Introducing dentists with special interests (DwSIs) -- past, present and future perspectives.

This paper provides the national context for the development of practitioners with special interests (PwSIs) in light of the recent introduction of the concept to dentistry. Given the shortage of specialists and consultants in some dental specialities and the fact that a number of referrals could be managed in the primary care sector, the development of an additional tier to bridge the gap between current capacity and demand for services in secondary care seems to be a practical solution. The introduction of the DwSI and the future training opportunities it affords will pave the way for the development of a cadre of accredited primary care practitioners with enhanced skills who, together with their secondary care colleagues, will help widen the choice available to patients in terms of the nature and locality of NHS dental care provided. In time, DwSIs may wish to train to become full specialists or consultants and have their accredited prior learning and experience recognised towards completion of full specialist training.     

Oral and Maxillofacial Surgery (OMFS) Consultant Workforce in the UK: reducing consultant numbers resulting from recruitment issues,pension pressures,changing job-plans,and demographics when combined with the COVID backlog in elective surgery,requires urgent action

Mean retirement age for UK doctors is 59.6 years, giving the average OMFS consultant approximately 20 years of practice. Current pension tax regulations, new consultant posts typically restricted to a maximum of 10 sessions (40 hours), increasing proportions of consultants working less than full time (LTFT), all combined with the backlog of elective care created by COVID-19 will create a significant gap between workforce capacity and clinical demand. The age of current OMFS consultants was estimated using the date of their primary medical/dental qualification. Changes in job plans were estimated using data from the BAOMS Workforce Census and from recently advertised posts. Reports of unfilled posts were collated by OMFS Regional Specialty Professional Advisors (RSPAs). First degree dates were identified for 476 OMFS substantive consultant posts. Estimated current average age of OMFS consultants was 52.7 years (minimum 35.9, maximum 72.1), 75th centile age 59.0 and 23% of the current consultant workforce above the average retirement age for doctors. The 10 sessions of new OMFS consultants posts is significantly less than existing consultants' average of 12.1 sessions (48.4 hours). Unfilled consultant posts in Great Britain are 13% of the total compared to 20% in Northern Ireland and Ireland. Many (23%) of the OMFS consultant workforce are above average retirement age. Forty-hour contracts; new consultants working LTFT; and early loss of senior colleagues because of pension pressure will reduce NHS’ capacity to treat OMFS disorders and injuries. This paper suggests increasing consultant posts, increasing trainee numbers, and actively retaining senior surgeons to maintain capacity.     

Conscious sedation services provided in secondary care for restorative dentistry in the UK: a survey

OBJECTIVES: To assess the views of consultants in restorative dentistry on sedation services in secondary care for restorative dentistry and their involvement in the provision of this. DESIGN: Postal questionnaire survey in the UK. SETTING: Consultants in restorative dentistry. RESULTS: There was an 80% response rate from 179 consultants. Among consultants in restorative dentistry there was a perceived need for sedation services in restorative dentistry within NHS hospitals other than for teaching purposes. Anxiety and level of trauma of dental treatment affected whether consultants felt it appropriate for patients to have such treatment under sedation. One third (48) of consultants treated patients under conscious sedation, a significant number of these held NHS posts and had graduated more recently. Of those (41) who provided treatment under conscious sedation in an NHS setting, most (38, 93%) provided treatment under intravenous sedation of whom only eight (21%) acted as operator/sedationist. Nearly all consultants (135, 94%) felt that specialist registrars in restorative dentistry should undergo some form of training in sedation. CONCLUSIONS: Although consultants in restorative dentistry recognise the need for training in and the provision of sedation in secondary care for restorative dentistry, only one third of respondents currently provide this service.     

Inequalities in the provision of NHS primary care dental services in Scotland in 2004.

