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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College of General Dentistry Blog, Careers

Our experience of the Certified Membership Scheme

Phill Brown FCGDent is a Facilitator on the College’s Certified Membership Scheme and dental therapist Poppy Dunton, Associate Member, is enrolled on the programme and supporting its development. In a recent conversation with Roshni Karia MCGDent, they shared their experiences of the scheme.

Phill Brown FCGDent, Poppy Dunton, Roshni Karia MCGDent

Roshni Karia: Thank you both for talking with me today. Can you briefly tell me about your roles in dentistry?

Phill Brown: Hi Roshni, I have a keen interest in primary dental care and have been a General Dental Practitioner for 17 years. Within that time I have worked in several practices as an associate dentist and was also fortunate enough to own a large NHS practice in the North West. My role in Dental Education began in 2017 where I have developed a career in Clinical Academia at the University of Liverpool School of Dentistry.

Poppy Dunton: I accidentally fell into dentistry, when a graphic design work experience placement fell through, I began training as a dental nurse, left for university to train in dental therapy and hygiene. I graduated in 2011, and from there have been fortunate enough to be able to complete my full scope of practice in a busy NHS surgery for over eight years; throughout that time I was privileged enough to be offered a business management position, and have since set up and manage a squat practice which is a private facility providing a multidisciplinary team. I currently serve as a Dental Hygiene Therapist focused on Periodontal care.

RK: Speaking as a Facilitator and a member on the Certified Membership Scheme, how does the Professional Framework support you to plan your development?

PB: As a Facilitator, the Framework allows me to structure and focus sessions with colleagues like Poppy who are on the Certified Membership Scheme. Each career stage within the framework has clear and concise examples of how each capability maps to their current career development and so for me as a Facilitator I can easily help and support discussions when a candidate has identified further areas of development.

PD: The Framework allows me to consider my next choice of professional development by allowing me to discuss my personal goals with my Facilitator. These could be examples of postgraduate training or new qualifications or skills I wish to gain. Once discussed this then supports me to see how my skills or day-to-day work life will match with the current direction of my professional development. We can then plan the next six months of my education together.

RK: Poppy, what does Certified Membership mean for you personally?

PD: Ultimately Roshni, I feel it means I am working towards a career goal. I qualified in 2011 and there were minimal postgraduate courses offered compared to the options available to undergraduates in today’s climate. However I have spent a lot of money in the past on courses – which I have only discovered post-qualification do not hold university merit. Therefore, by joining the Certified Membership programme I am able to ensure, with the help of my Facilitator, that my future investments into postgraduate education are the correct ones in line with my advancing through the Career Pathway towards my goal of Fellowship of the College. In addition it allows me to keep focused and not waste time or money on education which may not fit the goal I have set myself.

RK: Why do you think the CMS is a good idea for those working in primary care dentistry, Phill?

PB: Quite simple really! We have no other scheme currently like this in the dental primary care sector. The College has been very inclusive in who can join its programme. You have access to a Facilitator who will provide support alongside a uniquely developed Professional Framework, which maps to your own development no matter what discipline you work in. With the support of the College, primary care colleagues can start to consider how to develop a career pathway in a primary care setting, gaining recognition at every stage of their career development.

RK: So Poppy, can you explain what’s involved for you as a member of the scheme?

PD: Well, every six months I meet online with my Facilitator Martin, he is lovely! The meetings are structured and generally can be around 2-3 hours in length. Yes I know…this may sound like a long period of time, mapping out and planning career progression is based on forming a professional relationship with your Facilitator. Martin took the time to learn about my career, and I his – how I reached the current status of my job role, my concerns, and my desires to achieve more in further education. During the meeting we will set SMART goals together.

Following this meeting I will complete a reflective journal which allows me to self criticise, peer review my own goals and reflect on what needs improvement. This is then sent into the College to ensure my program is being completed and I am being held accountable. Throughout the six month periods there are constant streams of support and online study programme webinars which is helpful and allows me to focus on particular areas for improvement.

RK: One of the benefits of taking part in the CMS is ongoing support from a Facilitator like you Phill. What’s involved in your role?

PB: As a Fellow of the College I am privileged enough to be able to support colleagues at earlier stages of their career by being a Facilitator of the CMS. My role is to engage with those on the scheme throughout their development at specific points during the programme. The role requires me to set time aside to discuss candidates’ personal development plans and reflective logs, and further encourage, through active discussion, areas of professional development that may be helpful to them.

