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The Faculty of Dental Surgery
The Royal College of Surgeons of England

demic microbiology ora

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The Faculty of Dental Surgery,
The Royal College of Surgeons of England
35–43 Lincoln’s Inn Fields, London, Wc2a 3pe

T: 020 7869 6810

E: fds@rcseng.ac.uk
www.rcseng.ac.uk/fds
 July 2012

Contents
Introduction.................................................................................................2
What is dental surgery?............................................................................4
What should you expect?.........................................................................6
Career pathway for specialist dentistry................................................8
Career pathway diagram.................................................................................. 12
Choosing your career............................................................................. 15
Dental and maxillofacial radiology.............................................................. 16
Dental public health............................................................................................ 18
Oral and maxillofacial pathology................................................................. 20
Oral medicine......................................................................................................... 22
Oral microbiology................................................................................................ 24
Oral surgery............................................................................................................. 26
Orthodontics.......................................................................................................... 28
Paediatric dentistry.............................................................................................. 30
Restorative dentistry........................................................................................... 32
Special care dentistry......................................................................................... 34
Oral and maxillofacial surgery...................................................................... 36
Academic dentistry.............................................................................................. 38
Find out more........................................................................................... 40

1
Introduction
Dental surgery is a multi-faceted manually dextrous, then dental surgery
and rewarding career choice for any is for you. There are plenty of avenues
individual. It is so much more than that allow you to care for patients, work
providing a check-up or a filling for a with others, teach, undertake research,
patient. Dental surgeons work in many write, develop policy and improve the
different environments over a range quality of healthcare. It is the breadth
of specialist areas at a variety of levels, of opportunities to help patients either
allowing you to focus your clinical by directly providing their care or by
practice as you wish. supporting those who do that makes
dentistry and its various specialties a
Dental surgery provides you with a unique and rewarding profession.
secure career that can be pursued both
in the UK and overseas. The healthcare I encourage you to consider a career
workforce, including dentists, is required in dental surgery. I hope this small
by all nations to improve the oral health book gives you a glimpse of the diverse
of their populations. Even if you stay opportunities dentistry offers, and what
in one place, every day in dentistry is being a dental surgeon is like and how
different, providing a range of emotional we contribute to the health of society. We
and intellectual challenges – a great asset can actually make a difference to peoples'
if you want more than just a salary from lives and we do, every day.
your work.

So, if you are the kind of person who

enjoys helping people, relishes an ever-
changing and rapidly developing clinical
environment, thrives on working as Kathryn Harley
part of a team, is compassionate and Dean of the Faculty of Dental Surgery

2
About us
For over 65 years the Faculty of Dental Surgery of The Royal College
of Surgeons of England has been a national and international voice for
dentistry, providing informed specialist help and advice in the UK and all
over the world.

Our remit includes setting curricula, conducting examinations, awarding

diplomas in dental surgery and for the majority of dental specialties,
providing programmes of postgraduate education and continuing
professional development, and supporting dental research.

3
What is dental
surgery?

Dental surgery is one of the clinical arts There are a number of different
and sciences devoted to maintaining specialties and career areas within dental
the health of the teeth, gums, and other surgery, each is described later in this
hard and soft tissues of the mouth and booklet. Whatever specialty you choose,
surrounding facial structures. A dental you will find that a career in specialist
surgeon is both a scientist and a clinician dentistry will challenge, stimulate and
dedicated to promoting the highest reward you throughout your working life.
standards of health through prevention,
diagnosis and treatment of oral diseases
and conditions.

Although most dental surgeons work

in primary care settings (such as high
street dental practices), some are found
in the hospital service. Others work in
universities, healthcare industries, sales
and marketing, and in the armed forces.
There is a wide variety of careers open
to dental surgeons. More specialised
services are usually provided in hospitals.

4
Dental specialties
• Dental and maxillofacial radiology
• Dental public health
• Oral and maxillofacial pathology
• Oral medicine
• Oral microbiology
• Oral surgery
• Orthodontics
• Paediatric dentistry
• Restorative dentistry (endodontics,
periodontics and prosthodontics)
• Special care dentistry

Medical specialty
• Oral and maxillofacial surgery
(requires dual qualification in
dentistry and medicine)

An academic career within a university

can be pursued in each of the above
specialities

5
What should
you expect?

Dental surgeons work in demanding vulnerable, nervous or scared. Being able

clinical environments where the to communicate complex information
decisions and actions taken will directly to patients while understanding and
affect the health and well-being of their responding to their needs is essential.
patients. Dental surgeons must possess
keen academic skills and considerable Problem solving, diplomacy, continuous
focus to achieve the high standards learning, leadership, organisational
expected of them. skills, professional integrity – all of these
are vital for the dental surgeon. You will
Dental surgeons don’t work alone. From be joining a profession that carries a
the early stages of their careers, dental tremendous responsibility to promote
surgeons will be expected to lead a team and improve public health: it’s one of the
of healthcare professionals to provide the most challenging jobs available but one
highest quality and standard of patient of the most rewarding too.
care. A successful dental surgeon will
have excellent communication skills and The majority of a dental surgeon’s
be a supportive and responsible team work takes place in general practice,
worker and leader. And, of course, dental either in the NHS or within the private
surgeons deal with patients – people sector. Hospital-based dental surgeons
– at times when they are at their most predominantly work for the NHS. Within

6
this setting they undertake a wide variety
of tasks including new patient diagnostic
clinics, outpatient treatment, teaching
and audit. Many dental surgeons also
engage in additional professional
activities such as research, publishing
articles, representation on government
and regulatory bodies, and legal or
political work. For some of these activities
you can expect to travel, both within the
UK and internationally. The proportion
of a dental surgeon’s time taken up
with each of these activities will vary
according to his or her grade, specialty
and interests.

