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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College of General Dentistry Blog

The right to smile

David Shiers, Gordon Johnston and Vishal Aggarwal FCGDent believe that poor oral health need not be an inevitable consequence of experiencing severe mental illness.

Left to right: David Shiers, Gordon Johnston, Vishal Aggarwal FCGDent

In 2023 there can be no mental health without physical health, and no physical health without oral health. A recent bulletin by the Chief Dental Officer for England highlighted the scale of the challenge in addressing inequality in oral health for people with severe mental illness:

  • On average people with severe mental illness are less likely to engage with oral healthcare, with a studyfinding that only 75% of schizophrenia patients brushed their teeth daily, compared to 96% in the general population.
  • Poor mental health is often linked to other factors such as homelessness or substance use, which also have consequences for oral health.
  • In a meta-analysis of studies, patients with severe mental illness were almost 50 times as likely to have periodontal disease.
  • Patients with eating disorders had five times the odds of dental erosion. In patients with self-induced vomiting, the erosion rate was seven times higher.

Poor oral health may not be simply experienced as painful tooth decay or inflamed gums.  It can have a major impact on the quality of peoples’ lives, including feeling ashamed to open your mouth because of bad breath or unsightly teeth affects how you feel about yourself. Lacking the confidence to laugh, smile, or be close to others, relationships can suffer, and functions as basic as talking and eating may be impaired. 

Moreover, poor oral health may interact with other health conditions like diabetes and heart disease. For instance, poor oral health can upset diabetes control, while diabetes makes gum disease more likely.  Diabetes and cardiovascular disease are particularly prevalent in this population, potentially creating a vicious cycle of interdependent difficulties for an individual.

Yet oral health is a forgotten health inequality. There is a growing interest in the importance of protecting the physical health of people with severe mental illness, but while welcome targets and strategies exist to tackle health inequalities for cardiovascular disease and diabetes, oral health remains largely ignored.  Research has also largely ignored the need to improve outcomes for oral health of this vulnerable group.  We need more understanding of what interventions work best, particularly in the early phase of psychosis; yet only one study to date has investigated this, The Three Shires study, which found that monitoring alone may be insufficient to change oral health outcome.

So what can general dental teams do? Oral health practitioners know that an ounce of prevention worth a pound of cure, and dental diseases like tooth decay, gum disease and oral cancer are preventable if good oral self-care behaviours are implemented at the outset. These include regular toothbrushing with a fluoride toothpaste, reducing frequency of sugar intake, and cessation of smoking and alcohol intake. We therefore need to shift our focus from ‘downstream’ treatments that commonly involve extraction of teeth and are offered in crisis for advanced tooth decay and gum disease, to ‘upstream’ prevention and early intervention when a diagnosis of severe mental illness is first established.

While the importance of supporting the physical health needs of people experiencing severe mental illness is now widely accepted, the consensus statement The Right to Smile advocates for a ‘whole-person’ approach which recognises that there can be no health without oral health.  

To achieve this requires a ‘whole team’ approach right from the start, prioritising oral health from the onset of severe mental illness. The patient and their close supporters such as family must be actively engaged at the centre of the team in discussions about oral health. The mental health practitioner or team responsible for early diagnosis and treatment should consider oral health needs from the outset. The dental professional is responsible for ensuring optimal oral health but should also be alert to possible severe mental illness in individuals attending with unusual dental presentations. They must also be aware that people with psychosis are a high-risk group for poor oral health including oral cancer. Finally, commissioners need to prioritise dental access for people with severe mental illness as a vulnerable group, for instance ensuring the availability of free or subsidised care.

There are many opportunities for dental services to support people with severe mental illness. They can recognise and prioritise their oral health needs by initiating early intervention to prevent poor oral health outcomes. They can adopt a whole-person approach in managing the impact of poor oral health on severe mental illness, particularly in relation to social avoidance from poor oral health outcomes related to bad breath and poor aesthetics. And they can be aware of dental presentations of severe mental illness which can alert to a possible diagnosis, and provide immediate onward referral to mental health services if severe mental illness is suspected from dental presentations.