RK: Online Study Modules are another component of the CMS. What are these, Poppy? Do you find them helpful and what sorts of things do you discuss with your Facilitator?

PD: Online study modules are Zoom meetings and teaching lessons, on topics such as Record Keeping, that I attend with other members on the Certified Membership programme. They allow us to focus on a learning outcome for the next six months in terms of making improvements in our own dental daily workflow. We learn from each other and then listen to peers’ reflections and experiences. During my Facilitator meetings with Martin, we discuss recent events and my clinical progress – such as experiences, challenges faced – and we have an open discussion regarding any of my concerns. Reviewing achievements and planning the next six months make up a fair amount of our time – allowing Martin to guide me in regards to particular courses which will benefit me the most or help me to reach my goal of Fellowship.

RK: I wanted to ask both of you about the reflective journal, which is another requirement of the scheme. Have you learnt anything that you think might have been missed without a journal?

PB: As Poppy suggests the journal is very helpful and is structured in a way to guide and map development of skills to the Professional Framework. There are a lot of skills that we all naturally develop over time and so having a clear space to record these achievements ensures you can identify any gaps within each capability. It is really easy to focus on just the skills you are naturally good at and so encouraging CMS candidates to journal throughout can avoid missing important areas for consideration in their PDP goals.

PD: I must admit Roshni, I am a big fan of daily journaling; I think it forces your mind to reflect on exactly where you are. Therefore at times, I cannot recall missing anything but the opposite has allowed me to explore options which I haven’t previously or disregard ideas that upon reflection may not have been suitable in working towards my goals. I’m a particular fan of the Agency Domain in the Professional Framework, which includes the Autonomy competency, the ability to be self directed and take ownership of the work. This encourages you to look at yourself via the power of self audit.

RK: The fourth element of the Certified Membership Scheme is the objective evidencing of your capability, so formal qualifications you’ve gained or courses you’ve completed. Poppy, do you think this sort of external validation is useful for your career and are you currently working towards anything?

PD: Absolutely, I am proud to be part of the College and am so excited for all fellow dental care professionals who are going to achieve recognition for their contribution to the dental world. In the future this may also aid patients in finding an experienced clinician. I am currently working towards gaining Fellowship of the College. I previously completed courses which unfortunately did not qualify for the correct number of credits – therefore I am restarting my journey from a Level 7 status.

RK: Well thanks so much for sharing your thoughts about the CMS and your experiences so far. I’d love to catch up with you again a little further down the line to find out how it has been going.

PD: Thank you for allowing me to be part of this discussion, I am very grateful for the invite.

PB: Many thanks Roshni.

For further information about Certified Membership, click the button below.

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The Certified Membership Scheme is open to Associate Members, Full Members and Associate Fellows of the College, and in the first phase, specifically for dentists – we will be opening to other dental team roles soon.

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College of General Dentistry Blog

How the dental sector could retain dental nurses

Dental nurse, Dr Debbie Reed FCGDent, is Chair of the inaugural board of the College’s Faculty of Dental Nursing and Orthodontic Therapy and a Reader and Director of Advanced and Specialist Healthcare in Global and Lifelong Learning at the University of Kent. In this blog, Debbie reflects on the results of her recent research into dental nurse retention in the UK.

There are currently over 61,6631 dental nurses (DNs) on the General Dental Council (GDC) register, making dental nurses the largest occupational group of dental registrants.  However, in recent years there has been a perceived drop in the numbers of dental nurses, to the extent that this has been termed a ‘recruitment crisis’. In my capacity as Reader (associate professor) in Advanced and Specialist Healthcare, I conducted the Dental Nurse Retention Survey, in February – March 20232, which aimed to explore the  current state of the registered Dental Nurse workforce within the United Kingdom (UK).

The main conclusions of the subsequent report3 provide valuable insights into the reasons dental nurses want to remain in the profession, as well as some of the factors that may lead them to consider leaving.

There are three top factors that encouraged 50% of dental nurse respondents to remain registered with the GDC and working within the dental sector. These were, in order:

  • Meaning and growth, focusing on reasons associated with job satisfaction, including meaningful work, career structure and opportunities for professional progression and growth.
  • Extrinsic rewards, including contracts of employment, financial remuneration and pay, as well as additional rewards and incentives provided by employers.
  • Workplace culture and environment, which was defined as a set of values, beliefs, attitudes, and assumptions common to those working together, which influences behaviours and interactions amongst colleagues within the dental team. Workplace environment also means the setting and physical conditions, such as the building structure, equipment, and material, in addition to the culture.