7
Career pathway
for specialist
dentistry
The career pathway for specialty training Applying to a dental school
in dentistry typically involves five to seven through UCAS
years of training following completion of Dentistry is a degree course offered at
the Bachelor in Dental Surgery (BDS). a number of UK dental schools. The
length of the course for school leavers is
The pathway to becoming an oral and five years. The exact entry requirements
maxillofacial surgeon is different from differ between schools, with most
that of the dental specialties as you need requiring three high A-level grades,
to qualify in both dentistry and medicine including two sciences.
before entering specialty training. There
is some additional information specific For further details on the exact
to the oral and maxillofacial surgery requirements please contact the
(OMFS) career pathway later in this individual schools or visit the UCAS
booklet on page 36.

8
9
website (www.ucas.com). To secure you wish to work. Once your application
a place in a dental school (and also to be on a dental performer list in your
pursue a successful career in dentistry!) region has been approved, you can work
students will need to demonstrate they for the NHS in your chosen location.
can work well with the public, and have
good communication skills and manual Year 2 (DF2)
dexterity. A second foundation year is available
and applications are made in open
Bachelor in Dental Surgery (BDS) competition with other interested
This is a five-year degree. After trainees.
completing your BDS you will be eligible
to register with the General Dental DF2 training involves treating patients
Council (GDC), which enables you to in a variety of settings and working in,
practise in the UK. In your final year you and gaining experience of, the different
apply for Dental Foundation Training. dental specialties. The training may
be carried out in either the hospital,
Dental Foundation Training community or salaried dental services,
The Dental Foundation Training which provide care to patients who
programme is not compulsory; however, have problems accessing health services
individuals wishing to work within the because they have specialised health
NHS must have completed DF1. needs.

Year 1 (DF1)
This training usually takes place in a MJDF/MFDS Checkpoint
primary care setting where you will be It is recommended that you study for your
expected to treat patients and also attend
MJDF/MFDS examination with one of the
study days. surgical royal colleges during this time, which
will take about two to three years to achieve.
After completing DF1, you will be This qualification marks the end of foundation
able to apply for inclusion on a training and is desirable for entry to specialty
‘dental performer list’. These lists are training.
administered by regional healthcare
commissioning bodies throughout the
UK and you will apply for inclusion on
the appropriate list depending on where

10
Career Development Posts your particular skills
and attainments.
(up to two years) Evidence such as clinical audit
The purpose of these posts is to provide projects, publications in recognised
extra training to build your CV in order dental journals, continuing
to apply for specialty training posts. You professional development (CPD)
will gain greater clinical exposure and activities, courses you have attended,
experience in writing papers and case membership of specialist societies,
reports, teaching, and management. and presentations at meetings will
These posts are aimed at those who are: all be valuable as there is intense
• pursuing training in a particular competition for specialty registrar
specialty (StR) posts.
• unsure what specialty they wish • When you are accepted onto
to pursue and will therefore an StR training post you will be
rotate through different specialist allocated a unique national training
departments number (NTN), which is used for
• general practitioners with an interest administrative and funding purposes
in a particular specialty throughout your specialty training.
• interested in career grade non-
consultant hospital appointments. Specialty Membership Exam
Your three-to-five years of specialty
Specialty Training Posts training culminates in the specialty
(three to five years) membership ‘exit’ exam.
In order for you to be accepted onto
a specialty training programme as a If successful, you will gain a Certificate
specialty registrar: of Completion of Specialist Training
• You will need to have a minimum (CCST) and this will allow you to be
of two years’
broad experience included on the specialist list and be
in dentistry, which may include known as a specialist in your chosen area
experience within hospital and by the General Dental Council (GDC).
community settings, and general
dental practice. Typically, this
experience will be gained from Dental
Foundation Training or its equivalent.
• You are strongly advised to prepare a
‘portfolio of evidence’ demonstrating

11
Career
pathway
diagram
12
OMFS career pathway Dental specialty career pathway

OMFS trainees who began the pathway with a UK dental degree should start their medical degree
after completion of an OMFS career development/OMFS SHO/OMFS DF2 post. Once they have
completed the MRCS exam they can then apply directly for a specialty training post.

13
OMFS career pathway information Specialty Training (ST3 – ST7)
Specialty training lasts five years with
UK Medical Degree an exit Fellowship of the Royal College
This is a five-year degree or possibly four of Surgeons (FRCS) examination. The
years for graduate entrants. FRCS is a requirement for specialty
registrars to be awarded a Certificate of
OMFS Career Development / Completion of Training (CCT) in Oral
OMFS SHO / OMFS DF2 Posts and Maxillofacial Surgery and register
These posts are based in maxillofacial with the General Medical Council (GMC)
surgery departments in hospitals and and appear on the OMFS specialist list.
last up to two years. The postholder will
be expected to assist with inpatient care, Cleft Lip / Head and Neck
manage acutely injured patients and Individuals wishing to pursue a career in
develop confidence and competence in either cleft lip and palate or head and
dental alveolar surgery and oral medicine neck surgery must apply for a relevant
by working in outpatient and day surgery training post in these sub-specialties,
settings. which will provide advanced training in
these areas.
Foundation Year Training (FY1 and FY2)
This is a two-year generic training
programme that is designed to give The OMFS training routes change regularly.
trainees a range of general experience in It is advisable to contact your local deanery
various specialties. and/or the British Association of Oral and
Maxillofacial Surgeons (www.baoms.org.uk)
Surgical Core Training (CT1 and CT2) for updates and further information.
These posts are designed to give a
surgeon experience in performing
different surgical procedures.

