit in certain positions and it was painful to walk up and down stairs... it took me 10 minutes to get to bed at nighttime! Thankfully that subsided, but my immune system was clearly taking a beating from growing this new life. In my first trimester I had everything from a nasty bout of food poisoning to a chest infection. By the way, if you are employed any pregnancy related sickness should not count towards your sickness record.

Second and Third Trimester

As my pregnancy progressed, the difficulties with manoeuvrability became more prominent. Cannulating sitting on the floor (which was something I routinely did for many patients) became out of the question. Even the space where I sat in my chair behind the dental chair became rather tight!

The bigger I got, the further away the patients got! I ended up booking 15 minutes extra on top of my usual appointment lengths for treatments so I didn't feel rushed and could build in rest and when providing more complex treatments under sedation for example, I would book alongside another clinician or an extra nurse for support. My team were amazingly supportive and understanding - my nurse would always be ready with an emergency piece of fruit when my energy started to wane!

It was interesting to see which patients would notice my condition... often women who had had babies themselves! Scrubs can hide a lot. A couple of my patients even bought some small baby gifts which was very sweet. The commute also began to take more and more of my energy (it was about an hour or so on the tube). I did always get a seat thanks to my 'Baby on Board' badge, but especially as the summer heat set in, it was not a pleasant journey!

Going on Maternity Leave

Maternity leave started sooner than I had planned with my little one arriving almost a month early, which meant that my team literally saw me one day and the next I was off! I had planned to work quite late into my pregnancy to save the time off on maternity leave when the baby had arrived... but life has different plans for you!

What I would say for anyone who is pregnant or planning on being one day, you can make the most detailed plans, but whatever happens you will make it work. I felt terrible going off early, cancelling patients - I felt like I had really caused some inconvenience for them and my colleagues. But ultimately what matter is your health and your baby's health. There are always other dentists and your patients will still be there when you get back to work. And on a personal note the same applies in terms of being ready for being a parent. I don't think you can ever feel fully ready. I read so many books, listened to lots of podcasts, watched programmes and documentaries.... but what really made me ready for being a parent is when I cuddled my baby for the first time and heard her newborn squawk.

Now maternity leave is coming to an end! How time does fly and babies grow too quickly! I am thankful to have the most perfect, happy and healthy bubba and now its almost time for another life transition: working AND being a parent.

I am sure I will blog more about this in the future.

Please do share any experiences of working as a dental professional when pregnant and beyond if you feel comfortable doing so. Please leave them in the comments below.

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Mobile Dentistry... What are the Options?

2023-04-11T22:58:00.003+01:00

For many people and communities, travelling to the dentist at a dental practice can be a big barrier to care... whether that be because of issues with mobility, inability to afford travel or many other reasons. So taking care to patients in their environment, what are the options?

Domiciliary Dental Care

I have previously blogged about what domiciliary care or 'doms' is here and my top tips. The perception might be that doms is limited to care homes, but it is taking care out into peoples' homes which can include care or residential homes, but also people's own homes or even hostels or hospitals.

Domiciliary care can vary depending on what equipment is available to the dentist providing the service as well as the suitability of the patient and environment. I have worked in Community Dental Services providing doms and even between different CDSs, the care varied. Some used hygienists and therapists to provide aspects of care, some had access to mobile equipment such as handpieces and portable suction and x ray equipment; but some did not have access to all of this. On the whole the majority of care provided in a doms service is limited to the following, unless more equipment is available:

Examinations
Prevention and fluoride varnish application
Simple restorations using Atraumatic Restorative Technique (ART), some services also are piloting the use of Silver Diamine Fluoride (SDF)
Denture construction
Simple scaling
Simple extractions

Going out on doms in the one of the CDSs I worked in... medical emergency kit and oxygen in hand/on back!

For each domiciliary visit, a risk assessment must take place which will cover aspects such as assessing the environment for potential risks (e.g. what floor it is on, how far away is parking, trip hazards etc), the patient suitability (e.g. medical risk, manual handling risks, behaviour risks) and treatment risks (for example, if an extraction is needed how complex is it, do you have the correct equipment etc). There are guidelines which should be followed when providing domiciliary care.

