College of General Dentistry Student Advice

Reducing risk at the chairside

Dr Antony Visocchi, General Dental Practitioner and Independent Dental Expert Witness, explains how practising with ethics, morality and integrity will help you reduce the risk of litigious action.

We all know that dentistry is a challenging profession. In these days of increased legislation, tighter financial constraints and a blossoming blame-culture, working in a busy practice whilst taking care of your patients is a very tall order.

Having now worked for over 20 years in general dental practice, I have gained a great deal of knowledge and experience and I have drawn together some of that experience which you may find helpful. 

In my opinion, the best way to deal with the threat of litigious action is to minimise the chances of it happening in the first place. Nonetheless, complaints will occur. What we can do, is practice in the patient’s best interests with the ethics, morality and integrity that will allow these matters to be dealt with quickly and as painlessly as possible. 

I would advise you to ensure you maintain good relationships with colleagues and patients, you can communicate well, are empathetic, are humble and are confident that you follow a robust system that is employed each and every time, regardless of the apparent insignificance of the task. This will not avoid complaints, but it should stop most in their tracks and allow a degree of assurance that you have done your best. In the end, that is all any of us can do.

Communication

Of all the virtues to master, I think communication is king. Use simple techniques when discussing matters with your patient. For instance, sit the patient upright, wheel yourself to the front of the patient so your eye levels are the same, use good eye contact and remember to listen to the patient. 

Be precise in your speech, avoiding jargon, and use terms appropriate to the patient. Constantly check if the patient follows what you are saying by asking; “does that make sense?”, “do you have any questions?” and “what do you think?”.

Try to assume an air of confidence, even if you don’t always feel that way! This is very important when dealing with matters that do not go to plan. Not only does this keep a lid on things, but you will have a better chance of getting things back on track. 

Humility

I recommend carrying yourself with humility. Yes, you are a highly qualified health care professional who worked extremely hard to get where you are. However, regardless of the qualifications you have achieved and the string of letters after your name, it all counts for nothing if you do not have the humility and empathy to go with it. 

Build strong relationships

Spend time at the beginning of your career building relationships that will provide a stable, supportive, empathetic and appreciative base for your working life. This will be invaluable if you find yourself backed into a corner. Patients will be more forgiving and colleagues will go that extra mile.

Mistakes will happen

You will make mistakes. If you don’t, you will not learn and will not become the clinician you want to be. Your mistakes have to be embraced. Be prepared to hold your hands up, apologise when appropriate to do so, and genuinely convey that you will do all you can to put it right.  Don’t ignore a complaint and hope the problem goes away. It is always worth reflecting on what happened to prevent the situation recurring. 

Vigorous systems

I think it’s a good idea to establish a vigorous system to follow. Get in the habit of writing contemporaneous, clear and accurate clinical records. If you use custom screens or autonotes, be sure to personalise them to the patient you are treating. Always ensure some “free writing” is added to the notes and the custom screen and/or the autonotes are not left as the sole entry.

Advice sheets

Have a bespoke advice sheet for all your common procedures. Record when these are given to the patient but ensure you also go through it verbally. It is not normally recommended to complete complicated or extensive procedures at the same appointment that consent was obtained. In that case, you must remember that consent is a dynamic and ongoing process. When the patient comes back, ask them if they read the advice sheet, understood it and are still in agreement that the treatment is what they want. 

Make the advice sheets simple but include all requirements; all the treatment options; advantages and disadvantages of each, risks, what would happen if the treatment was not accepted, success rates, long term consequences. A flow-cart works well. This is a good way of ‘testing’ if the patient has understood your proposals. You can then confidently record in the clinical records “satisfied informed consent obtained”.

Additional aids to communication can be added to the advice sheet and used to good effect; photographs, diagrams, Youtube videos. If you suggested that they watch a video on Youtube, again, you can as at the next appointment “what did you think?”.

Don’t give in to patient demands

Refrain from doing treatment that the patient demands which you do not think is in the patient’s best interests. If the patient insists that they want treatment which is against your advice or better judgment, in my opinion it’s best to bail out! This is not an easy conversation, but it is far easier than dealing with a complaint. 