After two years, surgeons may sit the

Intercollegiate Membership of the Royal
College of Surgeons (Intercollegiate
MRCS) exam: this is a requirement to
enter specialty training in OMFS.

14
Choosing your
career
In the following pages you can find out Further information regarding entry
more about each specialty and other requirements and examinations for each
career options and read about ‘a day in of these specialties can be found on the
the life’ of someone who is working or relevant websites listed on page 41.
training in that area.

15
Dental and
maxillofacial radiology
Dental and maxillofacial radiologists focus on operating, interpreting and
understanding the diagnostic imaging used throughout dentistry (and a number of
other healthcare professions) to assess the anatomy of the face, neck and head.

This field of diagnostic study is highly specialised and requires the practitioner to
acquire an in-depth knowledge of a variety of areas, including:
• anatomical features as they appear on images taken using various imaging
techniques
• interpreting images of diseases, disorders and conditions that affect the teeth,
jaws, oral cavity, facial structures and the head and neck
• the provision of therapeutic radiology appropriate to specific conditions affecting
the head and neck region
• using evidence-based knowledge of good clinical practice and diagnostic methods
to justify the use of appropriate imaging.

Most specialists work in dental schools or hospitals. They will play a role in diagnosing
disorders of the head and neck areas by using modern radiological techniques such as
panoramic radiography, computed tomography (CT), magnetic resonance imaging
(MRI) and a variety of other external and intra-oral radiology advanced imaging
techniques to provide a detailed survey of these areas.

16
A day in the life…
Mr Jonathan Davies, King's College London Dental Institute

A typical day begins by checking the requests for dental imaging that have been received in the
x-ray department – under UK legislation all imaging must be justified. The referrals are checked
and the appropriate protocol for the investigation is selected.

A clinic list may include patients complaining of obstruction of a salivary gland (where the face
swells on eating). Here, the investigation of choice is an ultrasound scan of the salivary glands
using sound waves to investigate if the cause of the swelling can be found. A sialogram (an x-ray
of the glands using a dye that shows up on the image) may assist in the location of a salivary
gland obstruction caused by either a narrowing of the salivary duct or of a salivary stone.

The next patient may present with a lump on the face where the surgeon has requested a
sample of the tissue. We may use ultrasound guidance to enable a fine needle to be inserted
so we can take tissue from the centre of the mass with absolute precision. The session
continues with reporting of dental cone beam CT scans that have been taken during the week
for planning implants or surgical removal of difficult third molars.

Teaching and research are important aspects of a dental radiologist’s job. Tutorials are taken
with the specialist trainees, dental radiographers or with the dental students and regular
meetings are held with the specialist UK, European and international dental and maxillofacial
radiology societies to ensure we all remain up to date with the latest developments. Those
interested in research may be preparing papers for publication or reviewing an article prior to
publication for a dental journal.

The day can be varied and demanding, with both clinical and teaching aspects, since most
positions are based in hospitals and dental schools.

17
Dental public health

Dental public health is the science and (DDPH). Entry requirements and
art of preventing oral diseases, promoting examinations for this dental specialty can
oral health and improving quality of life be found on the Faculty’s website.
through the organised efforts of society.

A career in dental public health builds

on the basis of a broad clinical dental
background, and then extends that
clinical understanding to encompass
a population-wide approach to oral
health. It does not involve one-to-one
care of individual patients. It concerns
itself with the environmental, social
and behavioural influences on the oral
health of the population. It attempts to
reduce disability, dependence and health
inequalities by ensuring the provision of
effective and efficient services to restore
those with dental disease to health.

To enter this dental specialty candidates

will usually enter a four-year training
programme, during which they will
complete a Masters degree in Dental
Public Health at a recognised institution
and have the opportunity of sitting
the Diploma in Dental Public Health

18
A day in the life…
Euan O’Neill, NHS and King’s College London

My working week is both varied and challenging. I spend one

day in King’s College London working on academic projects,
two days a week in inner north east London and two days a
week in south west London. Having to move around during my
working week provides me with different experiences and a
richer working life.

While at King’s, I have the opporunity to sit alongside academics

in the university, attend journal clubs where we discuss recent
research, and have joint meetings with behavioural scientists and
statisticians who help with my projects.

Much of my day can be spent at a desk or attending meetings.

This may seem boring but if you have an interest in public health
it is great working with a team and contributing to the work of
an organisation. I might visit a hospital, a community clinic, go on
a fact-finding mission to a dental practice or be part of high level
decision-making at the Department of Health.

My training gives me the opportunity to work with many

different people and teams to meet the challenge of improving
the oral health of the local population. While there is never a
dull moment in training and there are always new challenges, it is
important to be able to handle several projects at the one time
and learn how to manage your time. Though I no longer treat
patients nor directly help the individual patient to improve his or
her oral health, I get great satisfaction knowing that I am helping
to improve the oral health of the local population where I work.

19
Oral and maxillofacial
pathology
Oral and maxillofacial pathology focuses
on the diagnosis of diseases of the mouth,
jaws and salivary glands by microscopic
examination of tissue samples removed
by surgeons.