Currently on the NHS, the only services that can provide domiciliary care need to have an Advanced Mandatory Service contract - therefore the majority of these services are as part of a CDS although not all of patients who require domiciliary care require the input of a special care dental service. There are some private services or dentists who will provide doms, but these are not very common as the legislation surrounding logistics of this model of care (CQC requirements to carry medical emergency equipment for example) put services off.

Mobile Dental Surgeries

Mobile Dental Surgeries or Units are dental surgeries on wheels in the back of a van or trailer. They can be expensive to purchase and run, but give the flexibility of taking a fully-equipped dental chair (including x rays, handpieces etc) out and about in communities.

An example of a MDS/MDU

MDS/MDUs are still used up and down the country by CDSs and other dental services including charities. They often provide care for populations such as:

People experiencing homelessness
Care at Special Schools
Care home residents
'Hard to Reach' communities such as fishermen and their families, asylum seekers, people in rural areas
Care in prisons or secure units

In order to provide care in this way, it might take more staff (for example to drive the vehicle) and resources (such as parking facilities) but it can increase engagement for people who would often not engage, or struggle to engage, with dental services otherwise. You can also provide more treatments than just a domiciliary visit alone. Many MDS/MDUs can be adapted for people with accessibility problems - for example I have worked on units with chair lifts or even hoists for people in wheelchairs.

Overall, taking dental care out to communities where access is a problem can increase engagement and allow people to get dental treatment. Domiciliary or mobile dental care using MDS/MDUs might suit some of the following populations:

Older people in care or residential homes (or in their own home) where they might struggle to get to a dental appointment due to medical, physical, psychological or social reasons
People who experience homelessness who wouldn't engage with fixed appointments at fixed site practices
Prisons or secure units where residents cannot be brought out of their residences
Schools (particuarly Special Educational Needs schools)
Rural environments or populations with little access to dental clinics
Fishing communities
Gypsy and Roma Travellers - lack of trust might stop them leaving their community to access care
Asylum seekers and Refugees living in accomodation such as hotels
Health 'one stop shops' or pop-up health events in the community e.g. Crisis at Christmas
People in hospital, hospices, or as part of End-of-Life Care.

And I am sure there are many more...

Have you worked on doms or on a MDS/MDU? What were your experiences and challenges? Please leave them in the comments below.

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5 London Museums Every Dental Professional Should Visit

2023-04-06T17:46:00.000+01:00

Are you a bit of a dental and medical geek like me and are looking for some inspiration for cool places to visit and drag your loved ones? There are some really cool museums in London which might tickle your fancy....

The Old Operating Theatre

1. The Old Operating Theatre Museum and Herb Garret

The first museum on the list is the Operating Theatre Museum and Herb Garret. Located in the attic of a historic church by London Bridge, this museum is a perfect blend of history and medicine. It is one of the oldest surviving operating theaters in Europe and showcases the development of surgery over the centuries. Here, you can see medical instruments of the past, as well as a collection of herbs and botanicals that were once used to treat patients.

2. BDA Museum

The British Dental Association (BDA) Museum is a must-visit for every dentist. I bet you didn't know that at our Trade Union's HQ in Wimpole Street is one of the largest collections of dental history in the world. From the early days of dentistry to the modern era, you can explore the evolution of dentistry through the exhibits. The museum also holds some of the earliest dental chairs, instruments, and dental advertising from around the world. You can access this for free and why not check out the BDA library while you're there. Contact the BDA before visiting as it was closed during the pandemic.

3. The Science Museum

The Science Museum in South Kensington is a popular destination for science enthusiasts from all over the world. This museum has a dedicated section on medicine and dentistry, tucked away on the top floor, which features some of the most exciting exhibits for dental professionals. You can learn about the history of dentistry and the development of dental materials, and see how dentistry is making strides in the modern era.

4. The Wellcome Collection

The Wellcome Collection is another popular museum in London that focuses on the history of medicine and health. Here, you can explore the intersection of science and art, and learn about the history of dentistry in a unique and engaging way. The museum houses medical and dental artifacts, including the earliest dental X-rays and some of the earliest toothbrushes (including Napoleon's!). I remember going here as a school girl and being fascinated by the collection. A few years ago, it hosted an exhibition called Teeth focusing on the history of dentistry. I also really enjoy the giftshop and cafe which you can access if you're just passing by Euston station.