This indicates the potential importance to dental nurses, of having career pathway routes, such as the College of General Dentistry’s Career Pathway for Dental Nurse and Orthodontic Therapists (OTs)4.  CGDent’s Career Pathway offers a progressive and flexible structure through which dental nurses can be enabled in equality of opportunity for career development and progression, alongside a route-map for the achievements of DNs and OTs to be recognised within a prestigious multi-professional, sector wide, recognition framework. CGDent’s progressive career framework, is an accessible and achievable  route to job satisfaction and professional longevity.

Uniquely, CGDent provides a transparent, progressive series of gateways that encourages DNs and OTs to maximise their development opportunities, with means to track their development throughout their career progression. The gateways offer much-needed commonality of approach to career progression across all registered dental professions, with parity of occupational esteem, unparalleled elsewhere in dentistry, nationally or internationally. 

Instinctively, the CGDent Career Pathway, launched in 2022, may go some way to responding to some of the reasons dental nurses not only become uncertain about remaining but the reasons that dental nurses go on to declare an intention to leave.

The Survey Report detailed, with regards to the other 50% of respondents, that 34% who declared having become ‘uncertain about remaining in dental nursing’.  The top three reasons for this, in order, were:

  • First – Dissatisfaction with pay.
  • Joint second – Employers not valuing, recognising, or showing appreciation for the dental nurses’ contribution or no longer enjoying working as dental nurse.
  • Joint third – Dental nurses not getting a sense of meaning and reward from their role or feeling that they were unable to progress in their career.

The remaining 16% of dental nurse respondents declared ‘an intention to leave dental nursing’.  Surprisingly, when requested to be specific, pay was not amongst the top three reasons why dental nurses were making the decision to leave, although it did feature. The three top reasons, in order, why dental nurses intended to leave dental nursing were:

  • Employers not valuing, recognising or showing appreciation for their contribution.
  • Feeling they were unable to progress in their careers.
  • No longer enjoying working as a dental nurse.

Reassuringly, the study also revealed that even within the group who were ‘intending to leave’, that 46% could be tempted by employers, with suitable progression routes, offers, rewards and incentives, to remain or return to dental nursing.  So, it is not too late for employers, there are steps that can be taken to retain this group of dental nurses, and the report offers ideas to be used as a starting point for such discussions and negotiations. The Dental Nurse UK Retention Survey 2023 Report offers hope in the form of possibilities which might be explored to retain or re-engage that group and tempt them to consider re-registering to work in the dental sector.

The Dental Nurse Retention Survey UK Report published the results in Autumn 2023:  Reed, D.P. (2023) The Dental Nurse UK Retention Survey 2023: An Internet Mediated Survey Of Members Of The British Association of Dental Nurses And Wider Dental Nurse Workforce Regarding What Encourages Them To Remain Within The Dental Sector.

Unsurprisingly, it has had over 1,840 reads so far. For those who wish to access the survey results, the report is freely available on ResearchGate: https://www.researchgate.net/publication/374919034_Dental_Nurse_UK_Retention_Survey_2023  

Over the course of the year, look out for the associated blogs (such as the GDC January 2024 Blog5),  papers, journal articles and speaker events, including part of the CDO Lounge events in March 2024 at BDIA Showcase in Excel London,  which will provide further detailed analysis of the survey results.

References:

  1. General Dental Council (GDC) (2024a)GDC Registration Reports January 2024. Available online: https://www.gdc-uk.org/docs/default-source/registration-reports/registration-report—january-2024.pdf?sfvrsn=2fc3066f_3
  2. British Dental Nurse Association (BADN) 2023) DN Recruitment and Retention Survey. Available online via: https://www.badn.org.uk/NewPublic/News/Dental-Nurse-Recruitment-and-Retention-Survey.aspx
  3. Reed, D.P. (2023) The Dental Nurse UK Retention Survey 2023: An Internet Mediated Survey Of Members Of The British Association of Dental Nurses And Wider Dental Nurse Workforce Regarding What Encourages Them To Remain Within The Dental Sector. Available online via ResearchGate: https://www.researchgate.net/publication/374919034_Dental_Nurse_UK_Retention_Survey_2023
  4. College of General Dentistry (CGDent) (2022) Career Pathways. Available online: https://cgdent.uk/career-pathways/
  5. General Dental Council (2024b) Blog 4 January 2024: What encourages dental nurses to remain within the dental sector? Available online: https://www.gdc-uk.org/news-blogs/blog/detail/blogs/2024/01/04/what-encourages-dental-nurses-to-remain-within-the-dental-sector

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College of General Dentistry Blog

‘What are you doing in Glasgow in December?’

