College of General Dentistry Blog

Why I became a College benefactor and philanthropist

Dr Tom Bereznicki FCGDent, founder of the Tom Bereznicki Charitable Education Foundation and a major donor to the College, talks to Professor Sir Nairn Wilson CBE FCGDent, President Emeritus, about his motivation to put something back into the profession

Tom Bereznicki FCGDent (left) and Sir Nairn Wilson CBE FCGDent (right)

Nairn Wilson: Tom, what motivated you to become a Founder of the College, the College’s first major benefactor, and a significant College legator? 

Tom Bereznicki: In recent years, I have been increasingly anxious to find ways to put something back into the dental profession, with emphases on making good some of the deficiencies in undergraduate dental education, encouraging early career dentists to develop their skills and knowledge to better meet the ever-increasing expectations of patients, and to enhance the standing and status of dentistry, both in healthcare in general, and in the eyes of the public.

The creation of the College, intended Royal College of General Dentistry, was a bold move to give oral healthcare professionals the benefits enjoyed by all those in healthcare who have their own independent Royal College – career pathways with recognition of enhanced skills, standards set by the profession for the profession, and a community of practice, together with, and very importantly in the case of CGDent, a much-needed, unified voice for the whole of the profession.

Also, I share the vision of the College to elevate the importance of oral health in the eyes of other healthcare professions, politicians and the public. The College initiative was one I identified with and considered worthy of my support, both to get it started and help secure its future.

Nairn Wilson: What are the aims, objectives and aspirations of your Educational Foundation?

Tom Bereznicki: My Foundation was created to support recently graduated and early career dentists and therapists to acquire knowledge and skills they were unlikely to have acquired in their undergraduate training, but which are needed to succeed in everyday practice. The focus is on aesthetic dentistry, occlusion and related aspects of periodontal health, all of which are fundamental to contemporary routine dental care.

Given my experience as a part-time clinical teacher and the interactions I have with newly qualified colleagues, I am increasingly concerned by the disconnect between undergraduate curricula and the reality of everyday clinical practice. Graduates who have not been instructed in at least the basics of aesthetic dentistry, underpinned by a detailed knowledge of tooth morphology, and have little if any idea of how to recognise and diagnose occlusal discrepancies, let alone manage them, are destined to run into all sorts of difficulties in the management of patients.

My Foundation cannot reach out to all new graduates, early career dentists and dental therapists, but it is hoped that the activities of the Foundation, specifically its competitions, will encourage much-needed personal development amongst those embarking on their careers in dentistry, with an emphasis on the importance of interactive, high quality, face-to-face learning. While online learning has a place, and there are many good programmes, much of what new graduates and early career oral healthcare professionals access, typically on their phones, is advertorial material, often presented by self-professed experts with limited experience, either lacking an evidence-base, or frankly wrong and potentially harmful to patients. Determining what is good quality online learning material is challenging, especially for colleagues transitioning to independent practice.   

Nairn Wilson: What is the intended synergy between your Foundation and the College? 

Tom Bereznicki: The Foundation is an independent body which seeks to work in partnership with other organisations and the dental industry to realise its aims and objectives. The link with the College is intended to introduce new graduates and early career oral healthcare professionals to CGDent, and what the College does and can do for them and the profession.

It is hoped that young colleagues, especially those who benefit from the activities of the Foundation, will appreciate the benefits of membership of the College, with a view, over time, to being recognised as an accomplished practitioner – a Fellow of the College. Young colleagues need to appreciate the value and importance of being part of the forward-looking College – part of the new, increasingly powerful, unified voice for dentistry, contributing to standards set by the profession for the profession, taking advantage of a recognised career pathway, mentoring and much more.

Nairn Wilson: With the need to grow and further develop the College, with one of its immediate, pressing priority being eligibility for the award of a Royal Charter, what is your message to Fellows who are not yet donors to the College?

Tom Bereznicki: The College has achieved a great deal from, in effect, a standing start three years ago, and still has a lot to do to achieve its potential, let alone operate on a level playing field with the long-established Royal Colleges, which history tells us, benefited from huge support during their development. There is no ‘something for nothing’. Dentistry must help itself to justify Royal recognition of its own independent college.

Rather than apply a development levy to subscriptions, it is better and more powerful to grow by means of voluntary donations. Yes, these are challenging times for colleagues, but it is also a challenging time for our profession, which needs parity with other mainstream healthcare professions, new UK-wide leadership and direction and recognition in general healthcare and in the eyes of the public – all the things the CGDent aims to deliver. This surely is worthy of support, specifically by those the College has recognised to be leaders in the field.

Nairn Wilson: Tom, thank you for your views and comments, which I very much hope will be read and taken to heart by both all members of the College and colleagues yet to join CGDent. Thank you also for your tremendous ongoing support of the College, which would not be where it is today without your contribution, nor without the support provided by all existing donors.  

Tom Bereznicki is a Fellow and Founder Member of the College and a College legator. The Tom Bereznicki Dental Education Foundation supports the CGDent-GC Award for Foundation Trainees, the Tom Bereznicki Award for Advanced Aesthetic Dentistry and the upcoming occlusion and perio-occlusion symposia for early career dentists.

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Entering the CGDent-GC Award has helped me to be a better dentist

After entering a successful case in the inaugural CGDent-GC Award, Associate Member of the College Dr Juan Salmerón Ramírez travelled to Leuven in Belgium to take part in a fully funded two-day composite layering course at GC’s Education Campus. In this blog, he reflects on his experience of entering and winning the clinical skills award, and what he learnt from the process.

Freshly out of university, having begun a new journey in a new country, the opportunity to participate in a dental skills competition was both exciting and daunting, and it is only now that the whole journey has finished and I have reflected on my experience, that I can describe this brilliant opportunity and what I’ve learnt. 

Entering the competition: a leap of faith

Foundation Year is not known to be an easy-going year. Portfolio, case selection and study days are the main focus of Foundation Dentists, thus the decision to enter the Award was not a simple one. As a newly qualified dentist, the prospect of competing against peers whose ability, training and skills were unknown to me, was daunting. However, with a healthy amount of friendly encouragement from my fellow FD Ammy, and Educational Supervisors, I jumped into the opportunity to challenge myself, showcase my skills, and most importantly, learn and grow in the process.

The aim of the competition was to present a clinically indicated restorative case, that we had treated with composite, and required as little as one anterior tooth to have a valid entry. The preparation involved meticulous planning, clinical photography, aesthetic mock up, treatment execution, and documentation. This process alone was a huge learning experience, as it forced me to critically evaluate my work and consider the finer details that contribute to aesthetic excellence.

Over the application process, the College of General Dentistry’s Early Careers Engagement and Editorial Officer, Clare Denton, helped with any questions we had, from formatting the case to submitting it, she kindly and reliably guided our best efforts.

My winning case: a brief overview

The case I presented involved a patient in their late 40s with significant enamel wear, inverted smile line, anterior diastemas and loss of anterior vertical dimension. The patient was highly self-conscious about their smile to the point of avoiding smiling in their day-to-day life, and was thrilled when presented with composite bonding as a minimally invasive solution. Once my patient and I had agreed on the treatment, the complicated journey of carrying out the ideas and techniques I had in mind began. Overall the case needed the following steps.

Clinical photography: this was the first and perhaps most crucial step, as it gave me a means of communication with the patient, and allowed them to visualise the improvements they wanted in their smile and to what extent.

Digital smile design: allowed us to set a visual goal to reach, and  to compare the before and after of what we were doing.

Aesthetic mock-up which included study models: this helped us to understand how the enamel loss had happened, what dimensions and spaces we had to work with and how to later on protect our work from further wear.

Composite build ups and polishing: this was challenging due to the extent of the enamel loss and the need to achieve a seamless interface between the composite and the remaining tooth enamel. I focused on meticulous shade selection and careful layering to create a natural-looking result.