OBJECTIVE: To assess inequalities in the provision of National Health Service (NHS) primary care dental services between Health Boards and the four provider groups (General Dental Service [GDS] non-specialist, GDS salaried, specialist working in primary care, Community Dental Service [CDS]) in Scotland. METHODS: A postal questionnaire survey of all dentists (N=2852) registered with the General Dental Council at an address in Scotland was undertaken. The following were assessed: the proportion of primary care dentists not accepting new children/adults for NHS care or using a waiting list, the proportion of dentists working in wheelchair-accessible surgeries, furthest distance travelled by patients to primary care surgery in an average week, waiting time for routine NHS treatment, and the proportion of dentists offering weekend or evening appointments to NHS patients. Data were analysed by Health Board and the four provider groups. RESULTS: A total of 2134 (74.8%) completed questionnaires were returned. One thousand, five hundred and seventy-seven dentists (73.9%) of the respondents were providing NHS primary care dental services for at least part of each week. There was a wide variation in the provision of NHS primary care dental services between Health Boards. Borders, Dumfries and Galloway, and Grampian performed poorly on most indicators, whereas Lanarkshire, Greater Glasgow, and Argyll and Clyde generally performed well. The CDS scored well on most indicators of service provision. There were problems with the provision of specialist dental services in primary care, and GDS services provided by Health Boards. CONCLUSIONS: Because the problem issues differed between Health Boards and the four provider groups, it is likely that both local and national solutions are required to improve the provision of services. Further research on service demand is required to confirm the apparent inequalities in provision suggested by the study.     

Want to do clinical research? Changes in the NHS mean there's never been a better time

This article aims to explain the recent changes in the NHS research support system as it applies to dentistry; information that will be of value to all clinical academics and dentists considering taking part in research. The changes mean that investment goes where patient benefit research is happening. The system has put in place transparent mechanisms to reimburse NHS organisations including dental practices that take part in research and train clinicians in research skills. Through NHS investment in 'translational research', public funds are used directly to deliver improved and more cost effective patient care.     

The role of postgraduate dental deans

Postgraduate Dental Deans commission and manage the delivery of postgraduate dental and medical education and training for dental practitioners. They are charged with developing and quality assuring opportunities for trainees in primary and secondary care so that they can reach their full potential, and must work with local organisations to ensure that sufficient training places are available to meet the future needs of the NHS. Postgraduate dental deans influence training opportunities and standards in NHS Trusts as well as dental vocational training practices. They also play a role in developing national policies on postgraduate dental education and implement new initiatives. Their roles cover modernising dental careers, national and international recruitment and retention in primary and secondary care. They are involved in leading the development of the dental workforce, including professions complementary to dentistry as well as managing the provision and quality assurance of CPD for general practitioners. They also provide support for doctors and dentists facing difficult situations.     

Attitudes and trends of primary care dentists to continuing professional development: a report from the Scottish dental practitioners survey 2000

OBJECTIVES: To describe the current and intended continuing professional development activity of dentists in general and community practice. DESIGN: A cross-sectional survey by postal questionnaire. METHODS: A semi-structured questionnaire was sent to all general practice and community dentists identified from the dental practices division as being in practice in Scotland. The issues addressed included personal demographics, current working patterns and job satisfaction, training and professional development and finally career and working intentions. RESULTS: Of the 1,917 questionnaires sent to general dental practitioners (GDPs), 1,357 were returned useable (70% response rate); 212 of the 283 questionnaires to community dental practitioners (CDPs) were returned giving a 75% response rate. Of the responders, 89% of GDPs (1,188) and 95% of CDPs (178) reported participating in some form of CPD in the preceding year. One sixth of GDPs (211) and one third of CDPs (62) had a further qualification. Short courses such as Section 63 were very popular with over 90% of GDPs, but more than half the respondents did not think that further qualifications would enhance their career prospects. The most commonly identified barriers to further qualifications were heavy clinical commitments (78%), with 73% citing the substantial cost with no additional benefit. Over a third of GDPs under the age of 30 indicated they intended to sit a postgraduate qualification, but this fell to 12% for those aged over 30. The number of dentists identified on a career break was low (18). CONCLUSION: Two years before implementation of the General Dental Council's mandatory revalidation scheme, over 90% of Scottish primary care dentists reported active participation in continuing professional development. Future initiatives must be sufficiently sophisticated to fulfil the educational needs of different age groups, and to focus on part-time and career break dentists as well as full-time practitioners. It is important to establish career pathways in dental primary care. Part-time modular courses such as Masters degrees in primary care based dentistry may be one solution. An increased number of part-time posts for primary care dentists in secondary dental care may increase the skill base and also increase service provision in secondary care establishments. These pathways should create an opportunity to adequately reward those who continue to develop the knowledge and skills necessary for a technically demanding healthcare profession.     