Respect and trust

Win your patients’ respect and trust. If a patient has sleep-loss, constant pain and/or a swelling – I always try and do something straight away to help them even if my schedule is tight. If  something does not go right in the future, you have a solid, trustworthy relationship with the patient, hopefully making them less likely to complain.

Like everything in life, a balance must be struck. First and foremost, I believe that, in order to allow us to maintain ethics whilst having longevity in this profession, we must first look after ourselves. You cannot pour from an empty cup. My advice, then, in order to tread a sound and safe professional ethical path is to strike a balance when treating all our patients between compassion and professional detachment. But please always remember the line from the Hippocratic Oath; do not treat a tooth, pathology or an edentulous saddle but a “sick human being”.

The views and opinions expressed in this post are not necessarily those of the College of General Dentistry.

Author bio

I have been in general dental practice for over 20 years. I provide expert witness reports for the General Dental Council and dental indemnity providers as well as clinical negligence and personal injury solicitors. I now split my professional life between clinical care, mentoring colleagues, dental practice compliance advice, dento-legal work, dental practice inspections, teaching and examining. In 2016, I attained the Cardiff University Bond Solon Civil Expert Witness Certificate and am now undertaking an LLM in Medical Law and Ethics as well as working to complete the portfolio for FFGDP(UK).

This student advice blog was originally published by FGDP(UK) in February 2019 and has been republished by the College of General Dentistry with the author’s permission.

College of General Dentistry Careers, Student Advice

Where will your career take you?

Dr Sahar-Tara Aghababaie, part time Dental Associate in North West London, recommends making a clear career plan to help you steer your career in the right direction.

Whilst you’re currently in dental school, how much thought do you give to your career development 5, 10 or even 20 years after graduation? Any plans you may have will certainly need to be flexible enough to reflect the changes the profession will undoubtedly go through over the coming decades. 

I graduated from King’s College in 2015 but soon discovered that once you graduate, the learning never really stops. And that’s the wonderful thing about dentistry – it’s definitely not a ‘one size fits all’ career path. The profession is constantly evolving and developing, and as a clinician you will need to ensure you have a good grasp of these changes – not just for your own personal development, but also to ensure you provide the best quality of care for your patients. 

During my dental foundation year I completed my MJDF exam and then undertook further post-graduate training on a one-year course in Dental Education, as I have a keen interesting in teaching in the future. So, I would say to any dental student – post-graduate training is paramount!

Many young dentists agree the main challenge facing them is working within the current NHS system. Dental school certainly helps prepare you for practice, building the core clinical skills needed to be a dentist, but it doesn’t really prepare you for the minefield of UDA targets, associate contracts, accounts and finances, the ever present fear of litigation and of course, rising indemnity and registration fees. All of these can place a lot of pressure on newly qualified dentists and might cause some to lose the drive and motivation to further their careers. 

Through every stage of my professional journey, I have been fortunate enough to have key people to support me along the way. In addition to my strong family unit, key clinical tutors at dental school gave me a solid clinical foundation, my principal in general practice who has been guiding me through the challenges of managing a dental practice, and most recently the consultants I work with currently, who are providing new insight and guidance on further specialisms in Dentistry. They, along with my mentors, have supported both my clinical and professional development – which is paramount for any dentist, whatever stage they are in their careers. 

In 2017 I passed my MJDF exams and became a member of the Royal College of Surgeons and Faculty of General Dental Practice. But as the saying goes, ‘it’s who you know, not what you know’, and the same can be true in Dentistry. Becoming a member of FGDP(UK) offered the opportunity to network within the profession, which has allowed me to meet fellow dentists, seek advice from more experienced clinicians and get more involved generally. 

Networking and social media are an increasingly invaluable way to keep up to date with advances in the profession. There are lots of dental groups where dentists can discuss different cases with peers, and can prove an invaluable learning forum for young dentists looking to increase their knowledge – And not just clinical knowledge; I’ve learnt about the implications of new regulations, such as GDPR. So, once you start working in practice and you have a question about managing certain cases, or want advice on courses to take, you might find these groups can offer a different perspective and support. 