The outcome was a significant improvement in the patient’s smile, which boosted their confidence and satisfaction – a rewarding experience that solidified my passion for aesthetic dentistry.

The most valuable key learning outcome from entering the competition was understanding the importance of accessible and well written documentation. The case needed to be both clear and powerful when presented to the judges and had to show how the decisions I made were patient-led, therefore I had to be thorough in my explanations, have a clear justification for my clinical decisions and the treatment choices that my patient and I made together. This experience has improved my clinical documentation in the practice, and has helped me to maintain high standards not only in clinical work but also in record keeping.

The trip to Belgium: an unforgettable experience

Winning the competition came with two incredible bonuses: first being invited to attend the CGDent Summer Fellows’ Reception and to be formally awarded by the President (now former President), Dr Abhi Pal; and last but not least, attending a fully funded hands-on clinical skills course at the GC headquarters in Leuven, Belgium, where a GC specialist together with Dr Bereznicki, trained us in state-of-the-art composite layering techniques.

The trip itself was a smooth and relaxing experience. The College and the charitable foundation set up by Dr Tom Bereznicki, had organised a night in a hotel close to St Pancras station for those who lived outside London. The following morning the whole team of awardees together with the organisers, met at reception, introduced themselves, and took the Eurostar train. Just over two hours later we were in Brussels, from there a short bus trip to Leuven.

Leuven is a small vibrant university city, with charming streets and beautiful scenery, and we stayed here for the rest of the trip. It just happens that there was a music festival going on during our visit, which made it only more magical.

Perhaps the best part about our accommodation, Penta hotel, was its prime location in the beating heart of the old town in Leuven, at a very short walking distance from the most well known landmarks such as the stunning Town Hall and the Oude Market, “the longest bar in the world”, as well as numerous cafes and restaurants.

The composite course: a transformative learning experience

The much awaited composite course was held at GC’s state-of-the-art dental training centre, where I was mentored by GC’s expert trainers and Dr Bereznicki, who share a passion for aesthetic dentistry and achieving excellence. The course content was comprehensive, covering advanced techniques in aesthetic composite restorations, from the latest materials and tools to innovative techniques that push the boundaries of what’s possible in cosmetic dentistry.

The programme included many topics from colour theory and how it affects our reconstructions, to material selection and how the GC line-up of composite is exquisitely created to cover different dentines and different enamels to achieve natural results.
Perhaps the most valuable aspect of the course was the hands-on training we received, under the supervision of Dr Simone Moretto, GC composite expert, who was incredibly knowledgeable and approachable, providing personalised feedback and tips that I’ve since incorporated into my practice.

A game-changer moment for me was the information given about the latest advancements in composite layering. The lecture and hands-on workshop explored the intricacies of shade selection, translucency, and the use of tints and opaquers to create restorations that are indistinguishable from natural teeth whilst enhancing a harmonic smile. This has improved my ability to deliver results that exceed patient expectations.

Furthermore the course was focused on minimally invasive techniques with reduced to no enamel modification. This emphasised the importance of tooth structure preservation whilst achieving aesthetic excellence, principles that align perfectly with my patient-centred care philosophy.

Why other Foundation Dentists and Dental Therapists should enter the competition

It is only through endeavour that we grow. Without a doubt, this experience has been tremendously valuable for my professional development, by pushing me out of my comfort zone and by challenging me to strive for excellence.

The Belgium trip and the course was the cherry on the cake, offering me an unparalleled opportunity to learn from the best in the field and immerse myself in a new culture.

My advice for Foundation Dentists and Dental Therapists considering entering the competition, is simple: GO FOR IT. It is an invaluable experience that goes beyond winning –  it’s about the journey, the learning and the life-long connections that you make along the way. Entering the competition will not only enhance your clinical skills but also boost your confidence and open doors to new opportunities, ultimately making you a better practitioner.

The CGDent-GC Award 2024/25 is open to Dentists and Dental Therapists who qualified in the UK or Ireland in 2024 or are undertaking Dental Foundation Training or Dental Vocational Training 2024/25. Entries close on Friday 14 February 2025.

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College of General Dentistry Blog

Implant Dentistry – a journey from the beginnings to what has become an established discipline

Igor Blum, Clinical Professor of Primary Care Dentistry and Advanced General Dental Practice at King’s College London and Editor of the Primary Dental Journal (PDJ), introduces two issues of the PDJ dedicated to implant dentistry

Modern implant dentistry begins with the pioneering work of Per-Ingvar Brånemark (1929-2014), professor of anatomy at the University of Gothenburg, Sweden, and André Schroeder (1918-2004) professor of operative dentistry and endodontics at the University of Bern, Switzerland. Professor Brånemark studied bone healing and regeneration and discovered in 1957 that bone could grow in close proximity with titanium without being rejected, developing a permanent attachment between bone and titanium. He termed this phenomenon ‘osseointegration’. 

Osseointegration established a new era in dentistry and paved the way for the development of the principles of biological acceptance of implants based on the science of bone biology. The first patient receiving titanium dental implants was 34-year-old Gosta Larsson, a man with a cleft palate, jaw deformities and missing teeth in his lower jaw. In 1965 he had four titanium implants (fixtures) placed into his mandible which were restored with a fixed prosthesis. The dental implants served for more than 40 years, until the end of Mr Larsson’s life.1

Early histological evidence demonstrating dental implant osseointegration was published in 1976 by Professor André Schroeder. He then went on to develop improved dental implant designs, and in 1980 Professor Schroeder founded the International Team of Implantology (ITI) of which he was the founding president. The ITI evolved into the largest global organisation of Implant Dentistry today.

At the Toronto Conference on Osseointegration in Clinical Dentistry in 1982, Professor Brånemark gave his landmark presentation that convinced dentists that a new era had dawned for dental implants, which became rapidly adopted as a new method of root-shaped screws in the jaws.2 He is widely known as the ‘father of modern dental implantology’ because of his milestone contribution in the field of implant dentistry. In tandem with the pioneering work in dental implants, and following the recognition of long-term success of osseointegration, this work was extended to orthopaedics for small and large joint replacement.3

The introduction of the concept of osseointegration of implants resulted in a paradigm shift that affected the dental care of partially dentate and edentulous patients. Dental implants continued to evolve with research and innovation over decades resulting in the treatment planning involving the implant option becoming part of mainstream dentistry in the present day. The widespread use of dental implants requires dental professionals to be up to date with maintaining the implant patient, regardless of whether the dental practice is offering the provision of dental implants. It is therefore essential for dental professionals to have appropriate training and a sound clinical understanding in the care of and maintaining the implant patient.

Although not a substitute by any means for a quality assured clinical training programme or structured course, the editorial team felt it was timely to produce an issue of the Primary Dental Journal devoted to Implant Dentistry. This theme has been split across two consecutive issues of the journal – parts 1 and 2.

Part 1, our Autumn 2024 issue which will be published imminently, addresses the role of the general dental practitioner in the care of the implant patient, dental nursing in implant dentistry, the hygienist’s role in the management of the implant patient in primary care, developing implant mentoring programmes, a personal journey from mentee to mentor, biomechanical principles of restoring a dentition with dental implants, a technician’s perspective on communication in implant treatment planning, placement and reconstruction in the digital age, the impact of implants on quality of life, and, very importantly dentolegal considerations in implant dentistry. The main objective of part 1 issue is to provide readers with a cutting-edge update on the above topics, including raising awareness of the need to manage implant patients in primary care.

Part 2, the Winter 2024/25 issue to be published in around three months’ time, will focus more on clinical aspects of implant dentistry, including complications and adverse events, and recent technological advancements in the field.

