A Career in Restorative Dentistry: The NHS Pathway

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. There are two main training pathways in most dental specialties, the NHS and academic routes.

Restorative Dentistry involves the restoration of diseased, injured, or abnormal teeth to normal function. This includes all aspects of Endodontics, Periodontics, Prosthodontics and Implantology.

In the second article of a two-part series, Stephanie King, Specialty Registrar in Restorative Dentistry, discusses the NHS Pathway for specialty training in Restorative Dentistry.

Click here for the first article in the series on the Academic Pathway for specialty training in Restorative Dentistry.

Stephanie King | BDS (Lond), MFDS RCS Ed, MRes (DPH), PG cert (Restorative), PGCLTHE, FHEA

Specialty Registrar in Restorative Dentistry

Liverpool University Dental Hospital

Stephanie qualified from King’s College, London, Dental School in 2009. Following vocational training in Cheshire she undertook a number of dental core trainee posts across Yorkshire and the North West including in Restorative Dentistry, Oral Surgery, Oral Medicine and Oral and Maxillofacial surgery.

Stephanie next worked for a year in Special Care Dentistry in the primary and secondary care setting, across Manchester and Lancashire, followed by 3 years as a General Dental Practitioner in an NHS practice in Bradford.

During the time since graduation, she completed the MFDS (RCS Ed), MRes (DPH) at the University of Manchester, PG Cert in Restorative Dentistry, and recently completed a PG Cert in Learning and Teaching in Higher Education at the University of Liverpool. Stephanie is currently in her fourth year of Restorative Specialty Training, undertaking this at Liverpool Dental Hospital.

An Career in Restorative Dentistry (Part 2): The NHS Training Pathway

What is Restorative Dentistry?

Restorative Dentistry is the study, diagnosis and management of diseases of the oral cavity, teeth and supporting structures. It involves rehabilitation of the functional, psychological and aesthetic requirements of the patient, and the co-ordination of multi-professional working to achieve this.  

Restorative dentistry encompasses the dental specialties of Endodontics, Periodontics and Prosthodontics and its foundation is based upon the interaction of these specialties in cases requiring complex, multi-faceted care.

The focus of the Restorative Dentistry speciality is to work with other dental, medical and surgical colleagues, to provide and support the integrated management of patients with complex treatment needs, such as:

  • Patients affected by developmental disorders such as hypodontia, cleft lip and palate, and amelogenesis imperfecta
  • Patients who have undergone radiotherapy and ablative surgery for the management of head and neck cancer.
  • Patients who have had traumatic injuries to the face, mouth and teeth
  • Patients who have sustained significant damage caused by periodontal disease, tooth decay, tooth attrition and acid erosion.

A career in Restorative dentistry involves the examination, diagnosis, and management of patients with complex restorative needs that are not suitable to be seen in primary dental care. Generally, clinically this encompasses managing the endodontic, periodontic and prosthodontic needs for patients in complex cohorts such as head and neck cancer, hypodontia, and cleft lip and palate.

The complex nature of these patient groups requires the Restorative Dentist to be fully involved in their multi-disciplinary management, by effectively communicating with and supporting other medical and dental specialties.

Restorative Dentistry may also involve supporting general dental practitioners in the local community by providing treatment plans appropriate for them to follow in primary care.

As highlighted, Restorative Dentistry is a specialty that requires multidisciplinary working, and complex patient management so would be suited to someone who enjoys working predominantly in that secondary care setting with other specialist colleagues.

An individual who wants to develop multiple clinical skills including surgical skills, endodontics and prosthodontics, and relishes in challenging treatment plans and execution.

An individual with the following mindset and skills:

  • Commitment to NHS service provision
  • Leadership and management skills able to run a service
  • Communication skills conducive to working with colleagues in other dental and medical specialties, for example when sitting on the Head and Neck Oncology MDTs
  • Clinical experience in a range of dental specialties

I have always appreciated a varied clinical working week with regards to treatment provided (surgical/endodontics/prosthodontics), and enjoy the challenge of the complexities that Restorative brings.

Additionally, I aspired to hold a senior leadership position within a team – Restorative requires strong leaders and you can be very much involved in running your own service.

Restorative Dentistry can be so complex that almost all cases result in a significant improvement in quality of life for patients, so it is impossible to choose any one case.

Not at all. I think the key to my progression and being certain of my professional goals was by not rushing – experiencing multiple specialties, including time in general dental practice, enabled me to become a confident and independent clinician ready to tackle specialty training.