It’s time to raise the expectations of those using mental health services to receive higher standards of oral healthcare. If we equip people with the right knowledge and skills, while supporting the adoption of healthy routines including regular dental check-ups before things go wrong, we can make a real difference to an individual’s health and their wellbeing.

Vishal Aggarwal FCGDent is a clinical academic dentist, currently Clinical Associate Professor in acute dental care and chronic pain at University of Leeds Dental School, with research and clinical interests including improving oral health outcomes in vulnerable populations. David Shiers is a carer and former Joint National Lead for the Early Intervention in Psychosis Development Programme (2004-10), and an expert advisor for the NICE Centre for Guidelines. Gordon Johnston is a peer researcher with lived experience of bipolar.

The Right to Smile consensus statement was developed by an oral health group spanning experts with lived experience and colleagues from primary care, mental health, and dentistry. The group was established by the Closing the Gap Network

Download The Right To Smile consensus 

References:

  • NHS England and NHS Improvement, Special focus: Dentistry and patients with mental illness. Your NHS dentistry and oral health update. 2021 Nov; issue 32. https://createsend.com/t/d-79BC6639C9930B492540EF23F30FEDED
  • McCreadie, R.G., Stevens, H., Henderson, J., Hall, D., McCaul, R., Filik, R., Young, G., Sutch, G., Kanagaratnam, G., Perrington, S., McKendrick, J., Stephenson, D. and Burns, T. (2004), The dental health of people with schizophrenia. Acta Psychiatrica Scandinavica, 110: 306-310. https://doi.org/10.1111/j.1600-0447.2004.00373.x
  • Adams, C. E., Wells, N. C., Clifton, A., Jones, H., Simpson, J., Tosh, G., … & Aggarwal, V. R. 2018. Monitoring oral health of people in Early Intervention for Psychosis (EIP) teams: The extended Three Shires randomised trial. Int J Nurs Stud, 77, 106-114.   https://pubmed.ncbi.nlm.nih.gov/29078109/
  • Kisely S, Baghaie H, Lalloo R, Siskind D, Johnson NW. A systematic review and meta-analysis of the association between poor oral health and severe mental illness. Psychosom Med. 2015 Jan;77(1):83-92. doi: 10.1097/PSY.0000000000000135. PMID: 25526527.
  • Turner E, Berry K, Aggarwal VR, Quinlivan L, Villanueva T, Palmier-Claus J. Oral health self-care behaviours in serious mental illness: A systematic review and meta-analysis. Acta Psychiatr Scand. 2022 Jan;145(1):29-41. doi: 10.1111/acps.13308.
  • Kang J, Palmier-Claus J, Wu J, Shiers D, Larvin H, Doran T, Aggarwal VR. 2022. Periodontal disease in people with a history of psychosis: Results from the UK Biobank Population-based Study. Community Dentistry and Oral Epidemiology
  • Turner E, Berry K, Quinlivan L, Shiers D, Aggarwal V, Palmier-Claus J. 2023. Understanding the relationship between oral health and psychosis: qualitative analysis. British Journal of Psychiatry. 9(3)
  • Elliott E, Sanger E, Shiers D, Aggarwal VR. 2022. Why does Patient Mental Health Matter? Part 3: Dental Self-Neglect as a Consequence of Psychiatric Conditions. Dental Update.
  • Elliott E, Sanger E, Shiers D, Aggarwal VR. 2022. Why does Patient Mental Health Matter? Part 2: Orofacial Obsessions as a Consequence of Psychiatric Conditions. Dental Update.
  • Aggarwal VR, Sanger E, Shiers D, Girdler J, Elliott E. 2022. Why does Patient Mental Health Matter? Part 5: Chronic orofacial pain as a consequence of psychiatric disorders. Dental Update.
  • Elliott E, Sanger E, Shiers D, Aggarwal VR. 2022. Why does Patient Mental Health Matter? Part 4: Non-carious Tooth Surface Loss as a Consequence of Psychiatric Conditions. Dental Update.

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College of General Dentistry Blog

Why I became a Life Fellow

Alasdair Miller FCGDent talks to Nairn Wilson CBE about becoming one of the first Life Fellows of the College.

