A Career in Special Care Dentistry

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.

Special Care Dentistry involves the improvement of the oral health of individuals and groups in society who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of these factors. It pertains to adolescents and adults.

In the following article, Nicholas Beacher discusses how you can establish a career in Special Care Dentistry.

Mr Nicholas Beacher | B.D.S. M.F.D.S. (RCPSG)

Clinical Lecturer and Honorary StR in Special Care Dentistry

University of Glasgow Dental School

I completed my undergraduate dental training at The University of Glasgow. As part of my undergraduate studies I undertook a year-long specialist study module in Special Care Dentistry. This was a fantastic opportunity for me to gain experience in the field of dentistry I was most interested in. I also developed a strong interest in research and managed to get some hands on experience working with academic colleagues in the Oral Microbiology Department. This was an invaluable experience as it developed my research and scientific skills and increased my appreciation of the value of research and the importance of our scientific colleagues to our dental team.

After graduation, I entered the South East of Scotland Longitudinal Dental Foundation Training Scheme. The training program allowed me to develop my knowledge and clinical ability across the dental specialties. I have developed a broad range of skills and a true understanding of the different dental services and how they relate to each other. It was of real value to me to work in General Dental Practice for two years. This allowed me to have continuity with my patients and I feel I am in a better position to relate to and communicate with referring GDPs. Having obtained my MFDS, I am now undertaking my specialist training in Special Care Dentistry following an academic pathway.

A Career in Special Care Dentistry

Special Care Dentistry focuses on the prevention and management of oral disease for the people in society who are unable to receive their dental care routinely as a consequence of a physical, sensory, intellectual, mental, medical, emotional or social impairment or, more often, a combination of these.(1)

In a world where everyone has an equal right to healthcare there is a need for dental professionals who possess a specialist set of skills to enable those with disability or impairment to receive the high quality, patient centred oral healthcare they deserve.

The specialty provides holistic dental care to a broad range of patient groups and considers the wider needs of each person individually. To care for these people the specialist is trained to have advanced skills in each of the dental disciplines. Furthermore, the specialist possesses an increased working knowledge and understanding of medicine in both health and disease to allow dentistry to be provided in the most difficult of circumstances.

No two days in the life of a Special Care Dentist are the same.  The provision of dental care to our patients is both challenging and complex. However, the rewarding nature of the speciality through making a difference, no matter how small, to a person’s quality of life can never be underestimated.

Some examples of the dentistry provided by a Special Care Dentist are listed below:

  • The oral health management of cancer patients before commencing and continuing throughout their therapy
  • Examination and provision of dentistry with the use of general anaesthesia or sedation
  • Dentistry for the medically complex and compromised and for those who are terminally ill
  • Dental care for those with a learning disability or autism which may require alternative communication techniques
  • Care of the elderly and domiciliary dentistry

The possession of excellent communication skills are essential to the special care dentist not only to allow us to interact with patients, their families and carers but, also to allow for the liaison with medical and dental colleagues who are regularly part of the team caring for the patient.

Pros & cons of a career in Special Care Dentistry
  • The rewards from working with this group of patients  is unrivalled by any other discipline
  • Challenging and varied clinical practice
  • Huge opportunities for research
  • As a relatively new specialty, there still exists some resistance to the recognition of our discipline
  • Not everything goes to plan first time round

Special Care Dentistry is for those who are dedicated to caring not only for the person’s mouth but the whole individual. To be challenged daily to provide the highest quality of dentistry in the most difficult of circumstances, for those in society who are most vulnerable, is unbelievably rewarding. As our population ages and people are kept alive for longer through advances in medicine, our specialty is only going to continue to grow.

 

I have always wanted to be able to care for people and somehow make a difference to their lives. From early on in my undergraduate career I was exposed to special care patients and I developed a real passion for the challenging nature and complexity of the treatment and care required to look after them. I was also able to work with a Special Care Dentist who I found really inspiring and encapsulated in her care of patients everything I valued.

So many of the patients we see have barriers put in front of them which limit their access to the high quality care they so deserve. Contributing to the reduction in healthcare inequality and removing barriers to care to provide dentistry which ultimately improves quality of life is a real privilege.

The appointment to my current position would have to be the highlight of my career so far. Being allowed to train as a specialist in the discipline you are passionate about is a great pleasure and honour.

I have been lucky enough to meet and provide care for a number of memorable and rewarding people already in my career. If I had to mention one case, it would probably be that of a genuinely lovely lady who was only a little younger than me at the time. She had previously been homeless and a history of drug abuse which was further complicated by her significant medical condition. When I first met her, she was in the process of turning her life around and was determined to get her teeth sorted. Despite all her anxiety and the difficulties in managing her medical conditions we were able to restore her mouth to health and give her smile back. The change in her as a person was incredible and she went on to find employment and was happy with her life.