Patricia Thomson FCGDent, Vice President of the College and Council representative for West and North Scotland, reviews the College’s third annual study day in Scotland, which took place on Friday 1 December 2023.

On 1 December 2023, the dental community of Scotland, and beyond, convened at Glasgow Science Centre for our third Annual Study Day as CGDent Scotland. This was the continuation of a tradition of annual high-quality CPD conferences in Glasgow, initiated by the highly esteemed John Craig, the man charged with setting up the West of Scotland division of FGDP (UK) when it was established in 1992. He was a man of great vision, and supported by a group of other altruistic like-minded GDPs, nurtured the community of dental practice in Scotland, an initiative which has been continued to this day.

Many distinguished speakers from around the world have addressed our conference over the years. Memorably, several years ago Professor Van Haywood travelled from Georgia with his wife to headline our study day. On being transported from Glasgow Airport by one of Glasgow’s finest taxi drivers, after asking where they had come from and receiving the reply Georgia USA, the taxi driver spluttered: “What the **** are you doing in Glasgow in December?!!!”. The warmth of this reply was much to Van Haywood’s amusement and he recounted the conversation to the delegates, delivered in his version of a broad Glasgow accent.

This year’s speakers, the mild mannered Professors Subir Banerji FCGDent and Shamir Mehta FCGDent may have been asking themselves the same question in less fruity language when they experienced the sub-zero temperatures during their stay in Glasgow, and woke up to a blanket of thick snow on the day of their departure. Finally, after spending Saturday’s daylight hours in Glasgow Airport, they managed to board a flight back to Heathrow that evening.

We were very honoured to welcome Subir and Shamir to spend the study day with us addressing the problem of toothwear.

The 400 delegates present comprised dental professionals of all levels of experience, over 130 Vocational Dental Practitioners, the final year students at Glasgow Dental School, and a number of dental students from Dundee University. Most delegates attended in person, but a small number participated online.

In step with our evolution from FGDP West of Scotland to CGDent Scotland, we were delighted to welcome VDPs from all parts of our country, and are grateful to National Health Service Education Scotland (NES) for continuing to engage with this event, which welcomes the most recent recruits to our profession into the community of general practice and demonstrates to them the fellowship and support that we offer.

The day was very generously supported by various dental organisations and members of the dental trade who have enabled the event to grow to the ambitious scale that we now enjoy.

Proceedings kicked off at 8.15am with hot beverages and breakfast rolls, before a prompt start to the lecture programme at 9am.

Our speakers held the delegates’ attention for two lectures in the morning and one lecture after lunch, during which they discussed the need to record and categorise tooth wear, and moved on to the aetiology and treatment. The lectures were titled “The How and The What and The Wear”.

Subir and Shamir have a unique style of delivery which consists of them sharing the stage and running through their presentation in a conversational manner, in which they discuss various points and anecdotes, bouncing ideas and, occasionally, challenging each other. They have an excellent interpersonal chemistry, and their discussion appeared to flow effortlessly throughout the sessions. Proposed treatment techniques were backed by evidence. The feedback revealed that this format was warmly received by the delegates, and is a presentation formula that works very well for them.

There was a separate breakout session for the students during the second lecture of the day, and they convened in another lecture theatre for several “TED”-style talks presented by multiple stakeholders. This started with an introduction to the College of General Dentistry, its aims and ambitions, the Career Pathway, and the study clubs and activities that we offer in Scotland, together with an encouragement to engage. This was followed by talks on entering the Vocational Training Scheme and ultimately embarking on general practice as an independent practitioner. There was a very enlightening presentation by one of our main sponsors, Martin Aitken, a Scottish accountancy firm with an in depth knowledge of the business of Dentistry, in which they were introduced to the concept of keeping financial records and paying tax!

It was a bit of an undertaking to feed almost 400 delegates at lunchtime, but this was ably achieved by the staff of the Science Centre, and there was even time for delegates to visit the exhibition hall and interact with our trade sponsors.