Alasdair Miller FCGDent (left) and Nairn Wilson CBE FCGDent (right)

Nairn: Alasdair, first and foremost congratulations on becoming a Life Fellow of the College. A few questions, if I may; firstly, what do you hope to contribute to the College as a Life Fellow and member of the 1992 Circle?

Alasdair: I was attracted to the College as its career pathway seemed ideally suited to a practitioner’s working life and rather mirrored my less structured career development with life-long learning at its heart. I have been very fortunate in my career and becoming a Life Fellow and member of the 1992 Circle allows me to stay in touch and continue to contribute.  I have assisted with the development of the College’s Certified Membership scheme, based on my experiences as Programme Director of Bristol University’s Open Learning for Dentists and updating the arrangements for Certified Membership Facilitators. Life Fellowship was a logical progression for me: FFGDP to FCGDent to Life Fellow, to support the College as it develops and give something back.

NW: Growth in the number of retired and, in particular, Life Fellows would be a great boon for the College. Why should retired colleagues eligible for FCGDent ‘By Equivalence’ or ‘By Experience’, who are not yet members of the CGDent, consider joining the College?

AM: I have always enjoyed the collegiate nature of the profession and company of colleagues. The College, specifically the 1992 Circle provides a ‘home’ for like-minded retired colleagues who wish to stay connected and involved in the profession, albeit they are no longer practising. Fellowship of the College ‘By Equivalence’ or  ‘By Experience’ allows retired colleagues to have their professional experience and achievements recognised and valued, with opportunity, amongst other things, to support young colleagues and put something back into the profession.

NW: What message would you like to send to existing retired Fellows of the College to encourage them to become Life Fellows?

AM: If one is retired and a Fellow, I would ask: What’s stopping you becoming a Life Fellow? In so doing, you provide invaluable support to the fledgling College, helping it to grow and prosper to become the Royal College all Fellows wish it to become.

NW: Is it a strength of the College that all members may aspire to becoming a Life Fellow in retirement?

AM: Yes, it is a strength, specifically as it applies to all members of the dental team. While becoming a Life Fellow in retirement is a personal choice, I hope that all retired Fellows, present and future will consider it a way of enabling the College to continue to grow and prosper.

NW: Finally, as one of the College’s first Life Fellows, what would you most like the College to achieve as it continues to grow and prosper?

AM: I hope the College’s Career Pathway will be valued by the profession and as many practitioners as possible travel up it and become Fellows. Having a structured plan for professional development that is customised to one’s own aspirations and circumstances is unique. The Pathway is a way to have your career development recognised and validated, whilst at the same time acquiring skills and knowledge in areas of interest that support a member’s professional aspirations. It encourages continuous improvement for the benefit of patients, the profession and the professional. I anticipate the College developing programmes that enable College members and others to meet the challenges of modern practice life. In the process, it is to be hoped that the College will be granted a Royal Charter.

NW: Alisdair, many thanks for your insightful views and comments. It is most encouraging and reassuring to know that the College will be able to avail itself of your wisdom and wise counsel during your lifetime.  Thank you on behalf of the College for your commitment and most generous support. Enjoy being a Life Fellow.

Subject to being 65 or over and no longer registered with the GDC or an equivalent body, eligibility for Life Fellowship of the College is automatic for retired former Fellows of the FGDP, and for retired current or former Fellows of CGDent, the Royal Australasian College of Dental Surgeons, the American Academy of Implant Dentistry or any of the faculties of dental surgery or dentistry of the Royal Colleges of the UK or Ireland. Retired colleagues from across the spectrum of oral healthcare who satisfy the criteria for Fellowship are also encouraged to apply. Further information is available here.

Nairn Wilson is President Emeritus of the College. Those interested in becoming a Life Fellow are invited to contact him at [email protected]

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College of General Dentistry Blog, Careers

From dental nursing to senior academic in dentistry: a personal career journey

Dr Louise Belfield AssocFCGDent is the College Council‘s Dental Nursing & Orthodontic Therapy Representative and Chair of the College’s Research Advisory Panel. The first dental nurse in the UK to achieve a PhD, here she reflects on the key moments, influences and lessons from her career to date.

