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A Career in General Dental Practice and the Dental Team

Learn from two vocational trainees what it is like to work in general dental practice and how the dental team works together.
My name is Andrew Leach, and I’m the owner of Riverbank Dental in Glasgow. My name is Kerri, I’m a vocational trainee at this practice and so I just graduated in June 2020. I graduated from Glasgow University in 1996. I did my vocational training up in Fraserborough in the North East of Scotland. I always wanted to do oral surgery and so I did a clinical attachment for a year in Aberdeen Northern Infirmary, but decided that my time in practice was more enjoyable and I decided to stay in practice. I came back to Glasgow after a few years and worked in various practices in and around Glasgow as an associate before opening Knightswood dental practice in 2006.
The practice burned down in 2012 and we then rebuilt a couple of miles down the road in Yoker and we’ve rebuilt as riverbank dental. Since then, we’ve grown from being a two surgery practice into a four surgery practice with a vocational trainee So in a general dentists, the team members that are here, there’s obviously the dentist, the dental nurses, practice manager, the admin staff. We all kind of take on different roles, so obviously the dentist is in charge of like the patient clinically and the nurse is like your left hand man and helps you with everything clinically wise, then they’re responsible for like the cleaning down, the changing of instruments, cleaning of instruments.
Sometimes the nurses are in the surgery, sometimes they’re in on reception and they book the patients in and they phone patients to remind them of their appointments they take money and I also have a practice manager and who supports in the business side of the of the practice. A lot of dentists do their own practice management, but I don’t like to do that. My strength is in teeth rather than in contracts, so I like my dental practice manager to do all that.
So at typical day in general practice, obviously in COVID times is a wee bit different compared to pre COVID, but when you come in you’ve got pretty much a full book, there’s some emergency slots booked out but in a day you’ll see some kids, some adults, do a few checkups, a few fillings, extractions, scale and polishes just things like that. There’s so many treatments that you can do, you’re not confined to kind of like one specialized treatment, and we do so much here. So before the COVID pandemic hit, a typical day would start
at about 8:45 and we generally run till probably about 7:30 or 5:30 depending on when we were finishing, we would do the occasional Saturday as well. In that time we would have four surgeries running and we would each see between 20 to 25 patients a day, sometimes a few more if there were lots of children in for checkups.
In terms of what we’re doing now post COVID NOTE Confidence: 0.96449816 we’re probably doing all the same treatments, just not as many, so I have two clinical bubbles in, working between the four surgeries to minimize any kind of down time, the way that COVID has changed the roles within the dental practice is, we now have a dedicated triaging dentist that’s working every day. They triage all the emergency calls in order to reduce the amount of waste time we have in the practice.
So if somebody calls up, we are triaging them and working out roughly what we want to do with them before they come in, so that we can then decide if they need a short appointment potentially for an extraction or a longer appointment for root treatment. The nurses are doing a lot more cleaning, and in fact the dentist will help with that as well, you know we’re all in the same boat, so we will also help with the cleaning, but the amount of cleaning we have to do between patients was always high, but now it’s taking, you know it’s now at a different level. During the pandemic we have to account for a fallow time.
We have to account for the time where there will be aerosol in the air. if we’ve been using any high speed handpieces, we have to wait for 10 minutes following that before we can then clean the surgery and then see the next patients. The impact Covid has had on dentistry. For starters, the whole PPE has obviously been increased, if there is anything that creates an aerosol we just have to wear completely different PPE as opposed to something that doesn’t create an aerosol, then there’s fallow time to incorporate into our appointment time as well.
When we had four surgeries running and were all really busy we would have you know you could potentially have 10 to 20 people in the waiting Room, waiting to come into to the surgeries and now we want to minimize the number of people in the in the practice at any one time. I suppose I’m in charge in the practice because I’m the practice owner and ultimately pay the wages. However, I don’t consider myself the most important person in the practice. Everybody that’s in the team is a kind of an equally important member of the team.
There is nobody that could work here without another person, so I can’t do my job in the surgery without the dental nurse supporting me, and we couldn’t do our jobs in here without the instruments being sterilized through in the sterilization room. We couldn’t do our job if the receptionist wasn’t there to book the patients in and take the money and we couldn’t do our job if the practice manager wasn’t here making sure the rotas were in place and making sure that everyone was being paid.
We couldn’t do the job if the dental technician wasn’t part of the team, and they’re an important part of the team because they meet the dentures, the crowns and you know, if they weren’t making them then we couldn’t fit them so they are another important member of the of the team. The most important thing is that everyone has an equal voice, so if somebody sees that something is not right or if somebody sees that some things may be needing improved or has even worked well, then we encourage everybody to voice that, and ultimately that leads to better patient care. It leads to a much safer environment and so no one voice is stronger than the other.