The wonderful thing about dentistry as a career is that you can make it whatever you want it to be. I thoroughly enjoy working within a multi-disciplinary team and different clinical environments. During the working week I’m mainly based at the dental hospital, where I’ve been able to conduct dental treatments under general anesthesia. At the weekends I work in general practice as an associate. It’s really been this variety that has given me an insight into different specialties and working environments plus the unique opportunity to manage more complex cases.   

There are so many different opportunities and career paths you can pursue, that the only limitation is you. You just have to have the drive to go for it. Whether that’s working in general practice, hospital, community, dental public health, research or training, you really have the unique opportunity to change paths during your career.  And that’s what makes dentistry so exciting as a career choice- you never know where it may lead you next.

Author bio

I qualified from King’s College London School of Medicine & Dentistry in 2015, after which I completed my dental foundation training. Following my training, I started to work as a general dental practitioner in a mixed NHS/Private dental practice in North West London which I help to manage.

In 2017, I started my position as a Dental Core Trainee at the Paediatric Department at The Eastman Dental hospital, whilst continuing my commitments in general practice part-time.

I have continued my post-graduate education and gained Membership of the Joint Dental Faculties of the Royal College of Surgeons England and the Faculty of General Dental Practice in 2017. I also have a passion for academic teaching and have recently completed my post-graduate qualification in Dental Education.

This student advice blog was originally published by FGDP(UK) in January 2019 and has been republished by the College of General Dentistry with the author’s permission.

College of General Dentistry Careers, Student Advice

Working in a Maxillofacial unit in a District Hospital

As a DCT 1 in a District Hospital in Yorkshire, Dr Kenny Strain takes us behind the scenes of a busy Maxillofacial unit, describing the range of treatments he has been providing.

I’m currently a dental core trainee [DCT] 1 working in the maxillofacial team at Rotherham District General Hospital in South Yorkshire. I wanted to give you a bit of a glimpse into what it’s like to do dental core training in a district hospital.

I completed my foundation training in Barnsley, I enjoyed my time in practice and felt like I learned a huge amount but I was keen to get some more surgical experience as this was an area of dentistry that I had not had a huge amount of exposure to as an undergraduate or during my FD year.

I researched various options in terms of getting more experience of oral surgery and there are quite a few to choose from. There is mentoring/shadowing, hands on courses which can be small group based and involve patient or more class room based and use pig mandibles to provide a hands-on experience. The other main option is to apply for a position as a dental core trainee.

Within the Yorkshire Deanery, all of the DCT 1 positions are a 12-month contract working in Maxfac. The positions are either in teaching hospital, major hospital or district generals. From speaking to previous DCTs, I got the impression that working in a major unit would involve more oncology treatment and I was keen to work in a unit with a more general focus and therefore I opted for a district hospital.

At Rotherham we work on an 8-week rota covering Rotherham and another hospital in Mexborough. The rota will cover doing on-call duty or being assigned to work with a consultant as their senior house office [SHO] for the week. SHO is a term still used in some hospitals and corresponds roughly to a DCT.

The consultant team at Rotherham / Mexborough is made up of 5 consultants with a variety of interests ranging from skin cancer, head and neck cancer, trauma, orthognathic and TMD. The variety of specialist interests of the consultants mean that no two weeks are ever the same.

This week I’ve been working with the lead consultant for head and neck cancer, we had a major oncology case involving a radical neck dissection, there have also been new patient assessment clinics for patients referred on a 2 week wait suspected cancer pathway. On these clinics you can either be helping the consultant or seeing new patients and then presenting them. I’ve also been in the day surgery unit this week working with one of the staff grade oral surgeons, these sessions involve treating patients under local or general anaesthetic. Types of treatment carried out are often surgical extraction of wisdom teeth, difficult teeth or extractions for patients with severe dental phobia. Working on the day case list, it is not unusual to carry out full clearance on patients.

As I was saying, no two weeks are the same and last week I was the on-call SHO. Being on-call is probably the busiest part of the job. Our rota has various on-call slots, it can be days, nights, weekend days or weekend nights. All of these on-calls can be very different. On-call days is definitely the busiest and will test your administration and delegation skills to the limit. It’s not unusual to have calls to go see patients in A&E and paediatric A&E at the same time as you are managing patients on the ward, discharging other patients and ensuring that they are going home with the correct medication, arranging follow up appointments for patients, helping out in theatre and getting phone calls for advice from GPs and general dentists.