My career in dentistry started at the age of 17 with an apprenticeship in Dental Technology. I worked as a trainee Dental Technician for 18 months and developed skills in crown and bridge work. During this time, I wondered with increasing frequency about the patients we were making prostheses for and decided to apply for a patient-facing role as a Dental Nurse. I trained in a small mixed NHS and private practice, and in 2003 gained my National Examining Board for Dental Nurses (NEBDN) Certificate in Dental Nursing. I was fortunate to work with a supportive team, and I was proactively included in continuing professional development (CPD) activities. The critical CPD event that changed the trajectory of my career in dentistry was a session exploring the links between periodontal diseases and systemic conditions, such as diabetes and cardiovascular disease, and how the oral microbiome might connect them. This sparked my curiosity and drive to find answers. What might this mean for our patients? What might we be able to advise if we knew more about it? The only path forward that I could see was to embark on scientific training at university.

The decision to leave my practice and enrol on a university degree was a difficult one because I was very happy where I was, and I enjoyed Dental Nursing. As I had gone straight into apprenticeship after leaving school, I chose a BSc in Human Biosciences university course which included a “Year Zero” to cover the prerequisite scientific knowledge in lieu of traditional A-levels. Throughout the university course I continued practising as a dental nurse, working as bank staff for a local hospital trust. This provided invaluable experience and kept me clinically active in the profession. I worked across a range of settings, including domiciliary care, school visits, emergency clinics, dental access centres, special care dentistry, and even on a mobile dental surgery van. I also worked at an emergency out-of-hours weekend service, and in a private practice which I fitted in around my lectures.

It became apparent to me through the course of my studies that it was the immune system that was the pivotal link between periodontal and systemic diseases, and in the final year of my degree course I focused my studies on the periodontal pathogen Porphyromonas gingivalis, and how it interacts with immune cells. This formed the basis of my further studies leading to a PhD, investigating how these immune cells behave in response to P. gingivalis when they are involved with oral cancer or chronic inflammation. As is often the case at the end of a PhD, there were many new questions formulating and I knew I wanted to continue to investigate these relationships further to answer some of these questions.

Career in dental research and education

At the end of my doctoral studies, an academic position became available and I was appointed as a Lecturer in Biomedical Sciences in 2013. This has enabled me to explore both the scientific and educational facets required in an academic career, and I have been able to establish research in both of these areas. My scientific research focuses on host-pathogen interactions, and I have been fortunate to work on multiple projects, including development of three-dimensional oral mucosa models, association of subgingival lipid A profiles with periodontal disease status,1,2 and in 2019 I received the Colgate Robin Davies Dental Care Professional Research Award from the Oral and Dental Research Trust (ODRT), for a project investigating modulation of osteoclast differentiation and activity by endotoxin tolerance. This Dental Care Professional (DCP) specific award was instrumental in developing an independent research career and I remain grateful to the ODRT for the opportunity.

Subsequently, working together with two colleagues at the University of Plymouth, we established the Oral Microbiome Research Group, where we run clinical and translational research investigating links between human health and disease, and oral bacteria. Two current clinical studies link the oral microbiome with pre-eclampsia, and formation of cerebral abscesses.3 Our research also explores how modifying the oral microbiome can be detrimental to maintaining oral and physiological health mechanisms; a study using chlorhexidine mouthwash to disrupt the normal microbiome found that a decreased diversity of species was associated with a decreased salivary pH buffering capacity, increased lactate and glucose levels, and reduced availability of nitrate and nitrite, with an associated increase in systolic blood pressure.4

Alongside my scientific research, I have also been able to develop scholarly activity, with a focus on inter- and intra-professional education, particularly relating to assessments and standard setting in multi-cohort programmes.5,6 Having come into higher education via a non-standard route, an area I have been particularly keen to invest in is access and participation, and a significant part of my academic role has been to develop a Foundation (Year Zero) entry pathway for the BSc Dental Therapy and Hygiene programme at Peninsula, with the specific focus on Dental Nurses, who make up the majority of our cohort. This Foundation pathway has been running successfully now for three years, and we will welcome our first cohort of BDS year zero students in September 2023, specifically designed to enable fairer access to dental education for local, South West students with non-traditional entry backgrounds.

