Careers in dentistry

Dental public health consultants and specialists hold a unique position combining a strong base in clinical dentistry with specialist public health training. They are concerned with the oral health of a population rather than individuals. It contributes to the design and assurance of safe high-quality dental services for all across organisations and systems alongside public health colleagues, policy makers and dental professionals, to impact on population health and patient outcomes. The specialty is supported by an active academic base which is involved in epidemiology, health services research, tackling health inequalities and research on the prevention of disease and promotion of oral health. Interacting with everyone from policy makers to clinicians and planners as well as local communities.

Working conditions

It involves networking and co-ordinated action locally and nationally. No two days are the same and consultants work across six domains of health promotion, healthcare public health, health protection, health intelligence, workforce capacity building, and academia. Anyone wishing to join the specialty should first gain a breadth of experience across different disciplines of dentistry.

Endodontics is a dental speciality with a pursuit to prevent, diagnose and treat pulpal and periradicular disease. It is not just a technical discipline but also requires a deep understanding of the pathophysiology of the affected tissues by these diseases in order to execute ever-increasing biologically based therapies. Endodontists must not only be mindful of treating an individual tooth or group of teeth with pulpal or periradicular disease but must have a good understanding of restorative dentistry. We recommend joining the British Endodontic Society and asking an Endodontist if you can watch/shadow them for a period of time to see what the job is really like. Getting experience in different fields of dentistry early on in your career is very important and a good way to do this is through different Dental Core Training (DCT) jobs.

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To be a good Endodontist you must be devoted to a pursuit in mastering technical skills and understanding trying to achieve perfection is not a bad thing. As an endodontist, there is more than just performing root canal treatments, it is also a surgical specialty with a large volume of cases being endodontic microsurgery. In addition, the last 10-15 years has seen a large increase in the ability to manage pulpal disease conservatively with vital pulp therapies and the introduction of regenerative procedures for necrotic open apex teeth.

OMFS is the surgical specialty that bridges between dentistry and medicine. All specialists in OMFS (and specialty trainees) are both doctors and dentists. Most start as dentists but some are doctors first. Although the training pathway appears long on paper the age on joining the OMFS specialist list is similar to other surgical specialties. There are two types of specialty training posts. ST1 run-through includes training in core surgery. It is the most competitive route into specialty training. ST3 is for those who have completed core surgical training and passed their MRCS exam. ST3 has the best appointment ratio in surgery. Focus could be managing trauma, cancer and reconstruction, facial deformity, cleft lip and palate and craniofacial surgery.

Working conditions

Whatever their focus, surgeons would usually have at least one or sometimes two all day operating lists every week. They would have a mixture of general and specialist outpatient clinics. On-call depends on the size of the unit with some units sharing the workload across 16 consultant colleagues. In many units consultants spend a week on the front line of trauma and infection to break up their normal job. The nature of OMFS consultant posts and the on-call makes OMFS one of the most family friendly surgical specialties, and the upward trend in the number of female trainees and specialists support this.

Oral and Maxillofacial Pathology (OMFP) is a branch of dentistry which is concerned with the assessment and diagnosis of pathology affecting the oral mucosa, teeth, jaws, sinuses, salivary glands and surrounding structures. Training takes approximately 5 years but some trainees undertake a PhD (an extra 3 years) to pursue an academic career where they have dual NHS and University commitments. During your training, you will spend one year in a general pathology department learning about pathology from different anatomic sites which is incredibly rewarding. A typical day may include macroscopic assessment of biopsies and resection specimens in the laboratory. Time is also devoted to reporting cases using histological slides or digital images.

OMFP is very exciting as it encompasses all sorts of different pathology from lichen planus, to salivary gland tumours, rare sarcomas and metastases from other parts of the body. New tumours and prognostic markers are constantly being researched so the job never gets boring. OMFP’s work closely with other specialties, particularly OMFS, oral surgery and oral medicine.

Oral medicine is focused on the non-surgical management of disorders of the soft tissues of the mouth, the salivary glands and abnormalities of sensation and movement of the orofacial region. Unlike many other specialties the patients who attend oral medicine units have disease that is rarely plaque-induced and can cover a gamut of widely differing aetiological drivers that may include genetic, immunological, infectious, neoplastic and/or degenerative mechanisms. Training may be three years for those who have a GMC-recognised medical qualification or five years who are ‘singly’ qualified. If you do not have a medical degree this will not act as a road block to entering higher training. Clearly securing a post requires a candidate to demonstrate that they have an interest in and some experience of clinical oral medicine.

Working conditions

Specialist oral medicine care is predominantly delivered in units within the dental hospital setting, with some also taking place in Oral and Maxillofacial Surgery units in District General Hospitals (DGHs). The management of patients often requires a multidisciplinary approach with specialists from many fields of dentistry (e.g. Periodontology, Oral Surgery, Prosthodontics and Special Care Dentistry) and Medicine (e.g. psychiatry, Oral and Maxillofacial Surgery, haematology, dermatology and gastroenterology).