All delegates reconvened in the IMAX auditorium for the afternoon with Subir and Shamir’s final lecture, and after another coffee break, the final lecture, The Caldwell Memorial Lecture, was presented by Professor Jason Leitch, the National Clinical Director for NHS services in Scotland. Jason graduated as a dentist from Glasgow University, became an oral surgeon, and then attended Harvard to undertake his Masters in Public Health. He then returned to Scotland, but not to dentistry, climbed the ladder of promotion in Public Health, and found himself in the unenviable position of Clinical Director of Scotland when the Covid pandemic arrived. He became the main media persona in Scotland during the pandemic, and was praised for the clarity of his Public Health messaging. He spoke eloquently on the demands that governments faced throughout the pandemic, balancing the four challenges of the harm to health of the virus, economic harm, impact on health and social care service, and social isolation. He then moved on to the challenges that we face in the future as a nation with the provision of health and social care, discussing the implications for both manpower and finance.

Although very sobering, Jason’s talk was delivered in an entertaining and thought provoking manner.

Just after 5pm, it was time for the delegates to return to the upper floor of the Science Centre for the post-conference drinks reception, and to admire the night-time panoramic view of the banks of the Clyde stretching to the spires of Glasgow University. This part of the day facilitates the mingling of the varied members of our community, the chance for delegates to meet the speakers, networking, and catching up with old friends and colleagues.

The success of the day is down to cooperation and engagement of the entire dental community, and was capably orchestrated by our events coordinator Patricia de Vries. As a result of Patricia’s expert and meticulous planning, we filled our sponsor and delegate places by early October. Patricia also liaised with the Science Centre to ensure the smooth running of the day. We are hugely indebted and grateful to her for the service that she provides.

The Study day in Glasgow is a well oiled machine that has been staged over the last three decades, but it does not happen without much planning and effort by the events planners and members of the CGDent Scotland Committee. However, it is very rewarding for all involved, and we believe it displays the essence of what it means to belong to the “community of practice”.

Any speaker or delegate who comes to Glasgow in future, even though in December, can be assured of a warm welcome from everyone…even the taxi drivers.

We look forward to seeing you at the 2024 Scotland Study Day on Friday 6 December!

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College of General Dentistry Blog

Promoting healthy oral health behaviours at every opportunity by all

Dental Therapist Sarah Murray MBE, Associate Member, Board member of the College’s Faculty of Dental Hygiene and Dental Therapy, and Senior Lecturer in Dental Public Health at Queen Mary University of London, discusses the role of dental practices in delivering preventative oral care advice.

As dental professionals, we are all aware of the challenges individuals are currently experiencing in accessing dental services. We are also very aware that tooth decay has a significant impact on children, their families and the wider society, with children experiencing pain, infections and difficulty in eating, the need to take time out of school to attend dental appointments, parents taking time off work to bring their children to the dental practices, and the high costs of general anaesthetic for extractions when preventive measures have not been adopted or failed. The latest guidance from Public Health England (2017) Health Matters: Child Dental Health, identified a staggering £7.8 million was spent on tooth extractions in 2015 to 2016 amongst children under the age of five, with the majority being a result of tooth decay.

As dental professionals we need to review whether we are utilising every opportunity to promote healthy oral health behaviours from early in a child’s life and through an individual’s life course, and it is the responsibility of all members of the dental team to provide this support. Utilising extended duties dental nurses who are appropriately trained and competent in oral health education and the application of fluoride varnish, dental hygienists, dental therapists and orthodontic therapists, in addition to dentists, is fundamental to this.  

We have all experienced that getting our patients to change their unhealthy behaviours is a challenge, so we should be promoting this at every appointment and see it as a long-term commitment from the dental team. The advice we provide needs to be tailored and individualised, and to regularly reinforce key messages in line with contemporary evidence.

Foundation Dentists’ experiences

A recent article by Rutter et al (2023) made me consider whether we need to review what messages we are providing to our patients and how we are delivering these. The authors explored the challenges that newly qualified dentists experienced in delivering oral health advice to parents and caregivers of young children in the Yorkshire and Humber region; one of the five themes was around motivation for behaviour change and this linked well to another theme around parental receptivity to the messages being provided.