5. Bedlam Museum

The final museum on our list is the Bedlam Museum in South London. This museum is a must-visit for any dentist who wants to explore the history of mental health and dentistry. Bedlam was one of the earliest mental institutions in the world and played an essential role in the development of dentistry. Here, you can learn about the role of dentistry in mental health, as well as the history of the institution itself.

So when will you be planning a trip to London and explore these museums for yourself? You never know what new knowledge you might gain that could help you in your own practice!

Do you have any other museums you'd recommend visiting? Please leave them in the comments below.

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5 Ways to Give Back in Dentistry

2023-03-13T22:49:00.003+00:00

I have previously blogged about volunteering in dentistry and it is something I am asked about all the time... so I thought I would update what I think are great ways that dentists and DCPs can give back to the community.

Donate or Fundraise

You might typically think of donations in terms of cash donations which might be one off or regular (for example once a month or year). This might be for a local charity such as a food bank that you care about, for other charities that support the population, local healthcare charities such as hospital charities, or to dental charities such as Dentaid The Dental Charity, the Oral Health Foundation, Dental Wellness Trust, Bridge to Aid and others.

But don't forget, charities such as Dentaid, accept equipment donation from dental chairs, to instruments, to toothpastes and toothbrushes. You can also donate oral health products to local food or hygiene banks. You can also hold events to fundraise for a certain charity; from bake sales, to sponsored runs or marathons! There are also easy online ways to fundraise, for example, Easyfundraising.com or via Amazon giving.

Volunteer in the UK

There are projects up and down the country with Dentaid the Dental Charity, where clinicians are able to give their time to volunteer on clinics helping the most vulnerable people access dental care, or as part of their Bright bites oral health promotion programme.

You can also give your own time to find communities near to you improve their oral health - for example in the past I have visited Brownies groups to deliver oral health promotion. This might be at local schools, care homes, community events, soup kitchens, homeless centres or even secondary schools to talk about careers in dentistry.

Overseas Trips

Having previously volunteered overseas in Tanzania I can tell you that the experience can really put things into perspective! Depending on where you choose to volunteer will influence what your experiences might be, but for me it really helped with my extraction technique, and also was super fulfilling to provide dental care for people who would not get any access to dentistry otherwise.

Overseas trips to countries such as Uganda, Malawi and Cambodia are organised by Dentaid the Dental Charity.

See Patients as part of your Practice

Do you have any patients who you know are in difficult situations? Or have been contacted by homeless organisations or other charities who look after vulnerable people? Or even nurseries or schools? Access to dental care is very difficult at the moment, and this is affected vulnerable people the most and the cost of living crisis is making life very challenging for a lot of people. Is there anything you can provide as part of your practice to help? Maybe taking on these people as patients, or seeing the odd patients probono?

It could just be as simple as agreeing to see patients from a local care home, or offering to get involved with projects with the NHS to see certain patient groups - for example, some practices in areas are piloting being 'child-friendly' practices, or offering sessions to see people who experience homelessness.

Teach and Support the Next Generation

Can you assist the training or inspire the next generation of dentists and dental professionals? Can you accept work experience students, speak at local schools about careers, or deliver talks or placements for dental students?

Newly qualified dentists or DCPs might also want mentoring through their first few years in their profession; could you support this, help with CVs, provide peer reviews or just someone to talk through about problems they encounter?

Many dental schools have student societies who hold lectures and events and look for speakers to help inspire them about different aspects of dentistry - these can even be online!

Do you have any other ways you can give back in dentistry? Leave them in the comments below.

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A Week in the Life of... a Specialist in Special Care Dentistry

2023-02-19T20:58:00.002+00:00

So Week in the Life posts have been a feature of my blog ever since I was a DCT... and I've featured many others' typical weeks. So it only seems fitting to describe what my week is like now I am a Specialist!

