Dr Louise Belfield AssocFCGDent is the College Council‘s Dental Nursing & Orthodontic Therapy Representative and Chair of the College’s Research Advisory Panel. The first dental nurse in the UK to achieve a PhD, here she reflects on the key moments, influences and lessons from her career to date.
My career in dentistry started at the age of 17 with an apprenticeship in Dental Technology. I worked as a trainee Dental Technician for 18 months and developed skills in crown and bridge work. During this time, I wondered with increasing frequency about the patients we were making prostheses for and decided to apply for a patient-facing role as a Dental Nurse. I trained in a small mixed NHS and private practice, and in 2003 gained my National Examining Board for Dental Nurses (NEBDN) Certificate in Dental Nursing. I was fortunate to work with a supportive team, and I was proactively included in continuing professional development (CPD) activities. The critical CPD event that changed the trajectory of my career in dentistry was a session exploring the links between periodontal diseases and systemic conditions, such as diabetes and cardiovascular disease, and how the oral microbiome might connect them. This sparked my curiosity and drive to find answers. What might this mean for our patients? What might we be able to advise if we knew more about it? The only path forward that I could see was to embark on scientific training at university.
The decision to leave my practice and enrol on a university degree was a difficult one because I was very happy where I was, and I enjoyed Dental Nursing. As I had gone straight into apprenticeship after leaving school, I chose a BSc in Human Biosciences university course which included a “Year Zero” to cover the prerequisite scientific knowledge in lieu of traditional A-levels. Throughout the university course I continued practising as a dental nurse, working as bank staff for a local hospital trust. This provided invaluable experience and kept me clinically active in the profession. I worked across a range of settings, including domiciliary care, school visits, emergency clinics, dental access centres, special care dentistry, and even on a mobile dental surgery van. I also worked at an emergency out-of-hours weekend service, and in a private practice which I fitted in around my lectures.
It became apparent to me through the course of my studies that it was the immune system that was the pivotal link between periodontal and systemic diseases, and in the final year of my degree course I focused my studies on the periodontal pathogen Porphyromonas gingivalis, and how it interacts with immune cells. This formed the basis of my further studies leading to a PhD, investigating how these immune cells behave in response to P. gingivalis when they are involved with oral cancer or chronic inflammation. As is often the case at the end of a PhD, there were many new questions formulating and I knew I wanted to continue to investigate these relationships further to answer some of these questions.
Career in dental research and education
At the end of my doctoral studies, an academic position became available and I was appointed as a Lecturer in Biomedical Sciences in 2013. This has enabled me to explore both the scientific and educational facets required in an academic career, and I have been able to establish research in both of these areas. My scientific research focuses on host-pathogen interactions, and I have been fortunate to work on multiple projects, including development of three-dimensional oral mucosa models, association of subgingival lipid A profiles with periodontal disease status,1,2 and in 2019 I received the Colgate Robin Davies Dental Care Professional Research Award from the Oral and Dental Research Trust (ODRT), for a project investigating modulation of osteoclast differentiation and activity by endotoxin tolerance. This Dental Care Professional (DCP) specific award was instrumental in developing an independent research career and I remain grateful to the ODRT for the opportunity.
Subsequently, working together with two colleagues at the University of Plymouth, we established the Oral Microbiome Research Group, where we run clinical and translational research investigating links between human health and disease, and oral bacteria. Two current clinical studies link the oral microbiome with pre-eclampsia, and formation of cerebral abscesses.3 Our research also explores how modifying the oral microbiome can be detrimental to maintaining oral and physiological health mechanisms; a study using chlorhexidine mouthwash to disrupt the normal microbiome found that a decreased diversity of species was associated with a decreased salivary pH buffering capacity, increased lactate and glucose levels, and reduced availability of nitrate and nitrite, with an associated increase in systolic blood pressure.4
Alongside my scientific research, I have also been able to develop scholarly activity, with a focus on inter- and intra-professional education, particularly relating to assessments and standard setting in multi-cohort programmes.5,6 Having come into higher education via a non-standard route, an area I have been particularly keen to invest in is access and participation, and a significant part of my academic role has been to develop a Foundation (Year Zero) entry pathway for the BSc Dental Therapy and Hygiene programme at Peninsula, with the specific focus on Dental Nurses, who make up the majority of our cohort. This Foundation pathway has been running successfully now for three years, and we will welcome our first cohort of BDS year zero students in September 2023, specifically designed to enable fairer access to dental education for local, South West students with non-traditional entry backgrounds.