Engagement with the professional community

I remain actively engaged with the Dental Nursing community through a number of external roles; I uphold my registration with the General Dental Council (GDC), and I am a trustee for the NEBDN, where I also chair the Education Standards Committee. In 2020, I was appointed as a Dental Clinical Fellow with Health Education England, which continues to afford me an insight into NHS dentistry, service commissioning, workforce challenges, DCP skill mix, and training needs, in line with the Dental Education Reform Programme.7 I am also a representative for Dental Nursing on the Council of the College of General Dentistry (CGDent), and with a dedicated and experienced team, we are working to establish the first Faculty of Dental Nursing. I am also grateful to the College for the opportunity to chair the Research Advisory Panel, espousing the message that research is open to all dental professionals.

Key learning points and recommendations

Instrumental in my career have been support and encouragement from those I work with, and seizing opportunities despite the frequent imposter syndrome! While by no means perfect, there tends to be more clarity in the pathway to an academic career for dentists, which is lacking for other dental professionals, which means it can be extra challenging to carve your own route. Promisingly, I come across more and more outstanding DCPs in academic positions and I hope this will continue. This is one of the reasons I am excited about the CGDent Career Pathways in Dentistry: Professional Framework and the establishment of the faculties, and to promote the CGDent vision to make research opportunities accessible for all members of the dental team, to pro-actively support Dental Nurses and all team members to excel in their profession to their fullest potential.

The skills and experience I accrued as a Dental Nurse helped me to progress in other areas, including academia and research; working as a bank dental nurse had its challenges, arriving each morning to a new practice, with different staff, surgery set-ups and protocols was difficult at times, but I learned to be adaptable, and to think on my feet. Communication and team working skills were vital; and I was privileged to work with a variety of patients with their own range of perspectives and experiences and I learned a lot from them. Finally, working in a high-pressure environment, developing effective time management was crucial to being a competent Dental Nurse and these skills have also served me well in academia. I would wholeheartedly encourage anyone with an interest in research or an academic career to pursue that, to reach out to potential mentors or advisors for guidance, and to explore the CGDent Career Pathways frameworks, as well as membership of the College and its Faculties.

References

1. McIlwaine C, Strachan A, Harrington Z, et al. Comparative analysis of total salivary lipopolysaccharide chemical and biological properties with periodontal status. Arch Oral Biol. 2019;110:104633.

2. Strachan A, Harrington Z, McIlwaine C, et al. Subgingival lipid A profile and endotoxin activity in periodontal health and disease. Clin Oral Investig. 2019;23(9):3527-3534.

3. Roy H, Bescos R, McColl E, et al. Oral microbes and the formation of cerebral abscesses: A single-centre retrospective study. J Dent. 2023;128:104366.

4. Bescos R, Ashworth A, Cutler C, et al. Effects of Chlorhexidine mouthwash on the oral microbiome. Sci Rep. 2020;10(1):5254.

5. McIlwaine C, Brookes ZLS, Zahra D, et al. A novel, integrated curriculum for dental hygiene-therapists and dentists. Br Dent J. 2019;226(1):67-72.

6. Zahra D, Belfield L, Bennett J. The benefits of integrating dental and dental therapy and hygiene students in undergraduate curricula. Eur J Dent Educ. 2018;23(1):e12-e16.

7. NHS Health Education England (HEE). New plans for dental training reform in England to tackle inequalities in patient oral health. HEE. 21 September 2021. [Internet]. Available at https://www.hee.nhs.uk/news-blogs-events/news/new-plans-dental-training-reform-england-tackle-inequalities-patient-oral-health-0 [Accessed Dec 2022]

This account was first published in the Primary Dental Journal (vol. 12, issue 1, March 2023)

Update (June 2023): Since this article was published, Louise has been appointed Academic Head of Assessment at Brunel University Medical School and has stood down from the College Council to focus on her new role; however she remains on the College’s Research Advisory Panel.

College of General Dentistry Blog

2022-2023: the year in review

.Janet Clarke MBE FCGDent, Chair of Trustees, reviews the College’s achievements over the last twelve months.

