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 Medicine is concerned with the oral health care of patients with chronic, recurrent and medically related disorders of the oral and maxillofacial region, and with their diagnosis and non-surgical management.
In the following article, Professor John Gibson, Consultant in Oral Medicine, discusses how you can establish a career in this field.
The British Society for Oral Medicine have helpfully defined Oral Medicine as follows:
“Oral Medicine is the specialty of dentistry concerned with the oral health care of patients with chronic, recurrent and medically related disorders of the oral and maxillofacial region, and with their diagnosis and non-surgical management.
Oral Medicine sits at the interface between dentistry and medicine. Many Oral Medicine specialists have dental and medical qualifications, although a medical degree is not a requirement for entry to specialty training.
The key difference from Oral Surgery and Maxillofacial Surgery is that in Oral Medicine the emphasis is on conditions that are primarily managed without the need for surgery.
There are three main, inter-related aspects to the practice of Oral Medicine: Clinical Care, Education and Research.” (BSOM website: www.bsom.org.uk).
As stated above, there are three main parts to the daily activities of a consultant in Oral Medicine: Clinical Care of patients, Education of undergraduate students and postgraduate trainees in the early and later years of their training pathways, and Research.
The proportions of each of these activities will be determined by the consultant’s employer. If the consultant chiefly works in an academic department within a Dental School (part of a university), there will be a major component of teaching and research. Such consultants will be employed by a university and have appointments as lecturers, senior lecturers, readers or professors. These consultants will have “honorary” status as consultants within the NHS to allow them to treat patients. They will be contracted to treat patients for several sessions each week and they will normally combine that time with teaching students Oral Medicine in a clinical setting.
Increasing numbers of consultants in Oral Medicine are being appointed with the NHS as their main employer. Such individuals will have a heavier patient treatment load but will also normally have an “honorary” contract within a university setting. As such, they will be involved in teaching or research too.
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’.
Oral Medicine is a demanding but very rewarding career. Sitting at the interface of medicine and dentistry, it offers a very real opportunity to use diagnostic and treatment skills of both medicine and dentistry – seeing the oro-facial manifestations of systemic diseases of the major body systems such as Crohn’s disease, lupus, multiple sclerosis and diabetes. Diagnoses made as a result of these manifestations may have profound and positive consequences for patients.
One of my medical colleagues, having spent some time in an Oral Medicine clinic, described the specialty as “the last bastion of general medicine”. He was genuinely astonished at the breadth of conditions seen in the course of a day!
That is the reason that I find Oral Medicine a delightful career – variety, intellectually challenging and offering a difference to patients’ well-being.
The highlight of my career was completing my PhD thesis, the results of which have made a genuine difference to patient care. On a daily basis, it is very satisfying to see patients helped with symptom control in mucosal diseases and severe facial pain syndromes. Every day is a highlight!
My most memorable cases are those patients I have been involved with for many years – mostly with orofacial granulomatosis (OFG). I have seen many of them transformed with simple diet manipulation, but also the increasing use of modern drugs such as the biologic agents. I have no doubts that, given a second chance at my career, I would do the same again! Would I do anything differently? Yes, I would probably have taken more trips abroad to soak up different cultures and learn from Oral Medicine practitioners in other countries and settings. We have some truly wonderful characters in the specialty of Oral Medicine and our national and international meetings are great fun and superb times of friendship and fellowship.
A typical day for me, as an academic, would be a teaching clinic in the morning followed by a quick sandwich lunch as I dictate the letters from the clinic and vet that day’s referral letters and review blood test and other results. I might also have a lunch-time research or teaching team meeting, journal club or research forum. In the afternoon I might have a meeting on the main university campus concerning administrative, research or other issues before returning to the Dental School to give an undergraduate lecture or seminar. Returning to my room at the end of a day, opens up the notes left by my secretary for action – NHS or university – and also the many emails on various subjects. My working days are normally 12 hours or longer, with evening administration happening 2-3 times each week. Not for the faint-hearted!
Entry to Specialty Training Registrar posts (with National Training Numbers) is competitive and you should work on achieving as full as CV as possible at all stages prior to applying. For example, during your undergraduate dental degree, an intercalated BSc or BDentSci might prove useful and so would a published paper or two during well-chosen elective periods, as well as the BDS or BChD degree being awarded with Honours or Commendation.
A medical degree is no longer required for entry to specialty training but I would contend that the undergraduate programme in medicine is excellent experience for a lifetime in Oral Medicine and is very helpful in confidence-building for dealing with patients who will have increasingly complex medical and therapeutic issues. For those who don’t possess this degree, the Specialty Training programme will accommodate the need for experience in relevant aspects of medical practise e.g. dermatology, gastroenterology, psychiatry and will, accordingly, be longer than for those with a medical degree.
Full details on requirements for entry to an Oral Medicine Training Post are given in the GDC’s document Specialty Training Curriculum for Oral Medicine (2010) as follows:
“Entry to an Oral Medicine specialty training programme in the UK may follow the satisfactory completion of a two-year period of Foundation Training in dentistry which includes periods of training in primary and secondary care settings. While the Diplomas of Membership of the Joint Dental Faculties (RCS England), the Faculty of Dental Surgery (RCS Edinburgh/RCPS Glasgow) or the Faculty of Dentistry (RCS Ireland) remain useful indicators of completion of this period, it is not essential that a candidate holds one of these qualifications. It is recognised that the achievement of competencies specified in the Curriculum for UK Dental Foundation Programme Training may be demonstrated in other ways.
The curriculum will be achieved by completing the necessary specialty posts within training programmes.”
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.
That same document also addresses the length of training:
“The normal duration of training is five years. Accredited prior learning, which may include possession of a medical degree, may be taken into account in assessing the agreed period of training. The practice for recognising prior learning is attached as appendix 1 to this curriculum. A CCST in Oral Medicine will be awarded by the General Dental Council on the recommendation of the local Postgraduate Dental Dean following:-
Successful outcome in the Annual Review of Competence Progression (ARCP) process as outlined in ‘A Guide to Postgraduate Dental Specialty Training in the UK’ (Dental Gold Guide).
For academic training jobs, there may be an expectation (and, indeed, a requirement) to complete a higher degree – Masters or Doctorate – during the period of training. The academic pathway can be challenging and is not for the faint-hearted! On successful completion of academic training, you may expect to continue teaching and research for the rest of your professional life – meeting universities’ requirements for publications, PhD and Masters students supervision and achieving grant funding. A number of academics in Oral Medicine in the UK have gone on to lead dental schools and take other senior positions in universities and wider academic life, including the GDC.
For those completing a conventional training pathway, there are increasing numbers of NHS consultant posts available. A number of consultants in Oral Medicine in the UK have gone on to take positions as Lead Clinicians and Clinical Directors as well as senior positions in Deaneries and Royal Colleges.