Implant Dentistry is truly an evolving discipline as seen by the remarkable advances since the early works of Professors Brånemark, Schroeder and many others over the past decades. Those dental professionals wishing to further their knowledge and skills in implant dentistry and wishing to choose postgraduate educational programmes or courses might also benefit from familiarising themselves with the College of General Dentistry publications Mentoring in Implant Dentistry: Good Practice Guidelines and Training standards in implant dentistry. The former describes the nature of mentoring which should be undertaken in order to safely carry out implant dentistry following completion of an appropriate training course, while the latter helps with identifying quality postgraduate education in implant dentistry.

I am very thankful to Dr Amin Aminian and Professor Ilser Turkyilmaz, the guest editors respectively of our part 1 and part 2 issues on implant dentistry, and to all our contributing authors, for producing such a wealth of excellent and informative articles which I am certain readers will find of interest and use.

The Primary Dental Journal is the College’s quarterly peer-reviewed journal dedicated to general dental practice. Printed copies of the Autumn 2024 part 1 issue on implant dentistry should arrive with College members in the second half of October.

Joining gift: Implant Dentistry parts 1 & 2

To mark the publication of the first of our new PDJ issues on implant dentistry, anyone joining the College or its Register of Mentors in Implant Dentistry before 31 December 2024 will receive a printed copy. They will also be sent part 2 once available.

References

1 Lewin T. Per-Ingvar Brånemark, Dental Innovator, Dies at 85. The New York Times, Dec 27, 2014. https://www.nytimes.com/2014/12/28/health/per-ingvar-branemark-dental-innovator-dies-at-85.html

2Zarb G, editor. Toronto conference on osseointegration in clinical dentistry. In Proceedings of the 1982 Toronto Conference 1983 (pp. 1-165). Mosby: St. Louis

3Albrektsson T, Lekholm U. Osseointegration: current state of the art. Dent Clin North Am. 1989 Oct;33(4):537-54

College of General Dentistry Blog

The Dental Health Barometer – an oral health practitioner reflects

Frances Robinson AssocFCGDent, Advanced Oral Health Practitioner and Chair of the Board of the Faculty of Dental Hygiene & Dental Therapy, reflects on The Dental Health Barometer report on preventative oral healthcare, published by the College and Haleon.

The Dental Health Barometer report, stemming from a collaboration between the College of General Dentistry and Haleon, surveyed patients and dental professionals and more recently held focus groups with dental professionals throughout the UK. The report highlights inconsistencies in the provision of preventative oral healthcare and how this type of care is understood by both the dental population and the wider public.

Due to my roles as an Advanced Oral Health Practitioner in London and as Chair of the Board in the College’s Faculty of Dental Hygiene & Dental Therapy, this piece of research with Haleon, was particularly interesting to me. I currently lead a mixed team of dental professionals and admin support to provide an oral health promotion service, through an NHS trust, contracted by the local authority. In my borough the decay rate was 39.1% for five-years olds in 2019 – I have much work to do!

I can sense clinicians are frustrated when working at the coal face of primary care seeing so much decay and periodontal issues, but dental outreach teams, like mine, and the dental public health workforce, work tirelessly to address some of the points raised by clinicians in the report.

I would like to use this blog piece to highlight some of the key summary points raised in the CGDent-Haleon report that are directly related to my role and also to explain some of the work that goes on in oral health outreach teams.

What is the current picture of oral health?

23.4% of children in England had tooth decay in 2019, normally with three to four teeth affected (National Epidemiology Survey for England). Furthermore, tooth decay still persists and is the top reason for five to nine year old children to be admitted to hospital and given a general anaesthetic. In 2022, the prevalence of the tooth decay in more deprived areas was 35% compared to 13.5% in the most affluent.

For adults, the last adult oral health survey showed 41% of people in deprived neighbourhoods had dental pain, compared with 25% of those in the least deprived neighbourhoods. Furthermore, 84% of adults fall into groups that put them at higher risk of the disease i.e. high sugar diet and infrequent dental attenders.

Tooth decay is preventable and inequalities are unfair, yet avoidable. Preventative dental care is proactively helping a patient to take action to maintain a healthy mouth, however, as the CGDent-Haleon report highlights, both the ability to provide preventative advice and the consistency of the advice given varies between professionals.

Greater provision of CPD

In clinical practice, clinicians are used to treating patients to a high standard according to the best available evidence base. This may be using the best materials and the selection of treatment options on a case-by-case basis. ‘The Dental Health Barometer‘ seems to demonstrate that current understanding of evidence-based population dental approaches varies in primary dental workforces. Dental public health is taught on undergraduate curriculums but clinicians may be unaware of recent updates to evidence bases. Subsequently, in order to use the primary dental health workforce to contribute to improving oral health outside the dental surgery, it is pertinent to ensure the evidence base is widely understood. There is a risk that some oral health approaches and interventions, although well intentioned, are either at best ineffective or at worst could widen oral health inequalities.

Indeed, the report calls for “greater provision of CPD on the delivery of preventative care”, in this instance it would be a good opportunity for this type of CPD to also cover community based oral health approaches, as well as those more applicable to clinical settings.

Evidence based public health dentistry

Currently, it seems many well-intentioned efforts to improve oral health on a population level don’t actually align to the current evidence base. Giving oral health ‘education’ in the form of assemblies, class room talks or at health fairs, is not proven to improve oral health outcomes. The ‘commissioning for oral health‘ document highlights that for school aged children, one-off dental health education is ineffective and therefore discouraged.

These traditional oral health approaches that focus solely on education can actually widen oral health inequalities in deprived areas. A one-off oral health session only gives knowledge to those with the means i.e. financial and social resources to act on advice, but for vulnerable families it doesn’t empower them to make sustainable change. They might want to go home and buy toothbrushes and toothpastes and healthy food for their family, but they may also have to consider the family budget, constraints on the family’s time and other social factors. Furthermore, sustained behaviour change is seldom achieved in one visit, it takes time and patience to build daily oral health habits as we know from our work on a one-to-one level with patients in clinics.

In my role as an Advanced Oral Health Practitioner, I have heard of families all using the same toothbrush because they cannot afford to buy ones for each family member, and I have met families living in temporary accommodation with limited access to cooking facilities and personal hygiene spaces. These families living in deprivation as highlighted are more likely to be the ones suffering from poor oral health.

The Association of Directors of Public Health stated in 2023, “worrying oral health findings are not a result of behaviour, poor choices or a lack of education.” But rather research, conducted by Public Health England, has called for action to tackle the underlying causes of health inequalities including “creating healthier public policies, supportive environments, strengthening community action, developing personal skills and reorienting health services towards prevention”.

Creating healthier public policies, supportive environments and strengthening community action, to improve oral health.”

Figure 1

Indeed, Professor Sir Michael Marmott poses the question on the first page of his book ‘The Health Gap‘, “why treat people only to send people back to the conditions that made them sick in the first place?”.

On a population level, the conditions in which each family lives has a bigger influence on their health outcomes than individual decisions. Research has shown that the social determinants of health account for 30-55% of someone’s health outcomes. Subsequently programmes that consider the social determinants of health, (the conditions in which children and adults can live, grow, work and age) have the best evidence-base behind them.

There is strong supportive evidence for supervised toothbrushing programmes and fluoride varnish programmes, which were mentioned in the CGDent-Haleon report. Also dental professionals suggested collaboration and oral health training for the wider professional workforce (health, education, social). This is further encouraged by the commissioning for better oral health document, as they build on existing capacity and can be targeted to high risk groups.

Why is there variation between which oral health prevention services are offered in different areas?

Oral health is designated to local authority level and subsequently there are huge variations in what is offered on a national scale. This can be confusing for dental professionals working in primary care and the public, which is shown by the recent report.