The study identified two aspects to motivation: the parents’ motivation to change, and the practitioners’ motivation to engage in a behaviour change conversation. As many experienced  clinicians will have found, there are no surprises to the findings: the Foundation Dentists discovered that in general, parents did not return diet diaries and, if they were returned, there were questions about whether they were accurate. The lack of embracing positive oral health behaviours by patients created despondency in the practitioners; this is a sad outcome considering how Foundation Dentists are at the start of their career journeys and experiences such as these could hinder them in promoting behaviour change through the rest of their careers.  

Supporting patients to take the next step

We remind ourselves that changing behaviour is part of a cycle; every time we promote healthy habits we are enabling patients to think about making a change (precontemplation and contemplation), and one day, they inform you that they are planning on making that change and have set a date for the change (planning for change) – how wonderful is that! We should be there to support them when they are ready to make that change (action) and guide them if, and when, they relapse.

Reviewing our practices

So, what are dental practices or clinics actively doing to encourage positive oral health behaviours particularly in children? These could include:

  • embracing Dental Check by One in our clinics, by using the British Society of Paediatric Dentistry posters as a promotion tool; this could encourage parents to book an appointment and begin considering healthy habits for their babies which may result in a change for their other children and themselves. BSPD has other useful resources on its website so is worth checking out further
  • utilising extended duty dental nurses to provide health promotion in dental practices, and in outreach, such as schools and the community
  • ensuring children have a toothbrush and are using the correct toothpaste for their needs, and reinforcing the ‘spit, don’t rinse’ message
  • considering undertaking clinical audits of patient records to establish whether the advice being provided is highlighting any gaps; look to see if the messaging is clear and consistent and explore ways this can be improved 
  • reviewing the literature to ensure our skill set is maximised and for us to be open to making change and sharing new information with the whole of the dental team

How we work with the population who are experiencing common oral diseases and difficulties with access, and how we move to a future population free from dental caries, and other preventable oral diseases, is certainly food for thought.

References used in the compilation of this blog:

British Society of Paediatric Dentistry (2017). Dental Check By One. (2017). Available at https://dentalcheckbyone.co.uk/

Public Health England (2017) Health Matters: Child Dental Health. London: Department of Health Publications. Available at https://www.gov.uk/government/publications/health-matters-child-dental-health/health-matters-child-dental-health

Rutter L, Duara R, Vinall-Collier KA, Owen J, Haley I, Gray-Burrows KA, Hearnshaw S, Marshman Z and Day PF (2023). Experiences of newly qualified dentists in delivering oral health advice to parents/caregivers of young children —challenges and solutions. Front. Oral. Health 4. Available at https://eprints.whiterose.ac.uk/199925/1/froh-04-1079584.pdf

Join us for a webinar, in partnership with Haleon, to discover how we’re working together to enhance oral healthcare across the UK and to discuss the findings of our upcoming ‘Dental Health Barometer’ campaign. Join us on Thursday 30 November at 2pm (GMT) – more information and register.

Can you help us in the next phase of our research? We would like to hear from practices around the UK who are interested in hosting an evening focus group to explore preventative oral care advice given within practice – find out more.

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College of General Dentistry Blog

Clinical Dental Technicians: how we can benefit your dental practice

Clinical Dental Technicians Emily Pittard MCGDent and Carmel Vickers-Wall, an Associate Member of the College, examine the role of a CDT and how they can work efficiently and effectively within the dental team.

What are Clinical Dental Technicians?  

Firstly, what actually is a Clinical Dental Technician (CDT)? Well, they are a registered dental care professional who can provide complete dentures direct to the public. They can also provide partial dentures and other dental devices on prescription from a registered dentist.  

What can we do?  

A CDT  is able to oversee the patient’s whole denture journey. They can treatment plan (complete dentures), take the impressions, do a bite registration and then manufacture the denture from start to finish. This results in the patient receiving a high-quality denture, and changes can be made instantly rather than trying to communicate through prescriptions where information can be missed.   Many times, we’ve heard “A CDT is a Dental Technician who just takes impressions”, which isn’t true. A CDT has a large scope of practice and takes on a variety of responsibilities within the dental team:

  • taking impressions
  • taking a detailed medical history
  • carrying out clinical examinations
  • taking and processing radiographs
  • recognising abnormal mucosa and referring to the appropriate healthcare professionals
  • giving appropriate oral health advice

Many edentulous patients won’t see a general dentist as they believe they don’t need to if they don’t have any remaining teeth. This means that they might only see a CDT if their denture breaks, or they feel they need a replacement. Therefore, it is crucial that CDTs have a full understanding of a patient’s mucosa and are able to identify any abnormalities as well as understanding medications in detail and their interactions.  