Most oral and maxillofacial pathologists

teach and carry out research in
universities as well as carry out diagnoses
to support clinicians in their care of
patients. They work closely with specialists
in the fields of oral medicine, oral and
maxillofacial surgery and oral surgery but
do not usually see patients themselves.

Oral and maxillofacial pathology is

a small specialty with only a few such
pathologists working in the UK.

20
A day in the life…
Mr Adam V Jones, Cardiff and Vale University Health Board

There are two main components to my clinical work as a registrar: macroscopic and
microscopic reporting. The first is commonly referred to as ‘cut up’ and essentially involves
providing a description of the specimen and creating specimen blocks (readying a specimen
for diagnostic investigation by encasing it inside a wax block) to aid accurate reporting. Small
specimens such as polyps are often bisected and viewed in their entirety but large resections
require representative sampling. Following cut up, the specimen blocks are processed and the
slides are cut and stained by a medical laboratory scientific officer, leading to the second aspect
of my work: microscopic reporting.

The histology slides are viewed by the registrar using a light microscope and the pertinent
features described and reported. Correlation with clinical findings is essential for accurate
diagnosis so review of radiographs, clinical notes or alternative tests may be required. Once the
report is written and checked this is sent to the referring clinician.

A pathologist is a core member of the cancer multidisciplinary team and provides diagnostic
advice that aids the team in providing optimal care to the patient. This includes presentation of
histology slides as well as providing information on prognostic factors.

Teaching may form part of the trainee’s responsibilities and includes the provision of lectures,
small group teaching and practical classes. Opportunities to pursue a teaching certificate may
also be available. There are many opportunities to pursue research and, if you seek a higher
degree, the potential to study for a PhD.

During training the trainee will spend a minimum of 12 months in a general histopathology
laboratory covering all areas of histopathology and cytopathology.

21
Oral medicine

Oral medicine is the specialty of dentistry

that provides care for patients with
chronic, recurrent and medically related
disorders of the mouth and associated
tissues, with an emphasis on non-surgical
care. It sits at the interface of dentistry
and medicine and this is reflected by
the multidisciplinary approach to care
involving input from a wide range of
dental and medical specialties.

Oral medicine has at its centre patient

conditions that are mainly managed
without surgical intervention.

A dental degree is a requirement

for entry to specialty training in oral
medicine, although many specialists have
both dental and medical qualifications.

22
A day in the life…
Dr Roddy McMillan, Eastman Dental Institute, London

The working day starts in earnest with a clinic at 9am, either an oral medicine general clinic or
a facial pain clinic. Oral medicine covers a wide range of different patients and a multitude of
diagnoses. Although lichen planus (an itchy rash on the skin or in the mouth) is the stereotyped
oral medicine diagnosis, we see many other conditions such as pemphigus (a blistering auto-
immune disease), Crohn’s disease (a form of inflammatory bowel disease than can affect any
part of the intestinal tract and also the mouth), trigeminal neuralgia (a nerve disorder that
causes stabbing pain in parts of the face) and Sjögren syndrome (an auto-immune disease
where the body attacks its own tear and saliva glands, reducing the amount of saliva and tears
produced). Oral medicine as a specialty is significantly involved in the multi-disciplinary care of
many patients.

Unlike when I was a senior house officer, we usually have time to sit down and eat lunch in
oral medicine. After lunch we usually have another clinic or perhaps some time to complete
paperwork or undertake some clinical governance or research. Occasionally, we will be
called to review patients being treated under other specialties in order to help assist in their
management.

An important component of my duties is the supervising and teaching of junior colleagues. We

often have the opportunity to teach others such as general dental practitioners, postgraduate
dentists, and undergraduate medical and dental students. The training pathway in oral medicine
generally encourages clinical governance and research. There have been many opportunities to
publish papers and present at both national and international meetings.

23
Oral microbiology

Oral microbiology is the study of the micro-organisms of the oral cavity and the
interactions between the oral micro-organisms with each other and with the body. Of
particular interest is the role of oral micro-organisms in the two major dental diseases:
dental caries (tooth decay) and periodontal disease (a bacterial infection that affects
the gums and bone supporting the teeth).

There are many different types of oral bacteria and they exist in our mouths as a
diverse community. Oral microbiologists will usually be employed in research
laboratories, institutions and universities.

As well as studying bacteria, oral microbiologists will also study oral and facial
infections caused by viruses and fungi. They will research possibilities for causes,
treatments and cures.

24
A day in the life…
Ms Noha Seoudi, Queen Mary, University of London

Oral microbiology is one of the most interesting dental specialties. It integrates a wonderful
balance of clinical, laboratory, teaching and research activities to create an ideal training pathway.

Part of the training is dedicated to developing competencies in clinical medical microbiology,

virology and infection control. This period of training is spent with the consultant medical
microbiologists and their trainees; a typical Monday will start with a handover meeting,
discussing all the new cases in the presence of the consultants, then delegating cases to the
responsible specialty registrar. This will be followed by a period of time obtaining authorisation
of the laboratory reports, requesting any relevant extra tests dictated by the clinical picture
of patients and liaising with the laboratory staff. Preparation for the ward round is part of this
session, ensuring that the clinical file of each patient is reviewed and the laboratory results are
updated.