Within London, I am aware of every borough having a different approach to commissioned oral health programmes and this can result in a postcode lottery in terms of what is provided. The borough I work in has fluoride varnish programmes and supervised toothbrushing programmes in a certain proportion of targeted schools and all SEN schools. But we also provide comprehensive training for health, social and educational professionals for oral health – aligning to the evidence base around capacity building on existing services. This includes working with care homes, carers, outreach workers, social workers, health visitors, nursery staff and recruiting ‘Oral Health Champions’ in all settings we work with. This approach may not be replicated across the UK and dental professionals in primary care may not be aware of the current commissioning of an oral health team in their area.

Indeed, there are calls in the CGDent-Haleon report for a national oral health programme (similar to ChildSmile in Scotland or Designed to Smile in Wales) which creates a base level of preventative care, for both children and adults and integrates oral health into general health. It could use universal proportionalism to scale up priorities, identified by local need. If there was a national oral health programme there could be potential for local practices to assist with the running of this, for example training teachers on supervised tooth brushing programmes or visiting local care homes to provide quality assured oral health training to staff members. 

Oral health was included in a recent NHS England initiative Core20PLUS5, a national NHS England approach to support the reduction of health inequalities at both national and system level. The approach defines a target population cohort of the most deprived 20%, plus inclusion health groups and identifies ‘5’ focus clinical areas requiring accelerated improvement. The Core20PLUS5 for children did include oral health as a priority so there is hope that some of our concerns as professionals are being heard on a wider level, and taken alongside the recent publication of the ‘The Dental Health Barometer’ report by the College and Haleon, there may be hope for the future!

Figure 1 https://www.cancer.gov/rare-brain-spine-tumor/blog/2024/examining-social-determinants-of-health-to-improve-brain-tumor-patient-quality-of-life

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College of General Dentistry Blog

How to get the most out of Foundation Training and make the right investments

CGDent NextGen Ambassador and Associate Member of the College, Dr Choudhury Rahman, graduated from the University of Manchester in 2023 before moving into Dental Foundation Training. Here he offers tips to this year’s Foundation Dentists on how to get the most out of their training.

As I sat down waiting for my first patient as a qualified dentist, I debated how to introduce myself. Dr Rahman, or just Choudhury? I felt the same nerves I did when I saw my first patient as an undergrad, a sense of imposter syndrome. Am I really a dentist now?

When I think back to last year, having just graduated, I never thought I would have learnt as much as I have now, after just one year of FD training. Nothing quite prepares you for general practice.

The pace at which you learn and develop is unbelievable. From seeing three patients a day in the undergrad clinic to 20-30 in general practices, along with vast quantities of treatment. When people tell you that you’ll do more treatment in a month of FD vs the whole of undergrad, they aren’t joking.

Of course, the experience you get will depend on where you work. If you’re fortunate enough to work in an area of high needs like mine in Rochdale, you will get bags of treatment – lots of caries, restorations, extractions, and root canals. However, you may also work in an area where you can do more aesthetic work, or somewhere with great oral surgery experience.

Here are my tips on how to make the transition smoother and get the most out of your FD year:

  1. Spend time making good treatment plans

    Sit down with your Educational Supervisor (ES), discuss cases with them, and get help with deciding what treatment to do. This will be your biggest learning curve, deciding independently what treatment to do and when. The more experience you get doing this, the better you will be at planning by yourself over time. Remember, you don’t have to make it at your initial appointment, you can always bring the patient back for this.

  2. Don’t worry about how long you need for treatments

    Want to spend three hours doing a molar endo? Or two hours on some posterior composites? Do it. FD year is when you get the chance to spend as long as you want on the treatments you want to do. You aren’t paid by Units of Dental Activity (UDAs), you’re paid a fixed salary. Use the time you have to provide good, high-quality treatment, and then you can focus on building speed towards the later stages.

  3. Push yourself with complex treatments

    You will have the support of an Educational Supervisor by your side throughout the year. They are there to help you and guide you. Take on that difficult molar endo, and plan for that surgical extraction. It’s your one year where you have help at every step of the way if you need it.

  4. Build a good relationship with everyone at your practice

    From the receptionist, the practice principal, and of course, your nurses. If you build a good bond with your team, and look after them, they will look after you!

To make the best of your Foundation Training, I think it’s also important to plan some specific investments during the year. After five years of grafting in dental school, you can’t beat the feeling you get when you receive your first pay cheque as a dentist – you are finally being remunerated for your hard work. Not only that, if you haven’t earned any money during the current tax year, you won’t have tax deducted from your pay cheque for the first month or two! I’m sure many of you reading will be thinking of the holidays you want to plan or the new car you want to buy for yourself, but there are some key things that I recommend you invest in early which will set you up for the rest of your career in dentistry!

  1. Loupes

    If you haven’t already got a pair of loupes, I cannot stress enough the importance of buying some. The initial investment may seem steep, costing upwards of £2,000 for a good quality pair, but the return on investments is enormous. I got my loupes during 5th year of undergrad, and they have transformed the way I practice dentistry. I used to dread doing certain treatments because I just couldn’t see the fine details in certain procedures such as root canal treatments or crown preparations, however after getting loupes, these are now treatments I actually enjoy, and am able to do at a higher quality. Not only that, I have found my posture has greatly improved, especially since my loupes are refractive. To summarise, getting loupes will make your general dentistry more enjoyable, better quality, and potentially elongate your career by looking after your neck, shoulders, and back! I personally use the Bryant dental 3.8x Refractive loupes.

  2. Camera

    One of the first things I put money aside for was my own camera. Many of the training practices will have a camera lying about somewhere, but having your own is much better. You can set it up and leave it so you can easily and quickly take pictures whenever you need to. Photography is mega important in dentistry for several reasons. Firstly, it supports patient consent. By showing the patient what their teeth look like, and exactly the issues you are seeing, they are better informed in their decision-making, thus ensuring the consent you have obtained is valid. In addition to this, having before and after pictures for treatments is very useful medico-legally if you find yourself in some hot water (make sure your camera’s date and time settings are correct). Lastly, and most importantly, by taking pictures of your work, you can reflect on the good and bad things, finding ways to improve your work and develop as you go along. A bonus of having pictures of your work is that it enables you to compile a portfolio that you can use to show patients and future employers what you are capable of.

    It may seem daunting at first when trying to figure out exactly which photography equipment to buy, as I found out for myself. To break it down, most camera set-ups will require a body, lens, and flash. My own build consists of the Canon 2000D body, 105mm Sigma lens with a Sigma ring flash (Pictured below). This is by no means the best set-up, however it’s a good place to start if you want to get into dental photography!
  1. Income protection

    I’m sure many of you guys reading will remember the Wesleyan finance lectures from undergrad – I think most of us will have attended just for the free food and goodies. At the start of your career, you will think and feel like you are invincible, but you never know what life will throw at you which could cause you to put your tools down. I recently sprained my wrist and didn’t anticipate how much impact this would have on my work. Thankfully I recovered quickly and fully, but imagine if you had a serious injury, accident, or decline in health. If dentistry was your only source of income, and you had dependents/bills to pay, you would be under immense stress trying to stop the ship from sinking. By having income protection, if life throws a curve ball at you, you will be in a better position to manage financially, allowing you to focus on yourself and getting back to work. As a Foundation Trainee, the NHS will provide some form of sick pay for a limited period, but by having an additional income protection, if for whatever reason you had an extended period off work, you could be paid a certain % of your earnings until retirement age. It is one of those things to have, which you hope don’t need to use it, but is there if you do!

  2. Membership of the College of General Dentistry

    As I spent my time going through Foundation Training, I felt more and more unsure of what I wanted to do with my career. I applied for Dental Core Training (DCT) but felt as though I enjoyed working in general practice. However, I knew that I wanted to continue expanding my skills through postgraduate training. That’s where the College of General Dentistry is really helpful. They provide an excellent framework to help you navigate the world of being an associate in general practice, helping you develop the knowledge and skills you require to progress your career in dentistry and foster a commitment to lifelong learning.