So now I am a specialist, weeks don't always look the same! I work between the Community Dental Services and the Charitable sector with Dentaid. I also need to balance my roles within the British Dental Association and Managed Clinical Network Deputy Chair - so between patients and lunchtimes there might be meeting or two squeezed in!

But here is an example week...

Monday

I'm at one of the community dental clinics I work at seeing patients referred to me for treatment under IV sedation. This might be because of severe phobia, learning disabilities, limited mouth opening, severe gag reflexes or to control a tremor.

I will also see any patients for treatment under local anaesthetic - for example people with medical complexities like cardiac issues, dementia, cancer patients or patients taking bisphosphonates.

Tuesday

This is my day dedicated to Dentaid as their Clinical Director. This could be working from home on the guidelines and policies of the service, having meetings, heading down to our HQ in Totton to be in the office with the team, or even doing one of our mobile clinics.

Wednesday and Thursday

I'm back in another community clinic, seeing complex special care adults for assessments and treatments, including under conscious sedation. A lot of my patients might require hoist transfers to the dental chair as they use wheelchairs, and occasionally I might see a patient on a stretcher.

In between my clinical duties, I might have meetings or teaching sessions - for example as part of our Managed Clinical Network, sedation meetings or training sessions for our staff.

Friday

Once a month, we have a general anaesthetic list to see patients who cannot have their treatment any other way for example due to severe learning disability. This list is hosted by an external trust so it takes a lot of organisation and communication... and lots of emails!

Currently, I'm off on maternity leave so my weeks are never the same, with sporadic routine looking after my little one! And certainly when I do go back to working, I am sure that my week will look very different to this!

Specialists in Special Care Dentistry can work in the CDS like I do, hospital dental services or even in general practice (for example providing sedation or domiciliary visits). I would love to hear from other specialists to hear about how your week goes! Although as those of you who work with Special Care patients will know.... there is never a 'typical' week in Special Care Dentistry!

Do you have any questions about Special Care Dentistry or applying for specialist training? Leave them in the comments below.

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How to become a Consultant in... Paediatric Dentistry with Kirsten FitzGerald

2022-12-21T16:59:00.000+00:00

A slightly different post in my How to become a Specialist Blog series.... this time it's how to become a Consultant in Paediatric Dentistry with Kirsten FitzGerald.

My role as a consultant paediatric dentist at Ireland’s largest children’s hospital (CHI at Crumlin) is a huge privilege. It’s never boring and no two days are the same. The dental team here cares for some of our country’s most complex children, and we work with colleagues in the other children’s hospitals and in primary care dental clinics to optimise care according to our patients’ needs. I first worked in this hospital over 20 years ago and got bitten by the bug that has steered me towards this role ever since. As a part of my role, I also teach postgraduate students in paediatric dentistry at the Dublin Dental University Hospital and they work under my supervision here in Crumlin too. Over the years I have had the great fortune to work with and look up to some truly fabulous paediatric dentists, and I have had the opportunity to train the next generation of paediatric dentists so that each generation is better than the one that came before. That’s what it’s all about.

Why Paediatrics?

Following a house officer job, a period of time in general practice and in the salaried primary care services, I made the decision to specialise in paediatric dentistry. Adult dentistry was not for me!

I started my specialty training when I was 4 years out of dental school. Rather than stay close to home, I wanted a new set of experiences and horizons so I decided to undertake training in the US. The training programme in Dallas had an opening and I made a big leap of faith to move there. The programme also made a leap of faith as I was the first international student they had taken. What makes me very proud is that I have managed to maintain a strong connection with the programme there and at the time of writing, 6 young Irish dentists have been able to train there.

When I came back from Texas I undertook a two year Clinical Fellow training post here in Crumlin (akin to the two year post-CCST positions in the UK) and a consultant position came up at the right time for me. I have a joint appointment with the dental school and this helps me keep in touch with the dental world – sometimes teeth are the least of the problems when I am looking after sick children, so it’s nice to see healthy children with dental issues too!

What is a Typical Week like?

A typical week involves all day GA on Mondays, all day clinical teaching on Tuesdays, Wednesday morning GA and afternoon cleft clinic, followed by a more flexible Thursday and Friday where I can book meetings, do admin and see urgent care patients as well as look after inpatients here in the hospital. There is an on-call aspect of my role too, which although a burden, is also rewarding when we get children cared for out of hours when they need it.