On-call nights can be very different, there is much less of the administrative work to do and more dealing with patients presenting to A&E or getting referred from other hospitals that don’t have a Maxfac team. The types of patients that you’ll see at night varies massively from shift to shift. Some nights involve lots of trauma such as fractured mandibles and zygomas or lacerations. The next night you may see patients with dog bites, children with dento-alveolar fractures and dental abscesses.

Since working in Maxfac I’ve seen a wide variety of dental abscess from can barely tell there is anything there to Ludwig’s angina and calling your consultant at 2am to ask them to come in as the patient is going straight to the emergency theatre.

I’ve really enjoyed my time working in Maxfac and would highly recommend it. Initially your skills and knowledge will be pushed to the limit and you’ll be learning constantly, but with time and a bit of experience you will get the confidence to deal with situations you may only have read about in a text book. At the end of your year in Maxfac, you’ll realise that not only will your dental and surgical skills have improved but your medical knowledge will have expanded and you’ll have a solid foundation for working in practice or for further specialist training.

Author bio

I initially studied dental therapy and dental hygiene at the School of Clinical Dentistry at the University of Sheffield. I Covered all areas of Oral Health, Periodontal treatment and Dental Therapy.

After graduating I took a full-time position in practice as Hygiene/Therapist working in the Lake District. When I wasn’t fixing teeth I was running marathons or climbing rocks. After working in practice for just over a year, I decided to return to university to study dentistry at the University of Aberdeen. I really liked Yorkshire and was keen to return, so I completed my foundation training in Barnsley. I’m currently a dental core trainee [DCT] 1 in the maxillofacial team at Rotherham District General Hospital in South Yorkshire.

This student advice blog was originally published by FGDP(UK) in June 2018 and has been republished by the College of General Dentistry with the author’s permission.

College of General Dentistry Student Advice

Top tips for young dentists

Dr Sahar-Tara Aghababaie, part time Dental Associate in North West London, gives you some key pointers as you start your career in dentistry.

Dentistry is continuously evolving, and because of this, we ourselves should be moving along with it and getting the most out of our chosen career. Here are a few tips aimed at young dentists to hopefully help you with the first stages of your career.

  1. Build a portfolio

    Start a clinical portfolio sooner rather than later – this can include anything from the clinical cases you have done, audits, prizes etc. It is good practice to get into the habit of doing this earlier on as more employers are requesting to see portfolios at job interviews to see what you are capable of. So, if you have it – show it off!

  2. Clinical Photography

    A picture is worth a thousand words so they say – so ensure you have your camera at the ready. Invest in a clinical camera and kit and start taking photos of your clinical cases. Not only can these photos go towards your portfolio, but they can also help with treatment planning more complex cases as well as creating before and after pictures for your patients.

  3. Invest in Loupes

    Poor vision and insufficient lighting when performing dental treatment often results in poor posture. The use of loupes has been shown to help maintain a better posture – so invest in your back! Before buying a pair of loupes, ensure you do your research.

    Go in person and try on the different loupes from different companies and see which one feels right for you. Many companies provide personal visits to your place of work to provide demonstrations, or alternatively go to dental conferences so you can try all the different ones in person. Remember as newly qualified dentists most companies
    offer discounts!

  4. Get networking

    As the saying goes “it’s who you know, not what you know” and in dentistry this can often be true. In order to meet future employers you need to put yourself out there.

    This can be at dental conferences, dental talks and meetings at your local dental associations to give you the chance to not only meet your future employers but give you the chance to network with fellow peers and get involved in exciting
    opportunities.

  5. Keep on learning

    The 5 years of dental school is only the beginning – get out there and keep on training. This is important to maximise your learning, improve on your skill set and help build your clinical confidence. There are many opportunities out there, such as the MJDF, hands-on clinical day courses, and more long-term post-graduate courses. There are also many free taster courses out there too so you have nothing to lose!

  6. Start a career plan

    Time flies by so quickly, so to help plan your career create a plan for yourself on what you hope to achieve, starting from in 5 years’ time then to 10 years’ time. Then brainstorm how you will get there. This is a great way to manage your future career and acts as a fantastic motivational tool.