Pros & cons of a career in Restorative Dentistry

  • Multi-disciplinary work with other medical and dental specialities
  • Varied clinical skills developed and utilised
  • Leadership opportunities working predominantly in secondary care
  • Complex patient management, so an NHS pathway would require significant commitment to NHS secondary care provision
  • Demanding work needing to integrate with other clinical colleagues
  • Lengthy training pathway (5yrs from start of training until Consultant post)

A typical week...

As an NHS specialty trainee – needing to fulfil clinical training in all aspects of the Restorative Dentistry curriculum, a typical week includes;

  • New patient consultation clinics 2-3 per week – treatment planning patients such as non-responding periodontitis, hypodontia cases, diagnosing developmental conditions such and AI/DI, endodontic diagnosis and treatment planning, TMD, toothwear rehabilitation plans, unexplained pain, denture problems
  • Own clinical sessions 2-3 per week – complex endo (dens/open apex), periodontal therapy, surgical and prosthodontic implant treatment, prosthodontic management of complex toothwear or developmental anomaly patients including full mouth rehabilitations and overdenture prostheses
  • Polyclinics – clinical sessions involved treating complex oncology and implant patients under direct Consultant supervision
  • GA list twice monthly – assist and work with Consultant carrying out bone grafting and implant placement required under GA
  • Self-directed learning sessions – administrative work including letter dictation, learning, and preparing audits
  • Journal club at lunchtimes
  • Communicating with lab throughout the day/at lunch

Depending on your final Consultant post, it maybe that your clinical sessions are more focussed on one of the specific disciplines of endodontics, periodontics or prosthodontics.

Specialty Training Pathway

You are of course not required to join a specialist list to practise Restorative Dentistry, 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

  • GDC registration
  • MFDS/MJDF/MFD
  • At the time of interview, candidates should have a minimum of two years post-graduate experience (General Professional Training). This may include DFT/VT and DCT or GPT/LDFT, i.e. at least 12 months experience of hospital dentistry and 12 months of foundation training in general practice.
  • Candidates should have also successfully completed DCT2 at the time of post commencement

The above is the minimum typically expected from prospective applicants. However, 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

Completion of a NHS Restorative training programme involving:

  1. Satisfactory completion of training period– 5 years* full-time (7500 hours) or an agreed part-time equivalent period. The programme content will be approximately split as 60% Clinical, 25% academic and 15% research.
  2. Successful completion of the Intercollegiate Specialty Fellowship Examination in Restorative Dentistry is required to meet the eligibility criteria for the award of CCST in Restorative Dentistry.
  3. One may also typically undertake the Specialty Membership Examination in one of the Restorative mono-specialties at a Royal Surgical College

*Allowances may be granted for past training and experience in relation to the duration of training. This may be applicable to candidates with a prior research degree or completion of specialist training in one of the restorative mono-specialties. Please see the GDC Curriculum for Specialty Training (Appendix 2) in the Further Information section at the bottom of this page.

Restorative Dentistry does have an alternative within the specialty in the form of the academic route. The academic route requires a significant amount of commitment to the university with regards to education or research, so individuals must be certain that is a part of dentistry they are keen to pursue.

Training posts in one of the Restorative monospecialties (Endo, Perio, Pros) are available, these may be suitable if you have a keen interest in that clinical work, but must understand that your role as a mono specialist will be much less involved with the multi-disciplinary work required in secondary care as a Restorative Specialist.

Career Options

Once training is complete you are free to work as a Restorative specialist in many settings, the primary aim of training however is to obtain a Consultant post to work in an NHS secondary care setting. This is not to say that private practice opportunities will not be available but should be considered a secondary objective. Other clinical training pathways in one of the monospecialties have a more predictable end point in private practice.

Restorative training posts are usually funded by the deanery in which the NHS post is available, and no self-funding is required. If you wanted to carry out further postgraduate training alongside your post that was out of the remit of training this would likely need to be self-funded, and previously agreed with your training programme director.

Although no self-funding is required in post it is important to appreciate that your NHS training salary will likely be less than the equivalent you could earn in practice, and opportunities to supplement your wage working in practice will be very difficult given how demanding training can be.

There are opportunities to limit your practice mainly to restorative dentistry within primary care, without formally undertaking specialist training. These would mainly be limited to attendance at postgraduate courses to enhance your skills in for example composite restorations for toothwear, or advanced endodontic practices.

Recommendations to those considering applying for specialty training

It is extremely important to be certain your chosen specialty is one you will be happy in for the rest of your career. To confirm this, it is useful to immerse yourself within the specialty through attendance at conferences, memberships of specialty specific organisations and postgraduate training in the form of courses or university accredited further education. These are also useful examples to provide for commitment to the specialty when applying for training posts, a key part of the recruitment process.

Further Information

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