These are only some of the things which I recommend you invest in for yourself. There are many more investments you will make over your career such as your own equipment, materials and postgraduate training. You don’t have to do them all at once, or at the beginning. Don’t make yourself feel like you are behind if you see your colleagues or friends having invested in more of these things than you. Dentistry is not a race; you should learn, improve, invest and develop at your own pace. At the centre of this all is providing the best care possible for your patients, whilst also looking after yourself.

Overall, Foundation Training for me has been a tremendous experience. I was very fortunate to have an amazing practice and a supportive ES. FD training is a unique and enjoyable experience. You can practice all the things in dentistry you love, not worry about UDA targets or lab bills, and push yourself with challenging cases knowing someone has your back. But one thing is for sure, you will get out what you put in, and if you put in 100%, you will get so much out of your FD year.

I’ve been told by many colleagues that at this stage of your career, the world is your oyster. Yet it can be difficult to navigate and work out exactly what you want to do. Personally, having completed my year, I’m now working on becoming a well-rounded GDP, and with clinical interests including oral surgery and prosthodontics, I aspire to be able to provide full-mouth rehabilitation including placement and restoration of implants. Membership of the College reflects my commitment to becoming the best dentist I can be for my patients.

Our Student Advice and Careers blogs are written by members of the College and offer advice and tips, and share experiences with dental students and early career professionals.

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College of General Dentistry Blog

Oral healthcare and the environment – how do we make sustainable attainable?

Dr Steven Mulligan MCGDent, a founding member of the FDI World Dental Federation Sustainability in Dentistry Task Team, discusses the work they have undertaken and shares practical steps to foster a more environmentally conscious practice.

I am a practicing general dentist in South Yorkshire, and I work within the University of Sheffield as a clinical teacher. For the last few years, I have been involved in research around sustainable oral healthcare. Upon starting my dental career, I recognised that the science behind dental materials and its role in rehabilitating oral disease fascinated me as understanding what is in the dental materials we use is key to understanding their successful implementation. I have often considered that we would not cook and present someone a meal without knowing the ingredients, or the consequences of their use!

I have recently completed a PhD which primarily looked at the environmental impact of resin-based composite (RBC). The premise of the research was that as amalgam is being phased-out based on environmental pollution issues, with RBC consequently acting as the major direct-placement dental material in dentistry, what are the environmental pollution impacts with the use of RBC? Like any research, once you start looking, the more you see. Regarding RBC, the simple answer is yes, RBC has negative environmental pollution impacts. RBC can never be fully polymerised through normal use, and monomers elute for months and years from restorations into the environment.1 When RBC restorations are replaced, polished or adjusted, microparticulate waste, akin to microplastics are released into the environment.2 Manufacturing, distributing, using and disposing of RBC generates a significant carbon footprint. The sundry items required to use RBC, such as applicator brushes, dental dam, sleeves for light curing units are all single-use plastics (SUPs), contributing to dentistry’s waste burden. Comparing the environmental impact of RBC and amalgam is easy, RBC is less bad for the environment.

It was an easy link when considering the environmentally sustainable use of dental materials to consider other aspects of sustainable oral healthcare. But what does sustainability in this respect mean? Sustainable oral healthcare is basically providing care that does not jeopardise the equivalent care of future generations, and ensuring we are acting ethically, not just to our current patients but also to subsequent generations of patients. Global warming, climate change and environmental pollution is a reality and as healthcare professionals we contribute to it. Can we provide optimal care that is also environmentally sustainable?

To answer this, multiple research opportunities arose, and generated publications with interesting insights. Did you know we generate around 2 billion items of SUP annually in the UK dental sector, weighing around 14 tonnes?3 Or that the average UK 50-year old’s dentistry has a carbon footprint of around 1.2 tonnes CO2e, which would need over 130 trees planted to off-set it?4 Or that patients are willing to pay more for more environmentally sustainable oral healthcare?5

A few years ago, the FDI World Dental Federation (FDI WDF) contacted me as they were interested in establishing the FDI WDF Sustainability in Oral Healthcare Task Team. My colleague at the University of Sheffield, Professor Nicolas Martin, took the reins as Chair and we co-founded the team, which currently comprises of Asst. Prof Donna Hackley (Harvard Dental School, USA), Assist. Prof Duygu Ilhan (Istanbul Medipol University, Turkey), Dr Hasan Jamal (Saudi Arabia) and Dr Mick Armstrong (UK).

The FDI WDF acts as the global voice of the dental profession, representing over one million dentists worldwide, working with 191 Member Associations in over 130 countries. The Sustainability Project aims to increase awareness and guide the profession towards environmentally sustainable outcomes, working alongside industry partners such as Colgate-Palmolive, P & G, Kulzer Mitsui Chemicals Group, Haleon, SDI, Dentsply Sirona and Sunstar.

The FDI Sustainability project has delivered multiple resources, including the first Consensus Statement on Sustainable Oral Healthcare which was an evidence-based perspective of the current status quo, with suggested opportunities for implementing sustainable actions.6

In addition, the FDI developed a Toolkit, based around 18 topics and 150 actions that range in how impactful they are and how easy they are to implement. There are things that you can do in practice that are easy to carry out and have a significant impact on improving environmental sustainability, it is a simple process to enrol on and is a great starting point for anyone interested in the topic. The Toolkit aims to help oral healthcare professionals start (or continue) providing more environmentally sustainable care provision, via a structured approach.

The Toolkit is the direct result of two peer-reviewed scoping review publications that explored the awareness, barriers, drivers, opportunities and best practice for the delivery of sustainable oral healthcare. These key publications identified over 250 actions that can be carried out by dental professionals.7 8

The content within the toolkit is arranged in a way that reflects three aspirational challenge levels: Bronze, Silver and Gold. The criteria considers two parameters for each environmental sustainability (ES) activity: (i) The importance of the task as an ES measure and (ii) the level of implementation difficulty that the implementation of the task presents. Some examples of tasks include:

  • Putting recycling bins in staff areas.
  • Education of colleagues regarding appropriate recycling is an easily achieved, important task and compliance using the Toolkit can be demonstrated by uploading the minutes from a staff meeting that highlighted this. An example and a suggested task within the Toolkit is the separation and recycling of plastic and paper from sterilisation packets.
  • Rethinking the use of resources is another aspect of sustainability and is highlighted in the Toolkit via the use of paperless meetings, double sided printed when necessary, cancelling junk and unsolicited mail that the practice receives and the use of adjunctive technology in the practice such as tablets to record and update medical forms and intraoral scanners/ digital radiography to rethink the need for other disposable resources.
  • Reviewing how we provide care daily by carefully planning procedures before carrying them out and deciding what equipment is required to prevent waste and unnecessary reprocessing of instruments is another example of smart sustainability.
  • Selecting products with minimal packaging that is easy to recycle, selecting eco-friendly alternative sundries, products or equipment and choosing durable office equipment that has been sustainably manufactured.
  • Transport between dental clinics and dental laboratories can be optimised in order to reduce journeys and improve sustainability. The use of digital scanners and CAD CAM allows improved efficiency of transport between dental clinics and laboratories is one example.
  • Communicating with patients the importance of good oral health that not only benefits them directly but also the planet.

The Toolkit integrates not only sustainability messages but also other important issues within dentistry. An example is the requirement to reduce unnecessary use of antibiotics, not just for the vitally important prevention of antimicrobial resistance. This has a sustainability impact as there is a significant carbon footprint attached to the manufacturing, distribution and disposal of waste medicines.

The FDI WDF has also developed a Massive Online Open Course (MOOC) on Sustainability in Dentistry which consists of three hours of interactive learning modules that helps users understand the impacts of oral healthcare on the planet and how to use evidence-based dentistry to improve the oral health of patients in an environmentally conscious way. A final assessment at the end of the course provides certification of its completion, module one is currently available with future modules to follow.

