A Career in Oral Microbiology

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 Microbiology involves the diagnosis and assessment of facial infection, typically bacterial and fungal disease. This is a clinical specialty undertaken by laboratory-based personnel who provide reports and advice based on interpretation of microbiological samples.

In the following article, Deborah Lockhart, Specialist Registrar in Microbiology, discusses how you can establish a career in this field.

Deborah Lockhart | BSc(Hons), BDS(Hons), MFDS RCSEd, FRCPath

MRC Clinical Research Fellow / Specialist Registrar in Microbiology

Division of Molecular Microbiology

University of Dundee

I studied dentistry at the University of Glasgow and loved microbiology so much I intercalated a BSc in the subject. After graduating I completed VT in a small town on the East coast of Scotland and then two subsequent 6-month posts as (i) SHO in paediatric dentistry at Dundee Dental School and (ii) community dental officer in Aberdeenshire. During this time I obtained MFDS from the Royal College of Surgeons in Edinburgh, an essential pre-requisite for higher specialist training.

Next I moved back to Glasgow to take up the first NHS Education for Scotland funded oral microbiology Specialty Registrar post based at the Royal Infirmary. In addition, I became an Honorary Clinical Teacher at the University of Glasgow. Towards the end of my training I took 3-years out of programme to pursue a PhD at the University of Dundee having been awarded a prestigious MRC Clinical Research Training Fellowship. Right now I am writing up my thesis and will hopefully obtain my PhD and CCST in autumn 2014.

A Career in Oral Microbiology

Oral microbiology is a clinical and academic specialty concerned with the diagnosis and management of oral and maxillofacial infections, systemic and nosocomial infection arising in patients attending outpatient or in-patients services. The specialty has a key role in the provision of infection prevention and control education and training for undergraduate and postgraduate dentists and members of the dental team.

The specialty of oral microbiology is closely linked to medical microbiology under the auspices of the Royal College of Pathologists (RCPath) and there is a combined oral & medical microbiology training curriculum. All oral microbiologists have successfully completed the FRCPath examination in medical microbiology enabling them to undertake the range of activities associated with clinical medical microbiology in addition to their specialised role in the management of oral and maxillofacial infections.

As the smallest dental specialty, most oral microbiologists have carved a unique niche broadly involving the following key areas:

  1. Clinical liaison with a range of medical and other healthcare professionals on the diagnosis and management of patients with infection (not restricted to the maxillo-facial area).
  2. Authorisation and interpretation of laboratory reports.
  3. Laboratory management and quality assurance.
  4. Infection prevention and control.
  5. Clinical audit; development of guidelines, investigation protocols, surveillance systems etc.
  6. Undergraduate / postgraduate teaching and training.

Research (clinical and/or laboratory).

Pros & cons of a career in Oral Microbiology
  • Fascinating and varied career quite unlike that typically associated with a dental degree!
  • Involvement in a wide variety of challenging infection cases.
  • Ability to influence patient management and contribute to saving lives.
  • Collaboration with allied medical colleagues e.g. surgery, intensive care, orthopaedics.
  • Combine clinical work with academic activities.
  • Freedom and ability to create your own area of expertise within the specialty.
  • Scarcity of training posts.
  • Lengthy training  – all oral microbiologists have completed a minimum of 5-years clinical (FRCPath) and 3-years research (PhD) training.
  • Uncertain job prospects.

If you have a strong intellectual backbone, enjoy a bit of behind the scenes detective work combined with a clear interest in infection then you should consider microbiology. Excellent communication skills and an ability to liaise with a range of healthcare professionals is key. Although training programmes broadly follow the same curriculum there is regional variation depending on local specialties and populations. Some trainees may form close ties with oral medicine while others will align more with the medical microbiologists and might even find themselves on the on-call rota! 

As it is such a small specialty the best thing to do is have a chat with someone (see contacts) and find out ways of getting involved to see if it is something you will enjoy. Be warned: at first it is quite a culture shock from clinical dentistry. For example, it may be possible to arrange a 3-4 month taster block during foundation training. 

I was fortunate to be taught as an undergraduate by some inspiring oral microbiologists and thought what they did sounded incredibly exciting!  Stories of flesh-eating superbugs completely captivated me and after second year dentistry I made up my mind. Looking back I was incredibly naïve but although the training is challenging, I feel really privileged to have been given an opportunity to take a slightly more unconventional path. I have worked alongside some wonderful medical microbiologists and during my PhD evaluated targets for new antifungal drugs by joining a group of talented hardcore basic scientists. Neither of which would have occurred had I not specialised in oral microbiology.

There have been many exciting moments, for instance, becoming one of the very few dentists to pass the FRCPath in medical microbiology and being awarded a MRC Clinical Research Training Fellowship. Last year I won a European Confederation for Medical Mycology Young Investigator Award for my research.

Definitely the anthrax outbreak in Glasgow! This was something so rare I never imagined encountering it in real life. I even earned the name “Annie Anthrax” since new cases seemed to occur whenever I was on-call. This was an incredibly busy time filled with an immense buzz, as we never knew what was going to happen next. In essence this sums up a career in microbiology.