The transfer of FGDP to the College of General Dentistry in July and August of 2021 was not the end of a process, but just the beginning for the new organisation…

The first few months were dominated by the immense task for the small staff team, of building the necessary infrastructure to support our members and embark on the broader mission that we have set for ourselves. That work continued into 2022 – not just in building a College for the future, but re-thinking our role as an independent professional body, in the modern, post-pandemic world.

The most significant keystone for the College’s future will undoubtedly prove to be the Career Pathways that we have been developing in this time, culminating in the publication of the underpinning Professional Framework in June. So why is this quite so significant?

Dentistry, alongside so many other healthcare professions, faces immense challenges in attracting and retaining the talented people that will define the character of the profession for a generation, and inspiring the best from them. Yet dentistry in the UK faces a greater challenge than other healthcare professions, in lacking the structure and support of a national structure for progression, outside the Specialist Dentist pathway. Our Career Pathways provide a concrete, but adaptable framework, across the entire dental team, upon which we and others can now build the opportunities and recognition that dental professionals crave. It starts with College membership: we now have a clear point of reference for defining the ways in which your membership can reflect your capabilities and experience in dentistry.

Early this year (2023) we opened our Certified Membership scheme to a first group of candidates: a modern approach in supporting dental professionals to find their way and build a career in a fast-moving and confusing world. A chance to fully recognise their commitment and capability. It has been gratifying to see the immense level of interest in Certified Membership across so many organisations that are grappling with the workforce challenges we have been working to address, including regulators, policy makers, and dental corporates.

In April 2022, we launched our new Fellowship by experience, bringing new opportunity for highly accomplished dental practitioners, across our community, to be recognised. We have been delighted with the response, with a significant number submitting applications. The eligibility criteria are being further developed to embrace the great diversity of senior professionals. Feedback has been so positive: at last, we are told, their work can be properly acknowledged.

The College aims to build an authoritative community of leadership in dentistry, enabling the professional team to engage constructively with the challenges for all. In January, we hosted our first Fellows’ Winter Reception in Manchester, to complement the Summer Reception which has attracted an impressive group in the past two years. This is an inspiring occasion in itself; but important, too, in our ambitions to attract active support from those with the influence to make a positive difference in dentistry – harnessing their energy in a common cause. In the same vein, we also hosted our first meeting of the 1992 Circle in Manchester: nurturing the community of outstanding dental professionals in retirement, many of whom have so much more to give to support the profession that has been central to their lives. 2022 marked the 30th anniversary of the foundation of FGDP, and the 1992 Circle celebrates that anniversary in its title, providing the opportunity to reflect on all that the Faculty achieved, and inspiring us in our continuing mission today.

CGDent is now the authoritative body for standards in dentistry, building on the highly respected work of FGDP and reflecting our commitment to setting standards, supporting careers. We continue to revise and update our standards to serve the profession, but also to extend into other areas where we see a need to support the profession. In 2022, we published our Implant Dentistry Mentoring Guidelines, and plan to do more in the arena of implant dentistry in 2023.

One of the major areas of interest for FGDP under Ian Mills’ leadership was diversity in the profession, and we have continued that work in CGDent. Most notably, we are pleased to host the Diversity in Dentistry Action Group, previously hosted by the CDO for England. We have hosted a number of important webinars on the subject, all of which are available to members online.

We have continued the FGDP partnership with Dental Protection to offer a significant discount for Full Members, Associate Fellows and Fellows – but now, with our wider remit, we are delighted that Dental Protection have been able to extend their offer to all dental professionals. All our work aims to address the needs of the whole team, and this is a welcome step in line with our overall philosophy and mission.

Twelve months after the opening of the College for business, we were pleased to publish a special issue of the Primary Dental Journal to mark our own special anniversary: a year since the activation of CGDent. The journal continues to thrive, with a number of notable issues in this past year. The number of high-quality articles submitted to the journal has also increased, as illustrated by the special back-to-back “general issues” that were published in 2022.

Your College depends on the support of its members. These are historic times, as we seek to fulfil the long-held ambition in dentistry for our own Royal College, but that goal cannot be achieved without a strong membership. Help us build that support – which translates into a richer offer for all members, greater authority in the profession generally, and ultimately better advocacy for our patients.

Your membership helps to secure our future: we must not let this opportunity pass us by.
Do tell friends and colleagues!