All the above FDI WDF resources, including infographic posters on the importance of good oral health and its links to environmental sustainability (for use in patient waiting areas), are free to access and another patient-focused poster that highlights your practice’s involvement in this important facet of oral healthcare provision will soon be available to display.

As a practicing dentist, I believe the best way we can be environmentally sustainable is by implementing high-quality preventive and operative care that gives patients ownership of their oral health and an understanding that by having a healthy mouth, they can also improve their impact on the environment. This results in fewer interventions, less travel and less lab-work with reduced overall carbon emissions. It’s a win-win situation.

Dental professionals, patients and other non-clinical members of the dental team are often surprised that dentistry has a significant environmental impact as it may never have occurred to them previously. To that end, increasing awareness around this topic by communicating and engaging with others is a brilliant first step in improving the environmental sustainability of oral healthcare.

Everyone can do something, and even if it seems like something small (like promoting patients to use public transport or booking family appointments to cut down patient journeys or even turning off unused electric items or lights), cumulatively these small measures have a big impact on making dentistry more environmentally sustainable.

1 Mulligan S, Hatton PV, Martin N. Resin-based composite materials: elution and pollution. Br Dent J. 2022 May;232(9):644-652. doi: 10.1038/s41415-022-4241-7. Epub 2022 May 13. PMID: 35562466; PMCID: PMC9106581.

2 Mulligan S, Ojeda JJ, Kakonyi G, Thornton SF, Moharamzadeh K, Martin N. Characterisation of Microparticle Waste from Dental Resin-Based Composites. Materials (Basel). 2021 Aug 8;14(16):4440. doi: 10.3390/ma14164440. PMID: 34442963; PMCID: PMC8402022.

3 Martin N, Mulligan S, Fuzesi P, Hatton PV. Quantification of single use plastics waste generated in clinical dental practice and hospital settings. J Dent. 2022 Mar;118:103948. doi: 10.1016/j.jdent.2022.103948. Epub 2022 Jan 10. PMID: 35026356.

4 Martin N, Hunter A, Constantine Z, Mulligan S. The environmental consequences of oral healthcare provision by the dental team. J Dent. 2024 Mar;142:104842. doi: 10.1016/j.jdent.2024.104842. Epub 2024 Jan 17. PMID: 38237717.

5 Baird HM, Mulligan S, Webb TL, Baker SR, Martin N. Exploring attitudes towards more sustainable dentistry among adults living in the UK. Br Dent J. 2022 Aug;233(4):333-342. doi: 10.1038/s41415-022-4910-6. Epub 2022 Aug 26. PMID: 36028699; PMCID: PMC9412765.

6 Martin N, England R, Mulligan S. Sustainable Oral Healthcare: A Joint Stakeholder Approach. Int Dent J. 2022 Jun;72(3):261-265. doi: 10.1016/j.identj.2022.02.008. Epub 2022 Mar 29. PMID: 35365320; PMCID: PMC9275086.

7 Martin N, Sheppard M, Gorasia G, Arora P, Cooper M, Mulligan S. Awareness and barriers to sustainability in dentistry: A scoping review. J Dent. 2021 Sep;112:103735. doi: 10.1016/j.jdent.2021.103735. Epub 2021 Jun 25. PMID: 34182058.

8 Martin N, Sheppard M, Gorasia G, Arora P, Cooper M, Mulligan S. Drivers, opportunities and best practice for sustainability in dentistry: A scoping review. J Dent. 2021 Sep;112:103737. doi: 10.1016/j.jdent.2021.103737. Epub 2021 Jun 26. PMID: 34182061.

Visit our sustainable dentistry page for further free resources to help dental practices understand and reduce their impact on the environment.

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College of General Dentistry Blog

Leadership in dentistry – a personal perspective

Abhi Pal FCGDent, Immediate Past President of the College, says the dental profession needs to create opportunities for all team members to develop leadership skills

Oral health care in the UK is a complex, fast-changing sector, embracing dynamic and skilled teams, and our profession faces a number of key challenges, some of which are not new. These include workforce recruitment and retention, inequalities in oral health, NHS contract reform, the lack of recognition for oral health care teams, and the regulatory environment. This is of course in addition to the wider problems of the cost-of-living crisis, Brexit, and global issues. Overcoming these challenges will need leadership at all levels, from individual practices through to national bodies. It will not be a surprise to readers when I say that that leadership requires creating a vision. That vision has to be informed by listening to individuals, acknowledging their views, and understanding the working environment in order to create a vision that can inspire.

I often hear that leaders are not born but that leadership is a collection of skills that can be learnt. The profession needs to create opportunities for all team members to be encouraged to develop these skills. This starts from the individual surgery and practice level through to professional bodies and national platforms. It is essential that early-career colleagues are encouraged to participate in conversations and decisions which will shape the future of the profession. It is more important than ever that we have role models who reflect the diversity that exists within the profession.

As well as creating a vision, leaders need to be able to communicate the vision to others
and inspire teams to get behind the goals. It is important to create a common language
that can encapsulate the knowledge and capabilities that we value in our teams. All individuals have strengths and weaknesses. The successful leader will harness the
strengths of individuals to delegate successfully and support individuals to help overcome weaknesses.

Many styles of leadership exist but it is often the case that successful leaders understand that styles need to be adapted to suit the requirements of the environment and teams they work in. I have found over the years that demonstration of credibility and authenticity can often be more important than just style.

Leaders also need to readily recognise the hard work undertaken by team members. Monetary reward is only one part of this. There is a general lack of recognition for the skills of primary oral health care teams due largely to the lack of a proper career structure. Without such recognition, we cannot hope to recruit and retain the talent we need in this great profession of ours. We need to have a new look at how this recognition can be provided.

I see an increasing amount of negativity in the profession, much of it spurred on by
the ease of posting views on social media. Negativity can stem from the feeling of powerlessness. However, some groups and organisations are stepping up, in spite of those challenges, showing the there is a great deal the profession can itself do to improve matters. The answers to the challenges the profession faces cannot be solved by one body alone. It is time for cooperation and leadership across the whole sector to provide workable solutions.

This article was first published in the British Dental Journal (volume 234, page 921, 2023) by Springer Nature

College of General Dentistry Blog

Domestic abuse awareness in dentistry: shaping a safer tomorrow

Preetee Hylton RDN, an Associate Member of the College and full-time dental nurse and safeguarding lead, recently delivered a CGDent lecture on safeguarding in dentistry at the British Dental Conference and Dentistry Show. Here she describes how you can support patients and colleagues who may be suffering from domestic abuse.

Domestic violence and abuse (DVA) is a topic that sometimes infiltrates our conversations, appearing in discussions with family, colleagues, and friends, as well as in the news and our social media feeds. As we encounter these discussions, we often find ourselves looking for further information, looking into numerous articles that outline potential indicators of domestic abuse, perhaps stumbling upon statistics detailing its prevalence. It falls upon all of us – dental professionals included – to take on the responsibility of familiarising ourselves with the signs of domestic abuse in our patients and colleagues, enabling us to offer assistance and support when it is most needed.

Raising awareness about domestic abuse holds a deeply personal significance for me; it is driven both by my own lived experience and the desire to ensure that individuals facing similar challenges receive the support and assistance that I unfortunately lacked. In 2014, when I had escaped an abusive relationship, Pam Swain, Chief Executive of The British Association of Dental Nurses (BADN), offered me invaluable support. After losing touch for a few years, we reconnected at a dental conference. Pam asked if I would be willing to share my story to raise awareness of domestic violence and abuse. I first shared my lived experience at the North of England Dentistry Show in March 2022, where I encouraged dental professionals to register their workplaces/organisations with the Employers’ Initiative on Domestic Abuse (EIDA). Following this, I was invited to speak at the British Dental Conference and Dental Show in May 2022, with support from the National Examining Board for Dental Nurses (NEBDN), focusing on identifying signs of domestic abuse in patients, colleagues, and close ones.  Since then, I have written about domestic abuse and spoken at further dental events, including at a CGDent webinar on the subject.