My favorite part of dentistry, first of all, just having such a good team around you, you just form really close kinds of relationships with your work colleagues. My favorite part of the job is probably when you have a patient that’s maybe not been for a few years and they are very apprehensive and they come in and we put them at ease and they start to engage with us and they start to engage with their dental health again and they can improve their tooth brushing, their flossing and as their mouth then becomes healthier, we’re then able to restore the broken teeth. Maybe potentially take out the ones that are not saveable and then give them a nice smile again.
My favorite part clinically is endodontics or root treatments, I love opening up teeth, finding root canals, cleaning them, disinfecting them, and then sealing them up again. So what I wish I knew before I applied to dentistry, as how important it is to have that work life balance. Obviously it’s quite an intense job. It’s so important that you can leave your job here and go home and relax and do different things at your weekend to kind of keep your mind off things, your full life can’t revolve around your career. It’s not easy kind of closing the door behind you
at 5:00 o’clock and going home and forgetting everything that’s happened.
You take problems home with you and you go home worrying, about patients and worrying about things, potentially things that have happened. You also go home after a good day with you know on Cloud 9 and you think that it’s the greatest job ever, but even though I’m very good at switching off, it’s very hard to not think about what’s gone on that day. Being positive, being happy, I think that’s an important quality to have. Obviously you have days that you’re stressed out, but you always I think, there’s no point in being down in the dumps about something, you need to have that thing about you just to get up and go, be positive about a few things.
Being polite, I think gets you few places as well, with staff, with Patients, I think that’s important to have. Good communication skills I would say is really important, as well as good clinical skills, but I’d say to build that like patient dentist relationship you need to have really good communication skills. We could talk about manual dexterity, which is important However, if you can’t communicate with a patient, if you can’t communicate with your staff and then you know you’re going to get nowhere. Where patients start to complain, It tends to be on a breakdown of Communication, it’s very important. you have empathy with all members of the community, especially the kind of deprived population.
So when they come in and they’re not brushing their children’s teeth and their children have got a a high sugar diet, then it’s important to remember that actually, dental health is maybe not number one priority in their life. They’ve often got many other factors going on and you know, buying a toothbrush and toothpaste is is way down the list of important things.
You need to be very patient as well, things don’t always go smoothly and because we’re working in quite an enclosed environment, we’re working in a small area, often you can quite easily become frustrated if things aren’t going well and so you need to be very patient and just kind of work through problems methodically and not get stressed about them, so you need to, you ultimately need to have good patience. Yeah, I enjoy working with the team and I enjoyed the relationships I have with all the members of the team. My staff are very loyal, they’ve been with me for many many years and we work together really well as a team.
You get to know families and you get to build up these relationships with patients. And you know after patients who have had a long treatment plan as well, they can become, you know you can become quite close to them and you know they become almost friends and I really enjoyed that part of the job as well. I like that dentist patient relationship that you build when you’re in general practice, whereas if you’re in like the hospital, kind of side of dentistry you see one patient and you’ll never see them again almost.
I would say dental practice has an incredibly important role within the community, probably as important as a GP Practice, where we are here in Yoker, our practice is right next door to the GP surgery and we work together sometimes in treating Patients, they send us patients we send them patients. I think the best thing about working in a practice, you just have like colleagues around you that can support you. You can go to for advice, I’d say that’s really important, but just your relationship you have with your colleagues is so important. So just having that support behind you. Yeah, I see that’s a really good aspect About it.
As you develop in your career, you realize there’s stuff that you enjoy doing more and there’s stuff that you enjoy doing less. I enjoy root treatments and endodontics so I do a lot more of those, and I do a lot more kind of restorative dentistry because that’s what I enjoy. Because I’m self-employed, I can really pick and choose what I want to do. If my patient needs something that I’m not, that I can’t do, then I can refer them to a colleague within the practice or to another practice. The other good thing about working in general practice is that you’re not confined to general practice.
So although I’m a practice principle and I’m a dentist, I also started training new graduates, so I started in vocational training, probably about 10 years ago and from there I then became an advisor, so I’m a vocational training advisor for a group of new graduates and I’m involved a day and a half a week with NHS education. I also work some sessions for NHS 24 so I work evenings and weekends for them. And so it’s a huge variety of things I’m doing with the kind of diversity of roles I’ve got, it means that I’m probably going to be able to work in practice for much longer.
You do so many different types of treatments, so one patient you’ll have in, the next one is just completely different, and I think that’s what keeps you on your toes almost. I don’t think it’s a job that you’re ever bored in, so far anyway.