Sadly this will be my last blog as I stand down as Chair of Trustees at the end of March. I have very much enjoyed my time as Chair and am incredibly proud of what we have achieved. I am delighted to be handing over the role to Mick Horton, so I know the College’s Trustee Board is in safe hands!

You may be interested in Janet’s blog reviewing the College’s inaugural Annual Members’ Meeting in March 2022…

An Historic Event, the first Annual Members’ Meeting – were you there?

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College of General Dentistry Blog

Updating postnominals

Professor Emeritus Nairn Wilson CBE FCGDent, Honorary Founding President of the College, encourages former members and fellows of the FGDP, together with colleagues who have recently joined CGDent, to update their postnominals.

While honours and university degree postnominals may normally be used throughout life, the use of postnominals linked to membership and fellowship of colleges, academies and other bodies, including memberships and fellowships earned by examination and assessment, is more complex.

The College has previously issued guidance on the continuing use of postnominals awarded by the Faculty of General Dental Practice (FGDP). This guidance states that, while postnominals relating to diplomas awarded by FGDP(UK) and the Royal College of Surgeons of England – i.e. Dip. MFGDP(UK), Dip. FFGDP(UK), Dip. MJDF, DGDP (RCS Eng.), Dip. MGDS (RCS Eng.), Dip. Imp. Dent. (RCS Eng.) and Dip. Rest. Dent. (RCS Eng.) – were not affected by the transfer of FGDP(UK) into CGDent, postnominals which conveyed ongoing membership or fellowship of FGDP(UK) – i.e. MFGDP(UK) and FFGDP(UK) – should no longer be used, as the FGDP(UK) no longer exists.

The only exceptions to these arrangements are honorary memberships and fellowships of FGDP(UK), i.e. Hon. MFGDP(UK) and Hon FFGDP(UK), which are honours rather than denoting ongoing, substantive membership.

Continuing use of the redundant, membership-specific Faculty postnominals MFGDP(UK) and FFGDP(UK) could be considered misleading, specifically to patients, and therefore to contravene the GDC’s guidance on advertising.

Equally, failure to use recently acquired CGDent postnominals – MCGDent, AssocFCGDent or FCGDent – contributes to the unhelpful misunderstanding that dentistry continues to lack its own independent standards setting body.

In addition, it fails to convey our professional standing, and our commitment to the CGDent Code of Conduct and, in turn, the standards established and promoted by the College, to other healthcare professions, and more importantly to patients.

In updating their postnominals, former members and fellows of FGDP(UK) who have not yet joined CGDent may replace their redundant FGDP(UK) postnominals with CGDent ones by doing so – former members and fellows of FGDP(UK) being eligible, respectively, for MCGDent and FCGDent.

In this process, there is opportunity for former members of FGDP(UK) who have obtained experience and postgraduate qualifications since obtaining their FGDP(UK)/RCS Eng. diploma to apply for Associate Fellowship (AssocFCGDent) or even Fellowship (FCGDent) of the College ‘by experience’ or ‘by equivalence’.

Also, all retired oral healthcare professionals (i.e. colleagues who are no longer GDC registrants) who wish to maintain a link with their chosen profession, are most welcome to join the College through its ‘by experience’ or ‘by equivalence’ processes, with opportunity for those who become Fellows (FCGDent) in retirement to join the College’s recently established 1992 Circle.

The College’s online register of current members can be used to confirm the membership status of any individuals using CGDent postnominals.

The College will be most pleased to assist former members and fellows
of FGDP(UK) in updating and possibly upgrading their postnominals, together with all other oral healthcare professionals, both in the UK and elsewhere, wishing to join CGDent, which is increasingly gaining recognition and standing as a ground-breaking, world-first for the dental team – just get in touch with us here

This blog is adapted from a Letter to the Editor published in the British Dental Journal on 10 February 2023.

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College of General Dentistry Blog

How to be a dentist

Dr Shaun Sellars AssocFCGDent, general dental practitioner and co-host of the Incisive Decisive podcast on the philosophy and ethics of dentistry, has conducted detailed research into non-clinical skills in dentistry. Here he considers the ‘soft skills’ that improve patient care.