The one thing I don’t get to do much of and want to focus more on is research. You can’t do everything, and as I have an enormous clinical responsibility that always takes precedence. But hopefully over the next few years I will be able to carve out some research time. I do remember in my interview that this challenge was pointed out to me and I recall saying I would try to carve out that time, but it’s over 10 years and I haven’t achieved it yet!

Top Tips for applying

My advice to those considering paediatric dentistry is to think about where you would like to end up in terms of the setting – is it private practice, hospital dentistry, community dentistry or academics? Maybe it’s a blend? Be realistic about what is going to be available to you at the end of your training. Find out from those in the know what the future is looking like in your area of interest.

I know paediatric dentists who really would prefer to work in a salaried role, for example, but the only work available is in private practice, and that is not what makes them happy. I strongly recommend that people have a wide range of experiences before they decide to specialise. There are two main reasons – it helps the young dentist see what they like and don’t like about different work settings, but also it allows them to have insight into the realities of day to day dentistry in all types of settings. We refer patients out to and receive referrals from private practice and to salaried services, so it’s good to have worked in those so you understand the pressures, advantages and limitations.

Everyone seems to have ticked all the boxes now on their CVs, so I often find it hard to pick out the exceptional candidates. That is why having personal contact with prospective trainers/employers is key, in my view.

Aspiring paediatric dentists should try and put themselves out there by doing poster presentations, offering to work in a supernumerary capacity (without pay) if that is possible, or anything that they can do to make themselves known. Be yourself and relax - your personality and enthusiasm will then speak for itself, and you will find a good fit with the right job or training programme. If it’s not a good fit then it’s not for you.

Although sometimes I find my work is overwhelming in terms of volume, I never ever dislike the actual work I do. The paperwork is a bit more than I bargained for mind you! I just love working as part of a huge team at the hospital where everybody really pushes to get children the care they need. I feel so lucky.

Do you have any questions about Paediatric Dentistry or applying for specialist training? Leave them in the comments below.

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How Can you Develop your Leadership Skills in Dentistry?

2022-12-18T15:43:00.002+00:00

When applying for jobs you might see as part of the criteria a tick box for leadership and/or management skills. But how are you able to demonstrate this and gain leaderships skills in dentistry?

Graduation day with my fellow OCDO fellows back in 2019!

Responsibilities as part of your current Job

You could argue that actually every dentist has to demonstrate leadership within their surgery. You are there, with your nurse and your patient and you are leading the interactions, where things are going, instructing and training your nurse and communicating with your patient.

You could also take on additional roles, whether you are an associate in practice, or working in hospital or the community dental service. Some examples are:

Becoming a lead for the practice/service in areas like cross infection, CPD and training or safeguarding
Becoming a clinical lead for an area of the service - for example, when I was a dental officer in the Community Dental Service I was the lead for our Homeless Dental Service.
Becoming an Educational or Clinical Supervisor for trainees
Taking on roles such as sitting on a board, or clinical advisory group, for example if you work as part of a corporate
Roles as part of societies, the royal colleges or other dental organisations

Edward Jenner Programme

An online course for NHS professionals which is free to access and has a rolling intake, this programme is an excellent opportunity to explore what leadership is and develop your own skills.

I would definitely recommend completing this programme, and then you apply directly what you learn into what leadership roles you have in your day job. To learn more click here.

NHS Leadership Academy

The Edward Jenner Programme is one of several at the NHS Leadership Academy. They have several programmes to enrol on depending on your leadership experience as well as a learning hub and other events.

To see more click here.

Fellowships

You might have seen from previous blog posts, that I completed a year's fellowship with the Office of the Chief Dental Officer. These programmes are usually a year in length and are non-clinical roles that aim to help dental professionals upskill in leadership and management. You might have a specific project to work on or are generally immersed within an organisation to learn more about the other side of the decisions table! For example in my year I was involved in the recommissioning of the Community Dental Services in a region.