 

I would not have changed a thing! I am currently in my dream job doing something I am incredibly passionate about and dedicated to.

I would recommend the pathway I have followed to anyone. It allows you to become a well-rounded, balanced practitioner with a broad range of skills which puts you in an ideal position to enter Specialist Training.

A typical day…

As a training junior academic dentist, my days are very varied. Some days are dedicated to clinical training, where I will be working with patients or attending lectures. Other days are dedicated to teaching or contributing to the research of the university.

Specialty training pathway

Entry Requirements

Entry into any Specialty Training Post is extremely competitive. Making yourself stand out from the crowd is challenging but, having evidence of your commitment and desire to pursue your chosen career puts you in a stronger position when it comes to applying for positions. Publications and prizes look great on any application and show you are dedication to the profession and its advancement.

The full entry requirements as defined by the GDC for entry into a Specialty Training position in Special Care Dentistry are available at:

https://www.rcseng.ac.uk/fds/jcptd/higher-specialist-trainingStandard career route

In summary, to enter Specialist Training in Special Care Dentistry you require:

  • B.D.S.
  • Two years post-graduate experience (General Professional Training)
  • Although not essential, MFDS or MJDF is desirable

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

In 2008, Special Care Dentistry was accepted as the newest dental speciality by the GDC. In recognition of this, a specialty training programme was developed which has resulted in formal specialist training posts being created throughout the United Kingdom. Currently, there are two recognised pathways which upon completion lead to acceptance onto the GDC held specialist list. The first of these pathways is NHS funded and the training is focussed on developing the knowledge, understanding and clinical skills of the dentist to allow them to practice Special Care Dentistry. The second pathway is that of the academic trainees who undertake the same clinical training as their colleagues but, will also undertake additional roles in research and teaching. Some of the differences between the pathways are summarised in the table below.

Time Period of Training: 3 years

Location of Training: Based in community clinics with some clinical attendance at a Dental Hospital likely

Career Outlook: 

  • For those who primarily wish to work clinically. The majority of positions are within the P.D.S.
  • Will have a role in teaching and opportunity to participate in research.

Time Period of Training: 4 years

Location of Training: Based at a University Dental School with attendance to outlying community clinics

Additional Training Roles: 

  • Research
  • Teaching
  • Undertaking additional training / qualifications e.g. PGCAP, MSC

Career Outlook: 

  • For those with aspirations to contribute to both research and teaching.
  • Generally based within a University Dental School but, will have a role in the P.D.S.
  • For those considering further study or already in possession of a higher degree e.g. DDS , PHD

Career options after specialty training

At present there are two main career paths following completion of specialist training. Most specialists work within the P.D.S. although they may have a role within a Dental Hospital. Their main focus is on the clinical care of patients. However, it is likely they will be involved in teaching to a certain degree. Further promotion to a position as Clinical Director of an NHS board is possible, if so desired.

The second career option is that of the academic specialist. Following completion of a further higher degree, such as a PHD or DDS, it is possible for the specialist to be appointed to a position as a Senior Clinical Lecturer within a University Dental School. The academic specialist has a commitment to research and teaching whilst continuing to provide clinical care for patients as an Honorary Consultant.

I personally have a desire to pursue an academic career. This will require me to gain a further research based degree. Had I not entered into specialist training at this stage, another option for me was to apply to study for a PHD. Equally, I could have continued my training as a CT2 gaining experience in a different field of dentistry.

I think in life you have to embrace opportunity and gain as much experience as you can. You will never stop learning in your life so always be open to it. Be passionate about what you do and you will never be left disappointed in your choice of career.

I find this quote really inspirational and I think there is so much in it for any young student as they set out into the relative unknown of the future:

“Twenty years from now you will be more disappointed by the things that you didn’t do than by the ones you did do, so throw off the bowlines, sail away from safe harbor, catch the trade winds in your sails. Explore, Dream, Discover.”  – Mark Twain

Conclusion

Special Care Dentistry is an ultimately fulfilling and rewarding career where each patient is treated as a person and is put at the centre of care to allow their individual needs to be met. This is a growing speciality which is beginning to emerge from its infancy to flourish as an essential group of highly skilled professionals who manage the oral healthcare of some of the most vulnerable members of society. 

References

  1. Gallagher J E, Fiske J. Special care dentistry – a professional challenge. Br Dent J 2007; 202: 619–629

Further Information

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