Pathways in dental public health

Dental public health is one of the nine specialties of dentistry recognized by the American Dental Association Commission on Dental Accreditation. Dental public health has been defined as the "science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than as an individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis." This article will describe the many career and educational pathways dentists may follow to become irvolved in the practice of dental public health.     

Leadership theory: implications for developing dental surgeons in primary care?

The development of leadership in healthcare has been seen as important in recent years, particularly at the clinical level. There have been various specific initiatives focusing on the development of leadership for doctors, nurses and other health care professions: for example, a leadership competency framework for doctors, the LEO programme and the RCN clinical leadership programme for nurses. The NHS has set up a Leadership Council to coordinate further developments. However, there has not been the same focus in dentistry, although the recent review of NHS dental services (Steele review) has proposed a need for leadership initiatives in NHS dentistry as a medium-term action. Central to this will be a need to focus on the leadership role for dental surgeons. Leadership is all the more important in dentistry, given the change of government and the policy of retrenchment, major public sector reform, the emergence of new organisations such as new commissioning consortia, possible changes to the dental contract, new ways of working, and changes to the profession such as the requirements for the revalidation of dental surgeons. The question is: which leadership theory or approach is best for dental surgeons working in primary care? This paper builds on earlier work exploring this question in relation to doctors generally, and GPs, in particular, and planned work on nurses. It will seek to address this question in relation to dental surgeons working in primary care.     

Experience of dental care for children with congenital heart disease among Swedish dentists

This study was conducted in order to examine the experience of and attitudes to dental care for children with congenital heart disease (CHD) among Swedish general dentists. 183 general dentists employed in the Public Dental Health Service in the counties of V?sterbotten and Uppsala, and private practitioners listed with dentistry for children in the county of V?sterbotten, Sweden, were enrolled in the study. Data were collected with a questionnaire with 18 questions. Eighteen per cent of the dentists stated that they had received special education or information except the graduate training to treat children with CHD. Forty-eight per cent of the dentists had one or more patients with CHD. Seventy-two per cent of these stated that their CHD-patients had a caries problem. Statistically significant differences were displayed between answers on the questions "who in the dental team perform the major part of the dental care for children with CHD" and "what is your opinion on which personal category that should perform the major part of the dental care for this group of children" (p < 0.001). Among dentists whose clinical time mainly was used for dentistry for children, it was more common to treat children with CHD (p < 0.001) than for dentists with a lower degree of dentistry for children. The study showed that the Swedish dental care for children with CHD today mainly is performed by dental nurses, dental hygienists and general dentists. This strongly differs from the dentist's opinion on who should perform the major part of the dental care for this group of children. These findings taken together with the very low number of dentists that had received special education or information except the graduate training to treat children with CHD indicates that the Swedish dentists are unsettled and insecure in the dental treatment of children with heart defects. An early and close cooperation between specialists in pediatric dentistry, dentists with special training and general dentists is strongly desirable to support the dentists and facilitate the dental care for children with CHD.     

