A Career in Oral & Maxillofacial Pathology

The GDC currently recognises 13 various fields of dentistry with regards to their specialist register. You are not required to join a specialist list to practise a specialty, however, only dentists on these specialist lists have the right to use the ‘specialist’ title. In this series of articles you can find out more about each specialty from experts in their respective fields, with advice on the career pathway as well as sharing their experiences as a specialist.

The specialty of Oral and Maxillofacial Pathology involves the diagnosis of diseases of the mouth, jaws, face and neck by microscopic examination of tissue samples.

In the following article, Professor Keith Hunter, Consultant in Oral and Maxillofacial Pathology, discusses how you can establish a career in this field.

Dr Keith D Hunter | BSc (Hons), BDS (Hons), FDSRCSEd, PhD, FRCPath

Senior Clinical Lecturer/Honorary Consultant in Oral and Maxillofacial Pathology

School of Clinical Dentistry, University of Sheffield

I am Clinical Senior Lecturer and honorary Consultant in Oral and Maxillofacial Pathology at the University of Sheffield.

After BDS and an intercalated BSc in Pharmacology in Glasgow, I worked as a vocational Dental Practitioner and also worked as an SHO for 3 years (including time in Oral and Maxillofacial Surgery). I then completed my PhD at the CRUK Beatson Institute for Cancer Research in Glasgow and clinical training in Oral and Maxillofacial Pathology at Glasgow Royal Infirmary, whilst working as a Lecturer in the Glasgow Dental School.

Following postdoctoral work and the completion of clinical training, I was appointed as Senior Clinical Lecturer and honorary Consultant Histopathologist at the University of Glasgow in 2008. I moved to my current position at the University of Sheffield in 2009.

Currently, I am also Academic Director for the Oral and Dental Academic Directorate in Sheffield Hospitals Trust and lead a research group of one Post-doc, 4 PhD students, 2 Masters Project students, one intercalating BMedSci student.

A Career in Oral & Maxillofacial Pathology

Oral and Maxillofacial Pathology is one of the four Additional Dental Specialties. Speciality training involves 5 years of Oral and Maxillofacial Pathology training under the auspices of the Royal College of Pathologists, leading to fellowship of the Royal College of Pathologists (FRCPath) and CCST in Oral & Maxillofacial Pathology. This will include at least one year of General Pathology training and attachments to various specialist centres around the country. Following the training pathway, consultants practice the full range of Oral and Maxillofacial Pathology and many also report ENT pathology or other sub-specialities. Currently there are 23 Consultants in the UK,who have traditionally been associated with HEFCE funded academic posts within Dental Schools but there has been an increase in NHS funded posts held within major Maxillofacial/Head and Neck Cancer centres.

The curriculum for training in OMFP has been designed by the British Society of Oral and Maxillofacial Pathology in collaboration with the Oral and Maxillofacial Sub–group of the SAC in the Additional Dental Specialties and is approved by the General Dental Council. Training is delivered locally by consultants and specialists in Oral & Maxillofacial Pathology under the auspices of the Postgraduate Deaneries; these manage the ARCPs and training programmes with advice, when needed, from the SAC in the Additional Dental Specialties.

OMFP is unusual amongst the dental specialities: there is very little or no direct patient contact and the clinical work in this role is diagnostic histopathology (largely laboratory based), which represents a large change in pattern of work for most entering the speciality. Although previous clinical experience is valuable, the transition into a laboratory based specialty is challenging because, unlike other clinical specialties, the new trainee has little previous experience in the specialty unless they have had a dental core training post that involves experience in OMFP.

OMFPs play vital roles in Cancer Multidisciplinary Teams, and many OMFP colleagues now play active roles in the development of Head and Neck cancer services across the UK. Many of the training positions are situated in academic departments (although few are primarily based within Dental Schools) and this offers the opportunity for development of teaching and research skills. For some trainees there is the possibility of completing a higher research degree (PhD), particularly for those who are on the NIHR Integrated Academic training pathway (see later). This brings variety and new challenges to every day in the job. Furthermore, OMPF is a small speciality in the UK, but has wide links worldwide. One of the highlights is to be able to meet with OMFPs from around the world and organisations such as the International Association of Oral Pathologists (IAOP) facilitate this.