  7. Relax – and enjoy the ride

    At times dentistry can be stressful. However, life is not a race but a journey. Do not expect to have reached all your goals by tomorrow, and do not compare yourself to others. Always make time to relax, start new hobbies, go on holiday and recharge your batteries – it will help maintain a good work-life balance!

Author bio

I qualified from King’s College London School of Medicine & Dentistry in 2015, after which I completed my dental foundation training. Following my training, I started to work as a general dental practitioner in a mixed NHS/Private dental practice in North West London which I help to manage.

In 2017, I started my position as a Dental Core Trainee at the Paediatric Department at The Eastman Dental hospital, whilst continuing my commitments in general practice part-time.

I have continued my post-graduate education and gained Membership of the Joint Dental Faculties of the Royal College of Surgeons England and the Faculty of General Dental Practice in 2017. I also have a passion for academic teaching and have recently completed my post-graduate qualification in Dental Education.

This student advice blog was originally published by FGDP(UK) in June 2018 and has been republished by the College of General Dentistry with the author’s permission.

College of General Dentistry Student Advice

Four important reasons to get involved with research

Qasim Mohammedbhai, fifth year BDS student at King’s College London, explains the benefits of conducting research whilst at university or as a dental practitioner.

In this blog I am going to be talking about getting involved in research, either as an undergraduate, postgraduate or even a fully-fledged member of the dental team. The two questions I am going to address are:

  1. How do I get involved in research? 
  2. What can I gain and how can I benefit from doing research? 

In answer to the first question I will tell you about how I got involved in research. I got on really well with one of the professors at King’s College, Dr Ian Thompson, luckily, he was one of the teachers that had a lot of time to give to his students. I was always interested in research so I asked him whether I could get involved. He did a lot of work with bioactive ceramics, a burgeoning area of research within dentistry. From that point forward, we worked on a project which tests the ability of bioactive ceramics to prevent dentine hypersensitivity. 

So how can you get involved in research? My first piece of advice is to think about what you are interested in. It will make the work you do a lot more engaging and far more relevant. For me that happened to be dental material science. The next thing is asking around, be it your personal tutor, PhD students, or senior dentists in practice, and ask them whether they know of any research opportunities. This is where studying or working in a teaching dental hospital is invaluable, as there are so many research opportunities available. I had to ask a lot of people before I landed my research project, so you need to persevere with it.  

NB. Remember you are not pestering them; you are going to be a valuable asset as you will be the one doing a lot of the hard work!

The second question is what skills can one gain from doing research. Now the obvious one is something to write on your CV, but there are far more useful things to be gained:

1. Lateral Thinking
In research things always go wrong. Results will be off, the methodology won’t work out or the machine breaks, the list goes on and on. Ultimately, it is up to you to find a way around this hurdle. It can be very frustrating at times, but it hones your problem-solving skills. If you speak to the experienced clinicians, they will tell you that is what dentistry is all about.

2. Perseverance
Research is not as glamorous as it may seem. At times it can be cumbersome and disheartening when things are not going your way. This is where determination and patience are invaluable. 

3. Critical appraisal
One of my clinical supervisors always used to say: “If you have a patient seen by 5 different dentists, you’ll end up with 6 different care plans”. What this means is that unlike medicine there is no set guideline or protocol for dental treatment. Ultimately, the choice is in the hands of the practitioner. The way one decides is by reading papers, but these need to be critically examined and not blindly followed. Once you have carried out experiments of your own and evaluated your own research, you can understand the shortcomings of other experiments. Experiments can be hard to visualise, so the analogy I offer is imagine reading about doing an extraction versus actually doing one yourself. There is something to be said about actually doing the procedure in order to properly understand it. 

4. Public Speaking
This is a skill you learn by experience alone. Academics get the opportunity to discuss their research at conferences in front of large audiences. In my case, I was fortunate enough to give a talk at the British Dental Hygienist and Therapists conference and present a poster at the annual biomaterials conference. 

In summary research is not a members-only club and is easier to get involved in than you may think. Not only does it enhance your CV, but more importantly it enables you to develop a number of skills, key to becoming a successful dental practitioner.