Positive ethics and dental students

Recent negative publicity has drawn attention away from recognizing and celebrating the ways today's dental students differ in a positive fashion from previous generations of dental students who may have suffered the same ethical lapses we are hearing about now. Dental students are more diverse than their predecessors and learn to develop a sense of integrity that encompasses more toleration of alternative cultures. They are group-oriented, which expresses itself in sharing responsibility for their colleagues, both in educational settings and in their practices. With guidance from senior dentists and organized dentistry, they will contribute inclusiveness and group responsibility and thus strengthen the profession.     

Educating dental students about oral health care access disparities

Dental educators provide learning experiences for dental students that help them develop the belief that universal access to oral health care is a social justice imperative that will compel them to provide care to underserved patients after they graduate. To accomplish these learning outcomes, dental schools first recruit underrepresented minority students and students with previous volunteerism experiences. Dental educators then expose dental students to learning experiences in the classroom and in the community, dental school-based clinics, and community health clinics, to help them to develop the requisite knowledge, values, and competencies for serving underserved populations. The long-term, educational outcomes of these learning experiences have not been assessed to date. Systematic surveys should be conducted of dentists who have had these educational experiences to measure the number who actually care for the underserved in private dental offices, community health "safety net" clinics, and the Indian and Public Health Services.     

Better opportunities for women dentists: a review of the contribution of women dentists to the workforce

In June 2000 the Department of Health commissioned a review to examine the need for improvements to the employment opportunities for women dentists in the National Health Service (NHS) across England. Dame Margaret Seward carried out the review, which was published in September 2001. The review was considered necessary for four main reasons. Firstly, workforce panning, because now more than 50% of new entrants to dental undergraduate courses in the UK are female and by 2020 over 50% of all practising dentists will be female. Secondly, evidence that 50% of women in dentistry work for no more than two days per week for the NHS. Thirdly, most women work either as associates in general dental practice (GDP) or in the Community Dental Service (CDS). Lastly, the perception that women find it difficult to return to dentistry after taking a career break.     

Inequalities in the dental treatment provided to children: an example from the UK

OBJECTIVES: To identify the relationship between the socioeconomic status of frequently attending children and the dental care of their primary dentition provided by dentists working in the General Dental Service (GDS) of the UK National Health Service (NHS). METHODS: The study design involved a retrospective investigation of the case notes of 658 children who were regularly attending patients of 50 General Dental Practitioners (GDPs) working in the North West of England. The socioeconomic status of each subject was measured using the Townsend score of their electoral ward of residence. Logistic regression models, taking into account the clustering of the subjects within dental practices, were fitted to identify whether or not socioeconomic status was significantly associated with the proportion of carious teeth that were restored, all dental extractions, dental extractions for pain or sepsis alone and courses of antibiotics prescribed after controlling other variables. RESULTS: A significant association between socioeconomic status and caries experience could not be found. There was also no association between socioeconomic status and the proportion of carious teeth filled or courses of antibiotics prescribed. Disadvantaged children were significantly more likely to have teeth extracted than their more affluent peers, but there was no association between deprivation and extractions for pain or sepsis alone. CONCLUSIONS: Children from deprived backgrounds who regularly attended this group of UK dentists were more likely to have extractions than their more affluent peers, irrespective of their caries experience.     

The role of team dentistry in improving access to dental care in the UK

The role of professionals complementary to dentistry (PCDs) in improving access to NHS primary dental care is discussed. The pattern of under-supply of dentists in poor socio-economic areas is highlighted and identified, in drawing a parallel to the workings of primary medical teams, as a possible area where PCDs could be used.     

An investigation into Merseyside General Dental Practitioners' interest in primary care research, their views on research and their training needs.