Engagement with the professional community
I remain actively engaged with the Dental Nursing community through a number of external roles; I uphold my registration with the General Dental Council (GDC), and I am a trustee for the NEBDN, where I also chair the Education Standards Committee. In 2020, I was appointed as a Dental Clinical Fellow with Health Education England, which continues to afford me an insight into NHS dentistry, service commissioning, workforce challenges, DCP skill mix, and training needs, in line with the Dental Education Reform Programme.7 I am also a representative for Dental Nursing on the Council of the College of General Dentistry (CGDent), and with a dedicated and experienced team, we are working to establish the first Faculty of Dental Nursing. I am also grateful to the College for the opportunity to chair the Research Advisory Panel, espousing the message that research is open to all dental professionals.
Key learning points and recommendations
Instrumental in my career have been support and encouragement from those I work with, and seizing opportunities despite the frequent imposter syndrome! While by no means perfect, there tends to be more clarity in the pathway to an academic career for dentists, which is lacking for other dental professionals, which means it can be extra challenging to carve your own route. Promisingly, I come across more and more outstanding DCPs in academic positions and I hope this will continue. This is one of the reasons I am excited about the CGDent Career Pathways in Dentistry: Professional Framework and the establishment of the faculties, and to promote the CGDent vision to make research opportunities accessible for all members of the dental team, to pro-actively support Dental Nurses and all team members to excel in their profession to their fullest potential.
The skills and experience I accrued as a Dental Nurse helped me to progress in other areas, including academia and research; working as a bank dental nurse had its challenges, arriving each morning to a new practice, with different staff, surgery set-ups and protocols was difficult at times, but I learned to be adaptable, and to think on my feet. Communication and team working skills were vital; and I was privileged to work with a variety of patients with their own range of perspectives and experiences and I learned a lot from them. Finally, working in a high-pressure environment, developing effective time management was crucial to being a competent Dental Nurse and these skills have also served me well in academia. I would wholeheartedly encourage anyone with an interest in research or an academic career to pursue that, to reach out to potential mentors or advisors for guidance, and to explore the CGDent Career Pathways frameworks, as well as membership of the College and its Faculties.
References
1. McIlwaine C, Strachan A, Harrington Z, et al. Comparative analysis of total salivary lipopolysaccharide chemical and biological properties with periodontal status. Arch Oral Biol. 2019;110:104633.
2. Strachan A, Harrington Z, McIlwaine C, et al. Subgingival lipid A profile and endotoxin activity in periodontal health and disease. Clin Oral Investig. 2019;23(9):3527-3534.
3. Roy H, Bescos R, McColl E, et al. Oral microbes and the formation of cerebral abscesses: A single-centre retrospective study. J Dent. 2023;128:104366.
4. Bescos R, Ashworth A, Cutler C, et al. Effects of Chlorhexidine mouthwash on the oral microbiome. Sci Rep. 2020;10(1):5254.
5. McIlwaine C, Brookes ZLS, Zahra D, et al. A novel, integrated curriculum for dental hygiene-therapists and dentists. Br Dent J. 2019;226(1):67-72.
6. Zahra D, Belfield L, Bennett J. The benefits of integrating dental and dental therapy and hygiene students in undergraduate curricula. Eur J Dent Educ. 2018;23(1):e12-e16.
7. NHS Health Education England (HEE). New plans for dental training reform in England to tackle inequalities in patient oral health. HEE. 21 September 2021. [Internet]. Available at https://www.hee.nhs.uk/news-blogs-events/news/new-plans-dental-training-reform-england-tackle-inequalities-patient-oral-health-0 [Accessed Dec 2022]
This account was first published in the Primary Dental Journal (vol. 12, issue 1, March 2023)
Update (June 2023): Since this article was published, Louise has been appointed Academic Head of Assessment at Brunel University Medical School and has stood down from the College Council to focus on her new role; however she remains on the College’s Research Advisory Panel.