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.
Prosthodontics involves 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.
In the following article, Consultant Prosthodontist Krishnakant Bhatia, discusses how you can establish a career in the field of Prosthodontics.
Senior Clinical Lecturer/Honorary Consultant in Prosthodontics
Programme Director for MClinDent Prosthodontics
Edinburgh Dental Institute, University of Edinburgh
After qualifying from Glasgow Dental Hospital and School, I completed a range of hospital training posts within Scotland. In 2005 I was appointed as a specialist registrar in fixed and removable Prosthodontics at the Edinburgh Dental Institute. During this time I completed a masters degree in fixed and removable Prosthodontics and in 2008 my Membership in Restorative Dentistry (MRD) from the Royal College of Surgeons of Edinburgh specialising in Prosthodontics.
Completing this training pathway has provided me with experience of conventional and implant based fixed and removable Prosthodontics using restorative, surgical and multidisciplinary approaches. I have found these skills to be useful in hospital and specialist private practice.
My other big area of interest is technology enhanced learning and along with face-to-face teaching I am involved with the training of undergraduate and postgraduate dentists and dental care professionals.
Prosthodontics is a field of dentistry concerned with the replacement of tooth tissue, teeth and oral structures with the goal of providing or improving function and aesthetics. Such work involves delivering a range of simple to advanced restorative procedures and prosthetic restorations (including veneers, onlays, crowns, bridgework, all type of removable prostheses and dental implants). The prosthodontist is trained to deliver care with precision and commonly work within a dental team to achieve high quality results.
As with all dental specialities, a career in Prosthodontics involves treatment of patients, teaching and research. The overall mix and balance of those disciplines will vary depending on your job role and working environment. Treatment will involve managing individuals with complex dental issues (both in private practice and working under the NHS), sometimes spanning months to years to reach an end point. Teaching and research are mainly undertaken within academic institutions however; specialists also deliver these in private settings.
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’.
If you are a good communicator, have an eye for detail, can work within a team and wish to enhance your practical skills then a career in Prosthodontics can be highly rewarding. It still features all aspects of routine restorative dentistry and you will be involved with coordinating patient care.
I have always preferred the practical and creative side of dentistry combined with aesthetics and dental implants which is why it was always my preferred specialty. Cases normally take longer than routine general care but it is highly rewarding to manage a patients presenting complaint and deliver on an agreed treatment plan in a predictable manner.
I would say my biggest highlight is not one of the successful treatments, awards or grants I have achieved but actually learning the power of self-reflection. Maintaining this attitude ensures that I continue to get better at what I do while enjoying it at the same time.
All those cases where a team approach has resulted in a patient noticing a dramatic improvement in their quality of life come to mind.
Yes, though I sometimes wonder where my career may have ended up if I chose to study computer science.
Some time working abroad would have been good for me, though I would still consider it for the future.
A typical day for a Prosthodontist will involve specialised treatment of patients involving assessment, treatment planning, stabilisation and rehabilitative care. As with other specialties, there is also a lot of administrative work and being organised is very important.
You are not required to join a specialist list to practise prosthodontics, 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).
The General Dental Council (GDC) provides a clear document on what is required for prospective trainees in prosthodontics, information for this can be found on the GDC pages for the specialist list (link provided below). In order to be granted entry to the list an applicant must be awarded a Certificate of Completion of Specialist Training (CCST), while also holding a full GDC registration. If your training does not result in a CCST then entry to the list is not permitted.
There is a lot more to specialist training than to simply gain qualifications and a candidate is strongly encouraged to develop their all-round ability in dentistry. Communication skills, working within a team, journal clubs, publications, poster and lecture presentations at scientific meetings are other useful (though not necessarily compulsory) ways to demonstrate your ability and commitment as well as completing foundation training posts (such as DFT/VT, DCT or GPT/LDFT).
Each StR post will normally have desirable/essential criteria for applicants. Make sure you research these prior to applying
A standard training pathway would involve entry to a Prosthodontics programme with a dedicated national training number (NTN). In order to be awarded a CCST in Prosthodontics by the GDC, evidence of the following will be required:
There are alternative routes to become a Prosthodontist that also include completing Restorative training via NHS or academic training pathways. The latter would normally be combined with the completion of a PhD in a focused area of Dentistry. This allows entry onto the specialist list in restorative dentistry but to be eligible for entry onto the Prosthodontics specialist list, additional examinations need to be sat and passed. Approval to sit these examinations is at the discretion of the deanery in which you train.
No, I think the pathway I took was logical, well supported and I still followed areas that interested me. Some additional time in practice working as a dentist (in the UK or abroad) might have been good for experience.
After completion of training, the clinician normally works in secondary or private specialist settings (sometimes both at the same time). Secondary care is normally set at specialist level and along with developing other competences and the need of the appointing institution; a consultant post is possible though in no way a guarantee. Those interested in more academic development may apply for Senior Clinical positions as a lecturer or researcher. The majority of these are combined as an honorary NHS specialist/consultant post.
As a clinician, I like the balance of working in both specialist practice and as a senior clinical lecturer. Specialist practice allows me to work with patients and maintain my skill sets. The senior clinical lecturer position, while providing clinical contact, provides a great opportunity for me to express creativity and commitment in training new postgraduate and undergraduate students.
Finally, you do not have to specialise to gain some of the skills of a Prosthodontist. There are many taught postgraduate courses available from Universities targeted at different levels (taught masters, diploma or certificate) and private courses that you may also find as interesting alternatives. Funded prosthodontic posts are rare and the majority will involve a financial investment. Make sure you are comfortable with the funding required and research the teaching institutions to make sure you understand the quality of the training you will receive.