OBJECTIVES: The aims of this investigation were to evaluate the interests of primary care dental practitioners within the Mersey Postgraduate Deanery in research and their views on research, their experience and research training needs. METHOD: A questionnaire was sent to all practitioners in the Mersey Deanery asking for views on dental research, whether they had been involved in any research projects or had any research training, and whether they would be interested in research training and being part of a primary dental care research network. RESULTS: A total of 192 practitioners from the 1120 in the Mersey Deanery expressed an interest in being involved in primary care research. Most believed that primary care research was very important in providing a stronger evidence-base in dentistry and improved quality of dental care. Over 50% of respondents were interested in collaborative research, provided that their income and time could be protected and it was part of the normal working day. Almost 25% had some research experience and a number had undergone research training, ranging from informal training to part of a degree. CONCLUSIONS: A number of GDPs in the Mersey Deanery are interested in primary care research. With appropriate training, support and recognition within the new Personal Dental Services (PDS) contracts, there is a golden opportunity for more primary care dentists to participate in research. This, in time, will add to the evidence base in dentistry and should improve patient care.     

Opportunities for prevention: more than 'just the mouth'.

This paper has been written by two dentists from Colombia who are currently waiting to take the International Qualifying Examination. They have been working as dental nurses in London and have gained insights into both NHS and non-NHS practice in London. They have a particular interest in preventive dentistry and have analysed recent developments in England with regard to the prevention of disease and oral disease in primary care. They propose a preventive approach which brings together recent policy developments in the United Kingdom and worldwide. They conclude that there are now potentially better opportunities than ever before to develop programmes to promote health and prevent oral disease, and to adopt a team approach to achieve these goals.     

Dental bodies corporate and their approach to customer care

For many years the 27 bodies corporate registered with the General Dental Council were of little interest to most people in the UK dental profession, serving only as an anachronistic reminder of a bygone period. How times change. Although they still have only a small share of the dental market - with 4% of all dentists in the UK in early 1999 - they have expanded rapidly from a small base and are expected to continue to do so in the future. The reasons behind this growth are numerous and include such factors as: deregulation of the profession allowing dentists to advertise thus facilitating company branding; a general move away from NHS dentistry; a growing consumerism amongst the general public; precedents set by pharmacists and opticians; and, last but not least, the belief of venture capitalists amongst others that investment in dentistry will yield attractive returns.     

The ethnicity of dental practitioners in the United Kingdom

OBJECTIVE: To describe the proportion of dental practitioners, currently practising in the UK, who are from different ethnic groups. METHOD: Analysis of data from the British Dental Association Omnibus Survey 2000. The sample comprised 970 qualified dentists in all fields of practice. FINDINGS: Dental practitioners from minority ethnic groups constitute approximately 14% of the population of dentists. There has been an increase in the proportion of dentists from minority ethnic groups amongst cohorts of dentists qualifying since 1987. There is some evidence that dentists from minority ethnic groups are more likely to treat patients under NHS payment. CONCLUSIONS: The profession of dentistry in the United Kingdom appears to have little problem attracting members of some minority ethnic groups in particular those of Indian, Pakistani and Bangladeshi origin. Individuals of Black Caribbean and Black African origin are under-represented.     

Views of academic dentists about careers in academic dentistry in the United Kingdom

The aim of this paper is to report the views of academic dentists about careers in academic dentistry assessed by method of a postal questionnaire survey. The subjects of the survey were dentists in academic posts in the United Kingdom. The incentives in pursuing an academic career which respondents rated most highly were the opportunity to teach and the variety of work in an academic career. The greatest disincentives were competing pressures from service work, teaching and research, and the difficulty of getting research grants. Many would like to spend more time on research and less on service work and teaching. The length of time required for training, and the quality of training, was a concern, particularly for junior academics. Most respondents rated the enjoyment of their job highly but scored much lower on satisfaction with the time their job left for domestic and leisure activities. By contrast with academic medicine, in academic dentistry there is typically greater emphasis on teaching and less on research. In conclusion, the balance of activities in academic posts, particularly between service work, teaching and research, needs to be regularly reviewed. The development of a more structured training programme for junior academics, which does not disadvantage academic dentists when compared with their NHS colleagues, may be required.