What is the definition of domestic abuse?

In my discussions about domestic abuse, I have noticed a common tendency among those around me to focus mainly on physical assault. However, it is important to realise that domestic abuse extends far beyond visible signs, such as bruises, cuts, and broken bones.

In the UK, the government has defined domestic abuse and violence as:1

“Any incident or pattern of incidents of controlling, coercive or threatening behaviour, violence or abuse between those aged 16 or over who are or have been intimate partners or family members regardless of gender or sexuality. This can encompass but is not limited to the following types of abuse:

  • psychological
  • physical 
  • sexual
  • financial
  • emotional

Controlling behaviour is: a range of acts designed to make a person subordinate and/or dependent by isolating them from sources of support, exploiting their resources and capacities for personal gain, depriving them of the means needed for independence, resistance and escape and regulating their everyday behaviour.

Coercive behaviour is: an act or a pattern of acts of assault, threats, humiliation and intimidation or other abuse that is used to harm, punish, or frighten their victim.”

This definition, which is not a legal definition, includes so called ‘honour’ based violence, female genital mutilation (FGM) and forced marriage, and is clear that victims are not confined to one gender or ethnic group.”

So, what are the possible signs of domestic abuse?2

  • Manifesting visible indications such as bruises, burns, or bite marks on the body, particularly around sensitive areas like the neck, ears, shoulders, and arms.
  • Exhibiting signs of social withdrawal from loved ones, friends and colleagues – victims often make up various excuses as to why they are no longer able to socialise.
  • Experiencing financial constraints, whether through inadequate funds for essential needs like food or medication, or through complete control of finances by the abuser – especially if the victim and the abuser share a joint bank account.
  • Facing coercion into marriage by family members, accompanied by threats if the victim refuses – this is rather common in some cultures and often young people forced into marriage are not aware that this is abuse.
  • Encountering barriers to leaving the home, attending work, school, or social gatherings with family and friends.
  • Enduring continuous degradation, insults or humiliation, whether in private or in public settings – this could be about their physical appearance, about how they speak, about not keeping the house clean; the list is endless.
  • Being coerced into sexual activities or non-consensual intercourse, constituting rape, and warranting police intervention.
  • Experiencing “stealthing,” which involves the non-consensual removal or deliberate damage of a condom during sexual intercourse. This is considered a form of sexual assault and illegal in the UK.
  • Being subjected to gaslighting tactics, where the abuser denies or deflects blame for the abuse, leaving the victim questioning their own reality.
  •  Subjected to surveillance of all forms of communication, including social media, messaging services and online activities.
  • Being compelled to always share their whereabouts with the abuser via various tracking apps; at times, victims are unaware that the abuser has installed a tracking app on their phones.
  • Using young children as a means of coercion and/or control.

Shocking statistics

The Crime Survey for England and Wales (CSEW) found that approximately 2.1 million people aged 16 and above (4.4% of the population), experienced domestic abuse in the year leading up to March 2023. The police recorded 1,453,867 incidents and crimes related to domestic abuse, which shows a 14.4% increase compared to the pre-pandemic year ending March 2020, despite overall numbers remaining relatively consistent.3

It is often overlooked just how widespread domestic abuse truly is; many victims conceal their experiences out of an unjustified sense of shame. These above-mentioned numbers could be higher, due to the number of cases which go unreported.

How can we offer support to someone experiencing domestic abuse?

  • Find a private and safe setting to discuss their situation, respecting their willingness to open up.
  • Reassure them that we are available to support them and to listen to them without any judgment.
  • Acknowledge their courage for confiding in us and emphasise the fact the nobody deserves to ensure abuse, affirming their right to safety and happiness.
  • Offer ongoing support, encouraging them to express their emotions and respecting their decisions.
  • Avoid pressuring them into taking actions that they might not be ready for, such as leaving the abusive relationship or even reporting the abuse.
  • If they have sustained physical injuries, we must ensure that we offer to accompany them to seek medical help from their GP or from the hospital.
  • Help them in reporting the abuse to the police, should they choose to do so; we can call 101 to report it or if we feel that the individual is in immediate and/or severe danger from the abuser, we should call 999.
  • Consider seeking advice from social services, especially if children and/or vulnerable adults are involved in the situation.

What is our responsibility and duty as dental professionals?

Making sure that the safety and well-being of our patients is of utmost importance, necessitating adherence to training guidelines outlined by the General Dental Council (GDC) and Care Quality Commission (CQC).

When it comes to our yearly safeguarding training, we should all complete the following training4, and this should not be considered a box-ticking exercise.

Safeguarding of children and young people

Level 1: All non-clinical staff including receptionists, practice managers and staff without patient contact.

Level 2: Most dentists and dental care professionals.

Level 3: To be determined locally in larger organisations based on an assessment of need and risk.

Adult safeguarding

Level 1: All non-clinical staff including receptionists, practice managers and staff without patient contact.

Level 2: Most dentists and dental care professionals

Similarly, it is essential to extend this level of support to our dental colleagues, with employers bearing the responsibility to support team members encountering domestic abuse. It is our ethical duty to promote a workplace environment that is secure and supportive for all staff members. Cultivating a workplace culture of transparency and openness entails creating a space where individuals feel at ease discussing sensitive subjects. By championing this culture, we can help dismantle the stigma surrounding domestic abuse, empowering individuals to seek help and speak out on sensitive matters while ensuring they receive the necessary support they need.

Speaking about domestic abuse can often be emotionally and mentally taxing, yet I view it as my personal mission to guide and assist those in need and hopefully facilitate their journey towards breaking free from abusive relationships and situations.

Services to signpost patients and team members to:

– National 24hour Domestic Violence helpline for Women (Refuge): 0808 2000 247
– Women’s Aid: [email protected]
– Solace Women’s Aid: 0800 802 5565, [email protected]
– Flows: Finding Legal Options for Women Survivors: 0203 745 7707, [email protected]
– National Domestic Violence Helpline for Men (Respect): 0808 8010 327
– The Mankind Initiative: 0182 3334 244
– Honour Helpline (Karma Nirvana) for advice on forced marriage and honour-based violence: 0800 5999 247
– Forced Marriage Unit: 0207 0081 151
– Broken Rainbow for advice and support for LGBTQ+ victims of domestic abuse: 0845 2604 460
– Galop for LGBTQ+ victims of domestic abuse: 0800 999 5428 [email protected]
– Southall Black Sisters: 0208 571 9595
– Rape Crisis: 0808 500 2222
– Hourglass (supporting the elderly): call 0808 808 8141, text 07860052906
– Ask for ANI (Action Needed Immediately) in your local pharmacies and jobcentres.
– Ask for Angela in pubs, bars and clubs.
– UK Says No More Campaign provided safe spaces for domestic abuse victims: https://uksaysnomore.org/safespaces/

– Call 999 in an emergency or if someone is at immediate risk of danger.

Domestic abuse in dentistry – speak out

Preetee also co-presented this College webinar, which members can access, and claim CPD hours for, free of charge here

1 Circular 003/2013: new government domestic violence and abuse definition. Available at https://www.gov.uk/government/publications/new-government-domestic-violence-and-abuse-definition/circular-0032013-new-government-domestic-violence-and-abuse-definition

2 Victim Support: Recognising the signs of domestic abuse. Available at https://www.victimsupport.org.uk/crime-info/types-crime/domestic-abuse/recognising-signs-domestic-abuse/

3 Domestic abuse prevalence and trends, England and Wales: year ending March 2023. Available at https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/domesticabuseprevalenceandtrendsenglandandwales/yearendingmarch2023

4 Safeguarding in general dental practice: A toolkit for dental teams.  Available at https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/791681/Guidance_for_Safeguarding_in_GDP.pdf

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College of General Dentistry Blog

The year in review

Dr Mick Horton FCGDent, Chair of Trustees, reviews the College’s achievements over the past twelve months.