The research-in-progress lunchtime meeting will follow at about 12.45pm, where all new
research will be discussed. This meeting is very good for any trainee who wishes to develop
his or her own research interests. Specialty registrars will then join their supervising consultants
to review the patients during the ward round. During these rounds cases will be discussed
and microbiology advice will be communicated with the relevant team, eg surgical, renal or
intensive care. The day will end with another session dedicated to liaising with the laboratory
and authorising reports.

Each day comes with exciting new infection-related cases and a load of valuable knowledge
that will make your training journey a rich and varied experience.

25
Oral surgery

Oral surgery is involved with the diagnosis

and surgical treatment of conditions
affecting the hard and soft tissues in and
around the oral cavity.

Specialists in oral surgery will spend much of

their time dealing with the surgical aspects
of patient care that are beyond the remit
of general dental practice and, depending
upon where a particular specialist works,
may involve:
• complex dental extractions
• apical surgery
• implant placement
• dealing with minor trauma, carried out
under local anaesthetic with or without
sedation in a primary care setting
• dealing with more complex patients
or major surgery requiring general
anaesthetic in the hospital service.

It is a surgical specialty that works closely

with general dental practitioners and other
specialists in both medicine and dentistry.
It has close ties with oral and maxillofacial
surgery, but does not require a medical
degree.

26
A day in the life…
Dr Nadine Khawaja, King’s College London Dental Institute

A typical day normally starts with assessing patients in the general oral surgery consultant
clinic. Most cases are discussed with the lead consultant, especially the more demanding cases
involving orofacial pain. Any necessary further tests are organised including cone beam CT, MRI,
ultrasound, blood tests and biopsies. We dictate letters to the patients’ referrers and always
send a copy to the patients, which is particularly useful if they have had a lot of information to
take in on the day.

Fortnightly, a multidisciplinary audit meeting is held at lunchtime. Interesting cases are presented
and discussed with the consultant radiologist and oral pathologists also present.

In the afternoon, I run a minor oral surgery list with consultant supervision. We treat a lot of
patients under intravenous sedation with midazolam, which we administer ourselves. We are
increasingly using minimally invasive techniques, so more procedures are performed under local
anaesthesia only. I often have a good mix of challenging procedures on my list, including surgical
extraction of impacted lower third molars, upper canines and supernumaries, cyst enucleation
and soft tissue laser biopsies. Other specialty lists in the week include implants and endodontic
apical surgery under the supervision of restorative, oral pathology and oral medicine clinics.

27
Orthodontics

Orthodontists are primarily concerned with the correction of irregularities of the

teeth and jaws, such as malocclusions (improper bites), which may be a result of
tooth irregularity, disproportionate jaw relationships, or both. Orthodontic treatment
often involves the use of braces and retainers to set teeth into the correct positions,
leading to improvements in the appearance and function of the teeth as well as the
patient’s psychological well-being.

Orthodontics is a popular branch of dentistry primarily because it can be both

intellectually and physically challenging, requiring a high level of manual skill to
correctly manipulate the devices used to correctly set each patient’s teeth and jaw.

There is high demand for orthodontic treatment for both clinical and cosmetic
reasons. When you become a fully qualified orthodontist, you can expect to be
dealing with children, teenagers and adults so good interpersonal skills are a must.

Orthodontic practice occurs both in high street practices and in hospitals – the more
complex cases often require hospital treatment.

28
A day in the life…
Miss Samantha Stewart, Musgrove Park Taunton, Bristol University

Orthodontics is a hugely rewarding job.There are few specialties where you can build a rapport
with patients as you watch them transform from a shy individual into a confident young adult
with a great smile.There is always constant questioning as to when their brace is coming off but
this is all made worthwhile when the day comes and you see the delight on their face as they
run their tongue round their newly straightened teeth for the first time.

The day begins on a new patient clinic. In this specialty, managing a patient’s expectations is one
of the most important things. Taking impressions is one of the first things you learn as a dental
student; as an orthodontic trainee, attention to detail is vital and being precise about the quality
of impressions is essential.

Having taken records, a plan must be decided for the patient. Careful consideration must
be given to all the options available to the patient and clearly documented in the patient’s
records. The patient must fully understand the treatment and what it involves. It can be tricky at
times explaining to young adults and their parents why healthy teeth may require removal to
straighten other teeth.

The next stage could involve the ‘bond up’ of a patient’s fixed appliances. Initial bracket
placement is key. Taking the time to get this right is time well spent, especially as you see the
teeth unravel and align. Routine appointments will require close monitoring at around six to
eight week intervals. These will typically be shorter appointments to change arch wires, apply
auxiliaries (such as elastics) or repair breakages.

Having completed and put up with an orthodontic treatment for sometimes up to three years,
patients are delighted to hear the magic word ‘debond’ (removing the devices). A great way to
end the day.

29
Paediatric dentistry

Paediatric dentistry is the practice, teaching and research of comprehensive and

therapeutic oral healthcare for children from birth to adolescence, including care
for children who demonstrate intellectual, medical, physical, and psychological or
emotional problems.

Paediatric dentistry is unlike any other dental specialty in that it encompasses all
treatment areas for a particular group of patients: all aspects of oral healthcare
for children are included, such as restorative care, endodontic treatment and
prosthetics, minor oral surgical procedures, and interceptive orthodontics.

Paediatric dentists also contribute to multidisciplinary care of children with complex

medical problems which either impact on oral health, or where oral health issues
may affect their general health.

Paediatric dental practice occurs both in high street practices and in hospitals. The
more challenging cases are often referred to hospitals.