Author bio

I am a final year dental student at King’s College London. During my five years of university I have found an interest in Prosthodontics and research. Outside of Dentistry my biggest hobby is sport. I have competed in first teams for hockey, table tennis and squash. Another passion of mine is languages, I speak Spanish, Italian, Gujarati and am currently learning Arabic.

Qasim Mohammedbhai

This student advice blog was originally published by FGDP(UK) in March 2020 and has been republished by the College of General Dentistry with the author’s permission.

College of General Dentistry Careers, Student Advice

Tackling life in general practice after Foundation Training

Dr Khush Shah, General Dental Practitioner, delivers three pieces of vital advice to help you tackle life in general practice.

I graduated from King’s College London in 2016 and completed my Dental Foundation Training in Birmingham. During Foundation Training, I was in two minds as to whether I wanted to move back into hospital or continue life as an associate dentist. In the end, after speaking with numerous people and seeking advice on the matter, I chose not to apply for DCT and have been working as an associate since. Reflecting upon this decision, I have not regretted it at all. 

The step into General Dental Practice as an Associate can be very daunting to take. Having been sheltered at Dental School and then having the presence of an Educational Supervisor safety net, people can find themselves very isolated when they choose to move into general practice (over the more structured hospital route). Couple that with the added pressure of striving to achieve a UDA target or embarking upon more complex private treatment plans, this will all add up to more stress in one of the most stressful professions in the UK.

I have three key pieces of advice to help you tackle life in practice: 

  1. Set yourself realistic goals: Specify timeframes, self-reflect and adjust your goals accordingly. 
  2. Surround yourself with people who will help you achieve this
  3. Develop and invest in yourself: Don’t think twice about the expense of a good pair of loupes, a DSLR camera or a highly recommended course you’re considering, as you will reap the benefits of these without a doubt.

1. Realistic goals

My biggest piece of advice would be to plan where you would like to see yourself in 5, 10, 15 years and at the end of your career. With goal setting – AIM BIG – but plan your smaller steps to achieve this. Everyone is different, which is why it is so important to take the time to personalise your Personal Development Plan. It is easy to say you want to “produce the best dentistry for your patients” or “run a successful practice”, however these are too generic. Specificity will help you identify weaknesses and develop strategies to improve these, highlight your strengths and allow these to flourish, but most importantly enable you to work towards the final goal you have set yourself. Learning which methods of self-reflection work for you, is a vitally important part of this, as it will give you scope to amend these goals as you progress.

2. Develop a peer support network

It is important to surround yourselves with like-minded individuals. This will form the basis of your peer support network. This can be through horizontal integration, with colleagues of similar experience, or vertical integration by finding a mentor to support and advise you. Not only does this allow you to discuss how to handle different situations, it provides you with a channel of communication to share any problems or anxieties that you may have. However, it is also crucially important that you are not comparing or competing with your peers. This can have a hugely negative impact on one’s self-confidence as it is much easier to compare your weakest traits (e.g. molar endodontics) and forget about your strengths (e.g. your attention for detail when producing secondary anatomy on a composite restoration). 

3. Develop and invest in yourself

There is an increasing array of postgraduate courses available and this can make it difficult to narrow down which would be most suitable for you. They have been set up to target a demand from young dentists where there are gaps in the undergraduate teaching curriculum. There are many deciding factors to look at: level of hands-on experience, post-nominal accreditation, number of contact days, individuals teaching the course. These elements will be valued differently by all; however, it is important that the right course is chosen for YOU. 

People will advise you to do as many courses as you can early on, or in contrast not to dive into a postgraduate course too soon in order to build up clinical experience that will be directly relatable to the course that you plan to undertake. In hindsight, there is no right or wrong answer to either of these and it depends on how best you learn (i.e. theoretically or practically). What is very clear to me, however, is that if you pick the right course, you will be investing in yourself in a way where the rewards will speak for themselves. Do your research, ask other people about courses they have been on and decide which will best suit you.

Author bio

I qualified from King’s College London in 2016. I completed my Dental Foundation Training Scheme in Birmingham. Since then I have been working full-time as a dental associate in a mixed practice. 

I completed my MJDF qualification in 2017 and have continued my postgraduate training by currently undergoing both a restorative and an implant course.
 

This student advice blog was originally published by FGDP(UK) in November 2019 and has been republished by the College of General Dentistry with the author’s permission.