It’s an honour for me to take on the role of Chair of Trustees, following Janet Clarke MBE FCGDent who stepped down in April 2023. Janet remains with us as a Trustee, so we continue to benefit from her wise counsel and breadth of experience.

The last twelve months started with the President, Dr Abhi Pal FCGDent, giving oral evidence to the House of Commons Health and Social Care Select Committee on dental services in England, and drew to a close as the UK Government announced its “Dental Recovery Plan”. There’s no doubt that we live in febrile times, with the inadequacies and inequity of dental service provision ever more prominent in the public consciousness. The College is in a unique position to offer a constructive view: reflecting interests across the dental team, across the UK, and bridging private and NHS care provision. It is no surprise, then, that we find ourselves actively invited to contribute in the debate – and we seek to do so in a measured way, and with the independence, broad perspective and authority that you would expect. You will see more of our work in the year ahead to develop our policy thinking, with a new Parliament taking office later this year.

Core to our mission is dental education and training. The role of our College needs careful thought, in a rapidly evolving, diverse and confusing market: it is no longer enough for us to act as just another provider of training when others are better equipped for that role. But we are very clear that all dental professionals need support in making the right choices for their career progression and skills development. Building on the Career Pathways which we published in 2022, we have been working to develop our approach: helping dental professionals to make wise investment for their future. Certified Membership was opened to its first candidates early in 2023, providing mentored support. Later in the year, we added those qualifications which we judge to meet key requirements – “recognised qualifications” – to the CGDent Register of Members & Fellows. Watch out for further announcements as our longer-term plans fall into place.

It’s intimidating to be starting a career in dentistry these days, with so much choice of paths to follow, and pressure to follow the crowd. But there is help and support out there from committed and experienced members of the profession, and we think we can help. With the generous support of the Tom Bereznicki Foundation, in November we ran our first NextGen leadership event for dental students and Dental Foundation Trainees, in Manchester. Moving forward, we aim to build on this initiative.

Preventative care and advice is so obviously a long-term priority, and particularly for children; and yet the urgency of a lack of access to urgent treatment makes it difficult to keep prevention on the agenda. We are partnering with Haleon (formerly GSK) to develop our own thinking on the future role of dental practices, and the whole dental team, in this respect. A number of dental practices have generously hosted a series of discussions around the UK, and you will be hearing about the feedback and conclusions in the months ahead.

The Primary Dental Journal continues to grow as essential reading, and in 2023 we published three authoritative themed issues encompassing aesthetic dentistry, which spanned two issues, and dental trauma – essential references to have beside you. Beyond the themed issues, the PDJ is attracting an increasing number of exceptional papers, too, giving us two rich “General Dentistry” issues in the year. We are looking forward to themed issues in 2024/25 on Implant Dentistry and Oral Medicine.

Our Fellows’ Receptions are ever more eagerly awaited, and we filled the wonderful Cutlers’ Hall in June and in January – bringing together senior professionals to build new relationships and foster a community of leadership. We were honoured to recognise a number of achievements, including the admission of so many new Fellows of the College. We have plans to build on the Fellows Reception to offer more for our members and to strengthen bonds within the College.

Finally, our Honorary Founding President, Nairn Wilson CBE FCGDent, was recognised with a knighthood for his contribution to dentistry over a long and remarkable career – in which the formation of the College has surely been the particularly historic achievement (and highlighted in his citation). Sir Nairn continues to inspire us, as we work to build secure foundations for the future. The College’s own special recognition, the College Medal, was awarded to Andrew Hadden, who continues in his notable contribution to the College and profession as Editor of the College’s Clinical Examination & Record Keeping. Their service, and that of so many others, gives us hope for the future.

Thank you for your support.

Mick Horton

You may be interested in Janet Clarke’s blog reviewing the College’s second Annual Members’ Meeting in March 2023.

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College of General Dentistry Blog

Navigating the chaos of managing medical dental crises

Lecturer and Tier II-accredited Oral Surgeon, Dr Sukhvinder Atthi FCGDent, discusses some of the common medical emergencies that can occur in dental practice.

“Help… call 999 and tell them to get here quickly!” – the dreaded words you might find yourself exclaiming, when you realise something is not right, and you find your patient unconscious before you!

As dental professionals not only are we responsible for maintaining the oral health of our patients, but we also have a duty to be appropriately trained to deal with medical emergencies that may arise in the dental practice setting. It is an essential skill that the GDC recommends is maintained annually.

I treat a lot of nervous minor oral surgery patients and am sharing key advice in a CGDent lecture on managing medical emergencies at the British Dental Conference and Dentistry Show 2024 on Saturday 18 May (4.15-5pm).

Numerous studies have shown that rehearsing medical emergency training within a dental practice can increase the team’s confidence to manage and treat medical emergency scenarios. Keeping up to date with the required knowledge and undertaking skilled CPR and AED training is crucial in the successful outcomes of managing such patients.

The most common medical emergency is the vasovagal syncope, also known as the simple faint. There are many causes of fainting, however, within a dental practice it is mostly related to pain, emotional stress, fear and anxiety. Some patients may suffer from fainting spells due to other neurological or heart conditions too. 

Early recognition of medical emergencies can improve patient outcomes and often avoid further deterioration.  We have all heard it before; a patient enters the surgery and you’re there smiling and greeting them whilst they mumble, ”I don’t like the dentist!” or ”Last time I had an injection it made me go all funny and ill”.  At this moment, take a minute to think about their anxiety and the apprehension which has led them to feel like this.

Usually, these patients have been kept awake all night worrying about their upcoming appointment. They have often only had a light meal or skipped eating all together because their stomach can’t manage any food.

If patients have not eaten prior to attending, their appointment can worsen their condition hence this can be combated with something as simple as a glucose high energy sweet or glucose-based drink, which helps to maintain the patient’s blood glucose so they can cope with their body undergoing stresses that they are going through prior and during their appointment.

There is also an increased likelihood of encountering medical emergencies during treatment involving intravenous sedation. As an IV sedation provider, implementing the necessary Immediate Life Support (ILS) training is essential, and if you are thinking of applying sedation through your clinical practice workforce, you will need to make sure your training is up-to-date.

Sepsis from dental infections has become increasingly frequent in my referral clinics based on patients that have encountered failed extractions or are still unwell from being on antibiotics for dentoalveolar infections or pericoronitis, alongside other medical factors that the patient has been diagnosed with. When infection spreads within the head and neck region, there is a risk that the airway can be compromised. Patients can present with noisy breathing, stridor, trismus, breathing rapidly with a fast heart rate, alongside dysphagia. Initial management should include ensuring the patient is in an upright position, administering 15 litres per minute of oxygen, and calling for the ambulance.

Join me in the Enhanced CPD Theatre at BDCDS24, where I will discuss these topics as well as my own journey and experiences, and will talk through essential practice to help you deal with the most common medical emergencies.

The College is a key education partner for the British Dental Conference & Dentistry Show (BDCDS), hosting four lectures in the Enhanced CPD Theatre – register for your free place.

Managing medical emergencies in the dental practice
Dr Sukhvinder Atthi FCGDent
Saturday 18 May, 4.15pm, Enhanced CPD Theatre

Dr Atthi’s lecture will update your knowledge of managing medical emergencies within dental practice, including a review of the mandatory audit process for drugs to use in medical emergencies, how to deal with an unconscious patient and how to recognise and manage suspected sepsis.

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