30
A day in the life…
Dr Anjali Kandiah, Leeds Dental Institute

The day started at 7.30 am on the paediatric ward in the children’s hospital. On
the theatre list were three children, all having dental care under general anaesthesia.
One child was two years old and had significant dental decay; the second child had
leukaemia; and the third was six years old and extremely anxious. After clerking these
patients with another trainee and the consultant, we joined the rest of the team
(including a paediatric anaesthetist) in theatre. All of the children had their dental
treatment completed successfully. The treatment carried out included restoration of
teeth and extraction of those with poor prognosis.

In the afternoon I attended a trauma clinic. New referrals of patients with dental
injuries are assessed in addition to those who are under long-term review. The
paediatric dental team work with orthodontic colleagues to formulate appropriate
treatment plans. The children and parents are often grateful for the multidisciplinary
attention they receive, which makes this a very rewarding clinic to work on.

Each day of the week is different. I work part of the week in a nearby community
dental clinic with a specialist in paediatric dentistry. In addition to assisting on a new-
patient consultation clinic once weekly, I have a session where I treat children under
inhalation sedation and two other sessions in the week where children are treated
under local analgesia and many of them will have special dental or medical problems.
There is a strong emphasis on prevention of oral disease as well as treating existing
problems. I also visit the paediatric cancer ward once a week to carry out oral health
assessments on children who have been recently diagnosed with or are receiving
treatment for cancer.

Finally, I have two sessions per week where I have no clinical duties during which I
concentrate on my Master’s research dissertation and conduct personal study. We
also have a couple of hour-long seminars each week, one of which is a literature
review and the other, this term, is on oral care for children with pre-existing medical
problems.

31
Restorative dentistry

Restorative dentistry is so much more than just restoring teeth. It allows a full
understanding of how to manage all of the commonly occurring problems caused by
tooth decay, periodontal disease, dental trauma and tooth wear. It therefore relies on
expertise in endodontics, periodontics and prosthodontics, as well as in preventive
dentistry, dental materials, implants, occlusion and aesthetics. Restorative dentists
also provide valuable support for general dental practitioners and medical and dental
colleagues who refer patients for diagnosis and treatment planning. Restorative
dentists are also deeply involved with undergraduate and postgraduate education and
training.

Restorative dentistry as a specialty is essential in the management of patients who

present with the most challenging of dental problems. These patients may have
mouth cancer, a cleft lip and palate, hypodontia, medical problems affecting their
mouth, developmental conditions of the teeth or be an adult with special needs.

Within restorative dentistry are three component specialties:

• Endodontics: this is concerned with the cause, diagnosis, prevention and treatment
of diseases and injuries of the tooth root, dental pulp and surrounding tissue.
• Periodontics: the diagnosis, treatment and prevention of diseases and disorders
(infections and inflammatory) of the gums and other structures around the teeth.
• Prosthodontics: the replacement of missing teeth and the associated soft and hard
tissues by prostheses (crowns, bridges, dentures) which may be fixed or removable,
or may be supported and retained by implants.

Some specialists train in one of these area and tend to work in specialist high street
practices. Other dentists train for longer in all three areas and become consultants
working in hospitals.

32
A day in the life…
Dr Sarra Jawad, University Dental Hospital of Manchester

Describing a typical day in the life of a restorative dentistry specialty registrar (StR) is a
contradiction in terms, as no two days and indeed no two StRs’ experiences are ever the same.
Restorative dentistry frequently involves a multidisciplinary approach, requiring liaison with
colleagues within other areas of dentistry and further afield, such as oncologists, haematologists
and cardiologists to name but a few.

Training is very much ‘hands-on’, either by treating patients yourself or by supporting

consultation clinics. In both ways I am involved with a great variety and a large number of
patients. Aside from the clinics, StRs are given their own patients to treat. These are selected
by consultants to expose the StR to a variety of challenging cases, such as providing complete
dentures, endodontic re-treatment, periodontal surgery and tooth-wear cases.

The restorative dentist has a large part to play in providing the team with dental options, such as
working with oral surgeons, pathologists, oncologists and radiologists when managing head and
neck cancer. Here the restorative dentist receives information regarding the proposed surgical
and medical management of the patient’s tumour, and will then need to plan the patient’s
preoperative management, postoperative prevention, and eventually definitive rehabilitation of
the mouth.

Further to this, StRs are also involved in the teaching of under and postgraduates, often
supervising them at the chair-side, offering advice and practical help in the clinical situation.
Research is also part of an StR’s training. StRs working in the NHS are expected to develop an
interest in research and often an MSc or MPhil qualification is incorporated into the training
pathway. Critical analysis of evidence is a large part of the final exam, so this skill needs to be
developed accordingly.

33
Special care dentistry

Special care dentistry is concerned with the improvement of the oral health of
individuals and groups in society who have a physical, sensory, intellectual, mental,
medical, emotional or social impairment or disability or, more often, a combination
of these factors. It requires a holistic approach to the provision of care in order to
meet the complex requirements of people with a variety of special needs.

Special care dentistry was approved as a new specialty by the GDC in October 2008
and the number of trainees, specialists and consultants in special care dentistry has
grown considerably over the last three years and it continues to grow.

Training programmes are emerging across the UK for those who wish to pursue a
career as a specialist. However, clinicians at all levels, including generalists, can all be
expected to offer special care dentistry within their field of practice.