 

I think so despite sometimes wondering what it would be like to be an orthodontist.

In hindsight, I might have maintained closer ties with dentistry by including a session in a related specialty e.g. oral medicine during my registrar training in microbiology.

A typical day…

There is no “typical” day… Come and see for yourself if you are considering the specialty, as there could be an outbreak brewing or an exciting experimental breakthrough. A ‘routine’ day as a clinical microbiologist might involve:

A handover meeting summarising overnight developments with the on-call microbiologist and, yes, that could be you! Mid morning, authorisation of laboratory reports including the request of any relevant additional tests by considering the clinical picture of patients and liaising with laboratory staff. Urgent results and updates will be telephoned e.g. positive blood cultures from patients with suspected septicaemia. You may also be responsible for taking incoming calls from clinicians and/or preparing for a ward round by ensuring all laboratory results are updated. In the afternoon, there will be Consultant-led ward rounds where individual patients are discussed; the microbiological results and management communicated with the relevant teams e.g. intensive care, max-facs or orthopaedics. Alternatively, there may be journal clubs or teaching duties. If you happen to be the on-call microbiologist then you will not want to venture too far from the telephone!

Specialty training pathway

Entry Requirements

Entry to an oral microbiology training programme requires satisfactory completion of: 

(i) Two year period of postgraduate dental training that may include general dental practice (VT) and a period of training in secondary care in an appropriate cognate specialty. I would definitely advise spending time in oral & maxillofacial surgery or another specialty that involves in-patient management to gain an appreciation of ‘life on the wards’. 

(ii) The possession of the FDS, MFDS or MJDF of the UK Surgical Royal Colleges or an equivalent qualification.

(iii) Candidates without FDS, MFDS or MJDF may be admitted to a programme but will normally be expected to possess an appropriate higher degree and/or to have had appropriate experience in a related discipline.

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

Following appointment at Specialty Registrar or Clinical lecturer level, for those already in possession of a higher research degree, dentally qualified trainees work alongside their medical colleagues primarily based in large teaching hospitals. It is important to emphasise that the current GDC approved competency based curriculum is the same as for medically qualified candidates with additional sub-specialty components in oral microbiology. 

Training is for a minimum of 5-years full-time with candidates required to pass a Year 1 OSPE (Objective Structured Practical Examination) and a two-part FRCPath examination in medical microbiology that is usually taken in Years 2 and 4. There is no standalone examination in oral microbiology. Candidates without a higher research degree will be required to enrol for a PhD and may be required compete for external Fellowship funding.  This will increase training by a further 3-4 years.

Career options after specialty training

Oral microbiology is an evolving specialty with only 7 registrants on the GDC specialist list and all currently hold academic appointments in UK Universities. Oral microbiologists have contributed to over 300 papers in the literature.

Traditionally trainees have aspired to senior clinical academic positions with honorary consultant status. To date there are currently no NHS funded consultant posts.

I think it is important trainees are fully informed of the options and opportunities post CCST. Be aware that things are continually changing and unpredictable. 

Make sure whatever branch of dentistry you aspire to it is something you are passionate about and enjoy. Try to make yourself and your CV standout from the crowd. Take advantage of intercalated degrees, electives and holidays to get involved with research, audit projects and taster sessions. There are endless possibilities if you are creative. Try to present your work at meetings or better still get it published. Nobody is expecting a paper in Nature instead consider short case reports or letters to get you started. 

You are unlikely to have a dedicated oral microbiologist based at your dental school so contact someone who has completed training (see below) to find out what it involves and if possible arrange a taster session. They will be delighted to hear from keen and interested students. 

An important consideration for anyone considering this specialty is the unpredictable nature of training posts.  In the last 10-years only three have been advertised in the UK (two in London and the one I was appointed to in Glasgow).  The Association of Clinical Oral Microbiologists (ACOM) is lobbying for greater awareness of the specialty.  In addition, changes to the medical microbiology curriculum may impact on future training of dentally qualified candidates.

Further Information

The GDC specialist list in oral microbiology provides up-to-date contact details of those in the specialty and the ACOM website is also a very good resource. Interested students may also contact the following directly for further information:

  • Dr. Riina Rautemaa-Richardson, Senior Clinical Research Fellow & Honorary Consultant Medical Mycologist, Wythenshawe Hospital, University of Manchester. ([email protected])
  • Dr. Noha Seoudi, Clinical Lecturer in Oral Microbiology, Queen Mary’s School of Medicine & Dentistry, University of London. ([email protected])
  • Prof. Andrew Smith, Professor of Clinical Bacteriology & Honorary Consultant Microbiologist, Glasgow Dental School, University of Glasgow. ([email protected])
  • Dr. Melanie Wilson, Senior Clinical Lecturer & Honorary Consultant in Oral Microbiology, School of Dentistry, Cardiff University. ([email protected])

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