The majority of the NHS dental workforce work in a General Practice setting. It’s where all dental graduates spend their first year after graduation working as Vocational Trainees (VT) like Kerri who features in this video.

It is vitally important that before you chose dentistry as your career you understand a little bit about what working as a dentist involves, but because everyone spends time as a VT (known as a foundation dentist outside of Scotland) and most dentists work as General Dental Practitioners (GDPs) it is especially important that you know a bit about General Practice.

Andy, who also features in this video, is a GDP but he is also the practice principal in this practice. He owns and manages his dental practice and acts as the employer for all the staff within the practice. To help him with the business side of running the practice he employs a Practice Manager who is also part of the dental team. Andy’s NHS income comes partly from the local health board who pay part of the patient’s charge for dental treatment and partly from the patient if they pay for their treatment. Some groups of patients who are on benefits may be exempt from payment. Any private income is paid directly by the patient to the practice. The payment system in the NHS is different in Scotland and England so that’s something you should spend a bit of time researching.

The other members of the team working in general practice include the Dental Nurses who support the dentists in providing treatment and look after the instruments and materials. It’s their job to make sure that everything needed for a particular treatment is available when the patient comes in. Some Dental Nurses are also trained to take radiographs (x-rays), others are trained to help with sedated patients, while others provide oral health and hygiene advice to children and their parents as part of the Childsmile programme. The team also includes the Receptionist who books all the appointments and makes sure the clinics run smoothly.

Kerri also works in Andy’s team as his VT and she is spending a year in the practice being supported to develop her skills in her first year after dental school. Most of the time she works on her own but sometimes she will do treatments with Andy if, for example, they are things that she is less used to doing or new things that she is learning to do.

The Dental Technician is a vital part of the dental team and may work within a dental practice or may work in a separate laboratory and work for multiple dental practices. The dental technician uses the impressions taken of the patient’s mouth to make dentures, crowns, bridges, and inlays to replace missing teeth. This is an extremely skilled job that requires a very high level of manual dexterity and artistic ability. It is important that the dentist can communicate to the technician exactly what the requirements are for a particular job as the technician does not normally see the patient and works solely from the dental impression and dentist’s instructions. Digital dentistry is a growing area, and more and more dentists are taking digital scans of their patient’s mouths instead of taking impressions. This allows the technician to 3D print some parts of the prostheses they make.

Working as a GDP is a very varied job, they provide all sorts of different treatments to a wide range of people of all ages so need to be good at everything. GDPs also need to be able to spot when something in the mouth is not as it should be and are often the first professionals to spot oral cancer. You might not realise but part of your regular dental check-up is an oral cancer screening.

Being a GDP is a busy job, there are often patients booked in all day plus emergencies to see but most GDPs enjoy the fast-paced nature of their job and the variety it offers. We’ll hear in the next section about how COVID-19 has changed the way general practices run and what dentists have had to do to adapt to these changes.

One aspect of general practice that most dentists really enjoy is getting to know the patients. They are often in a practice long enough to watch their younger patients grow up. Many patients confide in their dentist about all the good and less good things going on in their lives.

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Becoming a Dentist

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