34
A day in the life…
Miss Jessica Rowley, City Health Care Partnership Dental Services, Hull
Mrs Jane Temple, Sheffield Salaried Primary Dental Care Services

Both of us work under the supervision of our consultants within primary care, which in itself is
unusual for a training pathway. This gives us a wide exposure and breadth of experience. Our
first case of the day could be a patient with a haematological disorder for whom we must liaise
closely with other medical professionals to treat. The next may be a severe phobic who needs
encouragement just to enter the surgery.

The special care dentist can expect to encounter a very broad range patients, each requiring
different treatment and support. In the course of a day, we can provide intravenous sedation
to facilitate examination and treatment for a Down’s syndrome patient with severe congenital
cardiac disease, treat a quadriplegic patient who requires hoisting, travel out to a project for
homeless people to treat patients with a range of social issues including drugs, alcohol and
mental health problems, and carry out a home visit for a new patient who is repeatedly biting
his lower lip; the patient has cerebral palsy, uses a wheelchair and can only communicate using
a word pad. For this case, liaison with a speech and language therapist is required to determine
the best treatment.

All of the above cases are taken from just one day at work from the both of us. Alongside
treating patients, the special care dentist can expect to attend teaching sessions on a variety
of techniques and observe, and participate in, home visits, urgent care referrals and treatment
planning meetings. Each day is different and each patient is unique, making special care dentistry
a demanding but incredibly rewarding specialty.

35
Oral and maxillofacial
surgery
Often seen as the bridge between medicine and dentistry, oral and maxillofacial
surgery (OMFS) is the surgical specialty concerned with the diagnosis and treatment
of diseases affecting the mouth, jaws, face and neck.

OMFS is unique in requiring a dual qualification in medicine and dentistry, followed

by a comprehensive general and specialist surgical training. Most surgeons acquire
a degree in dentistry before training in medicine but it is becoming increasingly
common for those acquiring a medical degree to subsequently undertake a dental
qualification and then pursue a career in OMFS.

A range of oral and maxillofacial surgical operations are carried out on an outpatient
basis under local anaesthesia or conscious sedation. These include pre-implant
surgery, placement of dental/facial implants, removal of impacted teeth, and intra-
oral and facial soft tissue procedures. More major operations, for example those
for salivary gland disease, trauma, facial deformity or cancer, are carried out on an
inpatient basis under general anaesthetic.

Due to the nature of the work, surgeons often work alongside a variety of specialists in
other fields such as ENT, oncology, plastic surgery, orthodontics, restorative dentistry,
radiology and neurosurgery.

Surgeons may choose to train and specialise in one or more specialised fields in
OMFS, including head and neck cancer, craniofacial deformity, oral medicine,
craniofacial trauma or cosmetic surgery.

36
A day in the life…
Dr Matthew Idle, Queen Elizabeth Hospital, Birmingham

Ordinarily, the day would begin at around 7.30am in order to consent and prepare patients for
surgery. I would have coordinated the work-up of each case in conjunction with the consultant,
senior house officer (SHO) and the prosthetics laboratory, where appropriate, prior to the
day of theatre. Following this, I would then meet the rest of the team in the seminar room at
8.15am for the formal start of maxillofacial ward rounds. The ward SHO would present each
of the patients in detail and a management plan would be formulated. The entire team would
then review them on the head and neck ward, liaising closely with the nursing staff.

I would then go to theatre with the consultant and SHO for the team brief. We would be
expected to discuss the order of the list, any equipment needs and special considerations for
individual patients to ensure the list runs smoothly.

Under the supervision of my consultant I would usually undertake each procedure to

completion but occasional guidance might be required. I would be expected to write a
comprehensive operation note and formulate a suitable postoperative management plan.
Several patients would normally arrive mid-morning for the afternoon list and I would dip out
of theatre to consent them. I would continue operating through the afternoon; however, for
more simple cases, I would take the SHO through the procedure or assist the consultant in
more complex operations.

The postoperative ward round would be at around 5pm to ensure everyone from the list was
recovering well.

If I was on-call that day I would also review the patients from other members of the maxillofacial
team and liaise with the other registrars for handover. If there was any emergency work to deal
with we would negotiate a slot in theatres for the evening, otherwise I would be available on
my mobile overnight as required until 8am the following day.

37
Academic dentistry

The practice of dentistry comprises general practice as well as a number of specialties,

each dealing with a particular area or aspect of patient care. If our knowledge of
these areas and our ability to treat and care for patients is to evolve then the various
areas of dentistry must be investigated, and our practice developed and refined.
The academic dentist therefore works to increase understanding and push back the
frontiers of knowledge in his or her area of interest. This process normally requires
the scientific infrastructure and intellectual environment found in large universities.

A career in academic dentistry can be challenging because it involves many

components, including:
• The actual practice of dentistry (or a specialty within dentistry).
• Teaching at undergraduate and postgraduate levels.
• Research to progress the subject of interest.
• Successfully completing a higher dgree, such as a PhD.

Balancing these components can be difficult and usually the academic develops a bias
towards either teaching or research. Consequently, if you are looking towards dental
academia as a career you will need to have a genuine interest in teaching and have
the ability to convey knowledge to others in an interesting and engaging way. If you
are to succeed as a researcher you need an enquiring mind – one that is interested
in solving problems and is always posing questions. In today’s world, research is very
much an interactive process and normally involves working with other research
groups. It helps to be able to mix easily with others.

38
A day in the life…
Mr Paul Ryan, Clinical Research Fellow (Restorative Dentistry), Queen Mary, University of London

My appointment as an Academic Clinical Fellow in Restorative Dentistry initially allowed me to

explore dental research and academia as a career alongside my clinical training in restorative
dentistry. This post allowed me to gain my research fellowship from the Royal College of
Surgeons and The Wellcome Trust and to pursue my PhD research project.