Clinical Dental Technicians have an extensive knowledge of anatomy, pharmacology, cross infection and health promotion. A CDT can also further enhance their scope of practice by gaining relevant training so that they can re-cement crowns, provide anti-snoring devices, replace implant abutments and provide tooth whitening treatment on prescription.  

How can we be beneficial to your dental team?  

Dentistry is currently in a crisis with some patients unable to see a dentist for up to four years. CDTs can help to alleviate this strain by seeing all denture treatment; allowing dentists to focus on other treatment. Dentures are very time-consuming as they require adjustments and reviews to help the patient acclimatise; CDT’s can take over this entire journey.  

They can also take impressions, see whitening patients, mouthguards and sports guards appointments and, on prescription from a dentist, they can temporarily fit crowns, bridgework and implant work. So how would this work in practice? Let’s take a look at three examples of how a CDT could help to significantly improve a workflow:  

  1. A patient who needs an upper denture but has teeth in their lower arch. Typically, this would take a dentist up to five appointments to get the patient to final fit, and then multiple review appointments. Instead, the dentist could see them for the initial examination and then hand over all the other appointments to a CDT.
  2. A patient who needs a dental implant. A dentist could see the patient up to their uncover and then the CDT could take over, take the impression / scan and temporarily fit the implant crown. The patient would then see the dentist for a review a few weeks later. This requires great communication within the team and a CDT who has knowledge of implants, but it would mean that in the time frame a dentist would have seen one patient for one implant placement, they could have seen two.
  3. A patient who wants a denture on locators. Again, the dentist can place the implants and uncover and then hand over to the CDT who can then complete the treatment for the patient.

These are just a few examples but there are many more. As with any dental professional, to incorporate them into the team workflow will take great communication between clinicians and excellent records, but as that is something that we all intend to maintain as part of our general standards anyway, it shouldn’t take much to adapt to incorporate a CDT.  

A CDT is also the only dental professional who bridges the gap between the dental practice and the laboratory. They have an intimate understanding of dental prosthesis and can help to manage patient expectations; take shades; quickly repair some things; provide teeth in a day and help to treatment plan complex cases.

Q&A

What was your experience like in your first few months to a year post qualification?

Emily:   I was in a lucky position to already be working in a CDT-recognising clinic, however I did find it took forever to be on the GDC register! I had previously worked and gained qualifications as a dental nurse and a dental technician and had been fortunate enough to work in a specialist practice as a Dental Technician under my extended scope of practice. So, I had been taking impressions of denture patients and implant patients and digital scans for a number of years before I qualified as a CDT. This helped me to gain confidence in my clinical skills and after qualifying I opened my own Clinic attached to my Laboratory.  

Carmel:   It was very daunting coming out of university from the new CDT course. Mainly because nobody else was out there who was in a similar position to me. I felt, on one hand, that some Dental Technicians I spoke to weren’t positive about the qualification I held and, on the other hand, general dentists didn’t understand what my job was!! However, I’ve met some fantastic Dental Technicians along the way who have been extremely supportive and provided me with a lot of knowledge and work experience. As I already came from a dentistry background (ex Dental Nurse) I had some good connections in the industry who helped me and I was even lucky enough to be offered a CDT job upon qualifying.

Do you feel like a CDT is a fully recognised member of the dental team by other professionals?

EP: Not at all, I have found that many dental professionals have never heard of a Clinical Dental Technician. I have, however, seen a shift for the better amongst new dentists just qualifying who seem to understand what a CDT can do and how valuable we can be to wider dental team, so it feels like we are moving in the right direction.  

CVW: Sadly not yet. I think this is due to not seeing Clinical Dental Technicians in general practice. We regularly see Dental Hygienists and Dental Therapists and even Orthodontic Therapists, but as CDTs currently don’t have an NHS contract, it means we are predominantly private/independent.

How easy was it to find indemnity or relevant CPD courses?

EP: Almost impossible to find indemnity! I ended up getting indemnity that has elements of every other dental team role in the script as they didn’t have a CDT-specific one!  

CVW: I agree with Emily, I couldn’t believe how few options there were for indemnity. This is the same with CPD. There are very few courses out there specifically designed for CDTs. I figured I’ll have to take courses aimed at the other members of the dental team which I could relate to within my scope of practice.

Emily Pittard is on the Board of the College’s Faculty of Clinical Dental Technology and Dental Technology.

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