Oral surgery is involved with the diagnosis and surgical management of conditions and lesions affecting the hard and soft tissues in and around the oral cavity. It involves treatment of children, adolescents and adults and also includes medically compromised and dentally anxious patients. Competition is tough as there are limited training posts available. It is crucial that applicants show evidence of carrying out audit/service improvement projects. CPD in oral surgery along with membership of an oral surgery specialist society is looked on favourably. Most applicants will have published articles in peer reviewed journals, and extra credence is given to first author research papers. Poster and oral presentations at conferences are seen as highly desirable and again those presenting at international conferences will be rated more highly than those attending national or local events.

Working conditions

Oral surgery is provided in a range of environments and by clinicians with different surgical skill levels. Some oral surgery care is also provided by Oral and Maxillofacial Surgeons (OMFS) as the clinical skills and competencies of the two specialties overlap. The most common pathway to become a specialist usually involves dental foundation training followed by DCT with some of the time being spent in an oral surgery or OMFS unit. The ideal time to start specialist training is around 4 -5 years post qualification. Academic training pathways (ACF/ACL) also exist and applicants have to go through the national recruitment programme in a similar manner to NHS trainees as well as a local academic recruitment process.

Orthodontics is the dental speciality concerned with facial growth, development of the dentition and the occlusion. It involves assessment, diagnosis, interception and treatment of malocclusions and facial irregularities with removable and fixed appliances. It aims to improve the appearance and function of the teeth and jaws as well as having positive psycho-social benefits. There is a high demand for these training posts. They are always over-subscribed and competition is fierce. Candidates must hold a recognised dental degree as well as an additional qualification such as MFDS/MJDF. Individuals usually have at least five years further dental experience on from their primary dental qualification. You need to be a good all-rounder with respect to your earlier training in a variety of posts and have a high degree of self-motivation and organisational skills. You need to be an enthusiastic individual and be able to demonstrate your commitment and relevant experience towards your Orthodontics career goal.

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Paediatric Dentistry is primarily the provision of specialist oral health care for children from birth up to 16-years, ensuring that they reach adulthood with a positive experience of dentistry and optimum oral health. The vast majority of children in the U.K. are looked after by non-specialists in general dental practice, but some young patients may require referral to a specialist paediatric dentistry service, in community or hospital settings. These children may have complex dental needs such as developmental dental and oro-facial conditions, severe traumatic dental injuries, oral medicine or oral pathology presentations. They may have serious medical conditions (e.g. bleeding disorders, congenital heart disorders, immunodeficiencies, cancers, organ transplants to name a few) that complicate even simple dental treatment and therefore require expert care with support from medical colleagues.

Working conditions

The practice of Paediatric Dentistry is one that is evidence-based but one that works flexibly, not only to meet the changes of environment but also to reflect the needs of the children and their families. The complexity of management of traumatic dental injuries, dental anomalies and children living with medical problems, gives a unique insight into some of the most challenging periods in a child’s life. Whether it is providing psychological support, treatment under local anaesthesia, sedation or general anaesthesia, the driver is often the child who helps making the decision how we provide dental care.

Periodontics aims to help people keep their teeth where gum disease is either a risk or a problem, to help them continue to function and look better, and to optimise the outcomes of implant treatment and to prevent or manage periimplant disease. This ranges from diagnosis and treatment of periodontal and periimplant diseases through to liaison with other specialties and reconstructive surgeries to manage the consequences of tissue damage and loss intra orally, either alone or before, during or after other therapies. There is strong competition for specialist training posts in Periodontics. The number of National Training Number (NTN)-holding posts is limited and many are in fact Academic Clinical Fellow or Academic Clinical Lecturer posts. These are aimed at those who are either working towards or who already have a PhD and need to complete specialist training. There are some local posts in teaching hospitals.

Prosthodontics is the branch of dentistry which is concerned with the functional and aesthetic restoration of damaged teeth and replacement of missing teeth. Whilst general dental practitioners will provide some or all of these treatments, prosthodontists have been trained to assess, diagnose and comprehensively manage the most complex problems, whether for just one tooth or many teeth, conforming to the existing biting relationship or establishing a new one. There is strong competition for specialist training posts in Periodontics. The number of NTN-holding posts is limited and many are in fact academic clinical fellow or academic clinical lecturer posts. These are aimed at those who are either working towards or who already have a PhD and need to complete specialist training. There are some local posts in teaching hospitals.

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Restorative dentistry is concerned primarily with the rehabilitation and management of diseases affecting the mouth, teeth and supporting structures. It integrates the specialties of endodontics, periodontics and prosthodontics (including dental implants), and its foundation is based upon how these aspects interact. The specialty has seen significant changes since its inception and has evolved in response to various factors, such as increased life expectancy, awareness and expectations of patients. Restorative dentists are continually exploring ways to improve patient care and are excellent at working within a team collaboratively. They need to be good at applying knowledge to situations and have a passion for helping others. On a practical level, many of the complex and intricate procedures the specialty demands require well-developed hand-eye co-ordination, 3-dimensional visualisation and high levels of manual dexterity. In a nutshell, you need to demonstrate your potential for developing these qualities to succeed.

Working conditions

Work for restorative consultants can vary widely including multi-disciplinary treatment planning clinics, surgery, personal or supervised treatment or research, to name a few. Working in this environment can typically include preparation for clinics and managing the ever-growing numbers of referrals throughout the day. Some days are long, but the work is enjoyable and rewarding.