There are lots of different fellowships around, some include:

OCDO/FMLM fellowships as I have mentioned
Health Educational England Fellowships
Chief Sustainability Officer Fellowships
NHS Regional Fellowships
Darzi Fellowships
Topol Fellowships

Masters and Diplomas

There are lots of Healthcare Leadership MScs and Diplomas about from universities and many of them are online or distance learning.

There's a dental one too! Queen Mary do an online diploma in Dental Public Health, Policy and Leadership.

Non Dental Roles

Don't forget all the things you do outside of dentistry and outside of work that will demonstrate leadership skills. Have you sat on a board, organised an event, been captain of a sports team, done voluntary work or anything else that shows you are a great leader!? Do not forget these!

Finally, if you need any one on one careers coaching or if you want more personalised help to develop your leadership skills get in touch! I offer personal coaching services which you can learn about here.

Do you have any questions about Paediatric Dentistry or applying for specialist training? Leave them in the comments below.

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How to become a Specialist in... Paediatric Dentistry with Richa Rughani

2022-12-11T17:21:00.003+00:00

Next in the series of How to become a Specialist... is Paediatric Dentistry with the wonderful Richa Rughani, StR in Paediatric Dentistry based in Belfast.

Why Paediatrics?

My own experience of healthcare as a child inspired me to work in paediatrics. I’ve always wanted to help children reach their full potential and play a role in their lives during their formative years so when I found out that dentists could specialise in paediatric dentistry it was the obvious path for me to follow!

As well as this, paediatric dentistry is a combination of everything I most enjoy – from being able to deliver treatment under GA, with inhalation or chairside, to the various fields of dentistry within it such as trauma management, oral medicine, surgical procedures, and restorative work. Finally, working with children brings out the best in me and I have the most fun with them.

How long is the training?

There is national recruitment for both specialty and consultant training posts in paediatric dentistry. It takes three years to complete specialist level training and trainees will then sit the Tri-Collegiate Diploma of Membership in Paediatric Dentistry (MPaedDent) examination administered by the Royal Colleges of Surgeons. Aside from national recruitment, you can also become a specialist by completing a three year DClinDent in Paediatric Dentistry which is privately funded and will also allow you to sit the MPaedDent examination.

It takes a further two years to complete to consultant level and this requires trainees to successfully pass the Intercollegiate Specialty Fellowship Examination.

What is a typical week like?

A typical week will vary between units and, to some extent, whether training is in a community dental service or hospital. Generally speaking, a typical week will include:

Theatre sessions where treatment is completed under general anaesthesia. This may be comprehensive care or extraction lists
New patient assessment clinics and review clinics
Treatment sessions, some of which may include the use of sedation
Joint clinics with other specialities

Traumas and emergencies are also common and if working within a hospital setting ward patients may also require review.

Top Tips for applying

1. Know your why

Why do you want to specialise in paediatric dentistry? Applying for speciality training and training itself is extremely tough and requires serious dedication and persistence. Specialising, irrespective of the speciality, is also a huge commitment and can be tough with very real sacrifices that may need to be made, so having a clear “why” is what gets you through these times. Your reason for wanting to specialise in paediatrics is unique to you and the genuineness of your passion will come across in your interviews.

2. Have some experience in paediatric dentistry, not just in being with children.

Ideally, gain this experience by doing a year of paediatric dentistry DCT, working as a clinical fellow, or in community dental services. Not only will this give you a taste of the speciality before you make a commitment, but it will also help you have foundations for speciality training.

3. Look at the personal specifications

Look at versions that that have come out over the last few years and try to meet as many requirements as possible. It changes every year so try to have a broad range of areas that you’ve covered. Audits, quality improvement projects, and even case reports involve a lot of work so make sure you do them on topics that you really enjoy.

4. Know the speciality

Keep up to date with the latest hot topics, research and the best way to do this is by attending conferences, webinars, and reading journals. The British Society of Paediatric Dentistry website, conferences, and regional meetings are always an excellent starting point!

5. Find a mentor

I found having a mentor very helpful and talked to many paediatric dentists to find out their best tips and tricks.

Finally.... give it your all, and then you’ll know that whatever the outcome is, you did your best.

Do you have any questions about Paediatric Dentistry or applying for specialist training? Leave them in the comments below.

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