Today, my fellowship allows me to spend four out of five days every week (not to mention
evenings and weekends) concentrating on my PhD and research training. My day of clinical
work is divided between treatment and consultant clinics, as well as postgraduate teaching. This
provides a week of varying activities and commitments, which I find challenging and extremely
rewarding. The four days of research allow me time to carry out experiments in the lab, write
scientific papers, learn research techniques, as well as attend conferences and disseminate my
findings to the research community.

Leaving behind the demands of clinical dentistry and daily clinical patient lists and moving to
academia brings with it considerable autonomy and, to some extent, the chance to be your
own boss. This is a fantastic privilege but it comes with the self-imposed pressures of producing
novel research and constantly questioning its future direction.

Life as a research fellow involves juggling the challenges that come with doing a PhD together
with teaching and clinical commitments. Dental clinical academia is a career option that I believe
all dentists should consider as it is a hugely varied and fulfilling career pathway.

39
Find out
more
One of the best ways to learn more about • introduce and refer you to other
any area of work is by talking to someone associates and colleagues that can help
who does it or is in training to do it. This further.
is certainly true of dental surgery and all
of its specialties. If you’d like to arrange to speak to
someone about a career in dental
The benefit of speaking to a more surgery, please contact the Faculty of
experienced person in the field is that Dental Surgery and we will be pleased to
they can: help you.
• demystify a programme of study or
career pathway by sharing stories, The Faculty of Dental Surgery,
including mistakes, and providing The Royal College of Surgeons of England
guidance based on their experiences 35–43 Lincoln’s Inn Fields
• help identify problems and provide London WC2A 3PE
solutions, or offer constructive
criticism in a supportive manner, t: 020 7869 6806
making difficult periods in your career e: fds@rcseng.ac.uk
much easier to navigate www.rcseng.ac.uk/fds
• discuss any fears or uncertainty about
pursuing a particular job or career

40
Specialty associations
You can find out more details about each specialty area from the associations below.
Dental and maxillofacial radiology British Society of Dental www.bsdmfr.org.uk
and Maxillofacial Radiology

The Royal College of www.rcr.ac.uk

Radiologists
Dental public health British Association for the www.bascd.org
Study of Community Dentistry
Oral and maxillofacial pathology The British Society for Oral www.bsomp.co.uk
and Maxillofacial Pathology

The Royal College of Pathologists www.rcpath.org

Oral medicine The British Society for www.bsom.org.uk
Oral Medicine
Oral microbiology Oral Microbiology and www.bsdr.org.uk
Immunology Group
Oral surgery British Association of www.baos.org.uk
Oral Surgeons
Orthodontics British Orthodontic Society www.bos.org.uk
Paediatric dentistry British Society of Paediatric www.bspd.co.uk
Dentistry

International Association of www.iapdworld.org

Paediatric Dentistry

European Academy of www.eapd.gr

Paediatric Dentistry
Restorative dentistry British Society for Restorative www.bsrd.org.uk
Dentistry

Association of Consultants and www.restdent.org.uk

Specialists in Restorative Dentistry
Special care dentistry British Society for Disability www.bsdh.org.uk
and Oral Health
Academic dentistry Dental Schools Council www.dentalschoolscouncil.ac.uk
Oral and maxillofacial surgery British Association of Oral www.baoms.org.uk
and Maxillofacial Surgeons

41
 It’s
about
impact (not Impact Factor)

The FDJ, produced by the Faculty

of Dental Surgery of The Royal
College of Surgeons of England,
is an independent dental journal
that provides expert opinion
on contemporary issues and
controversies relevant to the
whole dental community.

The mixture of opinion, cultural,

political, professional, training
and research material, combined
with an elegant, contemporary
design, makes the FDJ an exciting
and essential proposition for busy
professionals.

how Do i subscribe?
Members of the Faculty receive the journal
for free, as part of their membership. You
can find out more about joining us at:
http://www.rcseng.ac.uk/membership

Subscriptions If you want to take out a subscription to

from as little the FDJ please contact Portland Press:
as £36 per year T: 01206 796351
E: sales @portland-services.com
www.portlandpress.com/pcs/journals/
journal.cfm?product=FDJ
 dentists in training

undergraduates

orthodontic therapists
the
Dental Affiliates
programme
from the Faculty of Dental Surgery of
The Royal College of Surgeons of England. Registered Charity No. 212808

Benefits include
• Members’ welcome pack

JOIN
• Free online access to the Annals, Bulletin, FDJ and other
e-resources
• Access to selected online library services
• Regular online newsletter (every two months) specifically for
Affiliates and email bulletins providing information about careers
in surgery
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• Free use of College facilities, including Library, Lumley Study Centre
and Members’ Lounge
• Priority booking on Careers Afternoons providing advice on careers ONLY
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and skills (currently twice a year)
• Access to Faculty events incl. Affiliates’ Day (additional fee)
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• Free Hunterian Museum evening lectures PER YEAR
• RCS wedding venue discount
• Free College diary

W W W. R C S E N G . A C . U K / j o i n - A F F I L I AT E S
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ntic radiology pathology
ntics oral medicine acad
ublic health paediatric o
dontic restorative surger
gy oral special care dent
e academic microbiolog
ic orthodontic maxillof
torative surgery periodo
al dentistry endod
ology dental public heal