What makes a dentist? You might say that having a BDS and physically drilling, filling and extracting is all it takes. But I’d argue that there there’s more to it than that. To be a dentist, and importantly to be a ‘good dentist’, we need to develop a whole host of distinct and less well-understood non-clinical skills to complement our clinical abilities.

Undergraduate teaching has historically focused on developing the practical skills trainee dentists need to become competent clinicians. These ‘hard skills’ consist of the necessary knowledge and techniques students attain during training. While these clinical skills are critical to dentistry, it has become increasingly recognised that non-clinical attributes are also valuable assets to the dental practitioner. While considered ‘soft’, non-clinical skills are hard to learn and often overlooked because they don’t directly add to our clinical repertoire.

When we consider these softer skills, most people instantly think of communication. While communication skills are essential, soft skills are wider-ranging, incorporating empathy, leadership, professionalism and more. And if we can’t develop our non-clinical skills alongside our more practical ones, our lives as dentists can be fraught with difficulties. Having talked to dentists extensively about this, most agree that, at least further along in our careers, we will rely on our non-clinical skills much more than our clinical ones. The act of clinical dentistry often becomes second nature over time, but the challenge of interacting with people is fresh every day. The concept of emotional intelligence (EI) is vital to mastering these interactions. EI is, by definition, the capacity to be aware of, control, and express one’s emotions and to handle interpersonal relationships judiciously and empathetically. In practice, people with a high level of EI tend to have better social interactions, and for us, that means a better relationship with patients, work colleagues and peers.

Fortunately, EI and other non-clinical skills can be taught and developed. Russian psychologist Lev Vygotsky (1896-1934) developed the concept of the zone of proximal development (ZPD), from where people learned new skills. Vygotsky proposed that the ZPD could be expanded and knowledge gained, with the help of “more knowledgeable others”, such as peers or mentors, who could impart their wisdom. We cherry-pick the information we most closely relate to and incorporate that into our knowledge base. This doesn’t just increase our comprehension but helps us interpret what we already know in a different light adding a depth of insight to our understanding. All our skills develop in this manner, from a new clinical technique to a method of dealing with a difficult patient situation.

Our non-clinical skills also help us develop into ‘good dentists’. Or, more accurately, as there is no specific ‘good dentist’ template, they allow us to practice ‘good dentistry.’ This is more than just ensuring that our composites are aesthetically pleasing and that our crowns fit well. Good dentistry takes a less uniform approach to what makes a good professional because, in reality, good practice comes from a complex jumble of factors.

Much like our clinical skills, soft skills are best learned and developed through doing. Non-clinical skills are often difficult to pin down, so working on your own management or communication style, for example, is essential. Using the knowledge you’ve assimilated from those around you to hone your professional persona is vital and happens even if you’re unaware of it. Better to consciously take ideas and concepts from those who have already achieved success and whose professional attitude you admire.

Dental school teaches us how to do dentistry, but we must learn how to be a dentist. That involves surrounding ourselves with what we consider good practice and emulating it. All the time, building on what we know with other examples of good practice. This way, the profession builds on what’s been before it and emerges stronger. As Vygotsky suggests, the people we choose as mentors strongly influence how we develop as practitioners and, in turn, how the profession evolves. So choose your mentors wisely, not just from the realms of key opinion leaders or social media personalities we’re constantly exposed to but from the more discreet masters of their craft who quietly influence us to be better.

The College has recently launched its new Certified Membership scheme, which provides dental professionals with a structured learning programme to help us recognise and develop the skills we need in order to provide the best care to our patients – including the soft skills I’ve been discussing.

Certified Membership is underpinned by the College’s Career Pathways and Professional Framework, which describe the knowledge, skills, experience and behaviours a dental professional could be expected to demonstrate at each stage of their career. These attributes fall into five areas: clinical and technical, professionalism, reflection, development, and agency and aim to encompass the full range of abilities we need as dental professionals today.

Certified Members are guided through the learning programme by a trained Facilitator, who helps them realise their existing skills, plan further development and identify new skills to work towards acquiring as they develop their career.

Find out more about Certified Membership and how to enrol as an existing member or join the College and sign up for the scheme.

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