Pros & cons of a career in Oral & Maxillofacial Pathology

A career in Prosthodontics can be highly rewarding however, those up to the task must be able to deal with issues relating to practical skills, demanding patients, problematic clinical challenges and complications.

Many general dental practitioners provide prosthodontic work for their patients but the scope of work is normally limited by knowledge (especially treatment planning) and practical skill. Studying prosthodontics provides the opportunity to develop and enhance these.

On the negative side, prosthodontic care can be the source of problems and complaints for patients and for some clinicians, prosthodontics can be described as ‘problemodontics’.

Training in OMFP will suit an individual who has an inquisitive nature, wants to work in a stimulating, research-led environment and wants to contribute a vital part of the care of a whole range of patients, from simple Oral Surgery to complex Maxillo-facial resections.

I was enthused by Oral Pathology as an undergraduate by my late mentor, Professor Gordon MacDonald, and his drive to provide the best diagnostic service, excellent teaching and high quality research. Following on from my BSc, I know I wanted a to find a speciality which would give me the opportunity to pursue research in addition to clinical work, and OMFP provides the best opportunity in Dentistry to do that.

There have been a few (making a diagnosis in a difficult case is an ongoing source of satisfaction), but the best was getting on BBC Scotland News on the publication of the main paper from my PhD (Hunter et al Cancer Research, 2006). It was really exciting to get that level of exposure for Oral Cancer research, although the whole TV thing was a bit daunting.

It is difficult to pin down one case, but there is a great deal of satisfaction in arriving at a diagnosis in a challenging case, particularly if that directs patient treatment.

A typical day…

There is no such thing as a typical day! My current role includes diagnostic histopathology (which varies as to work load, depending on the number and complexity of specimens in a week), teaching (variable throughout the year) and Research (running a research group is in itself almost a full time occupation) and associated administration for all three elements. This brings the variety to the job which I love so much

Specialty training pathway

You are not required to join a specialist list to practise oral surgery, however, only dentists registered on the GDC held specialist list have the right to use the ‘specialist’ title in the UK.

To be granted entry to the list an applicant must have been awarded a Certificate of Completion of Specialist Training (CCST) as a result of completing a GDC approved training programme, with a dedicated national training number (NTN).

Entry Requirements

Currently candidates may seek entry to OMFP training after completion of Dental Core Training Posts (formerly DF2/CDP posts). It is also expected that the candidate will have obtained MJDF (RCS Eng), MFDS or equivalent by this point.

In practice however, many appointment committees like to see experience in Oral and Maxillofacial Surgery and also evidence of experience in an OMFP post at Dental Core Training (formerly DF2/CDP) level. A number of such posts exist round the country (e.g. Sheffield, Guys) and provide evidence of full exploration of the requirements of OMFP training before embarking on a formal training pathway

It is strongly recommended to check the essential and desirable criteria listed in the person specification provided for specific specialty training posts (StR). An exemplar person specification can be found in the ‘Further Information’ section at the bottom of the page.

Training Pathway

5 year training pathway, as outlined above. As many of the training centres are also academic units there is opportunity for both research and teaching experience. On completion of training, the initial appointment would be as an NHS Histopathology Consultant, which will most likely be in a large general Histopathology department.[/

This combines OMPF training with a higher research degree.

  1. NIHR Integrated Academic Training (IAT) pathway: this follows the progress from Academic Clinical Fellow (ACF) to doctoral training fellow (PhD) and then to Academic Clinical Lecturer (ACL). This full pathway may take up to 10 years, but places trainees in a competitive position for senior research fellowships.
  2. “Informal” academic training. Some centres offer NHS funded academic StR 7/8 year posts to encompass clinical training and a PhD, but this may not have the formal NIHR structure and often trainees get exposure to all aspects of academic training; however, they are not formally appointed as lecturers.

Completion of this pathway may lead to an NHS Consultant post or an academic OMPF post (Senior Clinical Lecturer).

I followed an academic training pathway which gave me a solid research background in addition to my clinical training. However, once the PhD was finished the focus was very much on completion of training, leaving very little time for post-doctoral research experience. Ideally I would have liked more of this before taking on the role as Senior Clinical Lecturer, with all the expectations that bring from the University.

The most useful advice is to visit departments and spend time with an OMFP if you are interested in this speciality as a career. Please come and see us – we don’t bite!

Further Information

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