Meet the specialists

My name’s Helen Rodd, and I’m a Professor and Honorary Consultant in Paediatric Dentistry. Paediatric dentistry is a specialty which involves looking after children, their oral health care, from birth right through to 16 years. And as it’s a specialist area, we only see children that are referred with particular medical problems, such as childhood cancer or haemophilia, or maybe they have behavioural problems, autism, severe dental anxiety. Or they might have particular dental problems that their general dentist doesn’t feel confident to manage, which might be children who’ve fallen off their bike and damaged their teeth, or children who have defects of their enamel, or very, very high decay rates. So a typical day for me is quite varied.

I might supervise students on one session where the students are learning to treat children. And I might also treat some patients myself, and those are the more complex ones. And that might even involve providing their treatment while they’re asleep, under general anaesthetic, at the local children’s hospital. And also, as part of my daily routine, I might do some lectures for undergraduates or be involved in some research. To be a paediatric dentist or a specialist in paediatric dentistry, you need to do at least three years general training, once you graduate, in practice and other settings. And then you spend three years purely treating children in a training post, which is usually in a hospital setting.

And after that, you’re considered a specialist. And then if you want to become a consultant, it’s another two years training. And if you want to become an academic, like myself, then you would have to do the two years training and a PhD, as well. My name is Ghazala Ahmad-Mear. I’m an Associate Specialist in Oral Surgery. Oral surgery is defined as management of diseases, and surgical management of soft and hard tissues of mouth, jaws, and teeth.

So it involves surgery, so it’s cutting into soft tissues, working around bone and teeth, and jaws, and the majority of the work, doing the day-to-day work, is really about removal of impacted teeth, problematical teeth, teeth that the local dentist cannot get out, for whatever reason. So a lot of it is under local anaesthetic. Often we use sedation for patients who are anxious, and we also use general anaesthetic for cases that cannot really be done under local. So it does take you out, from the dental surgery, out into theatre environment, and it can be quite a dynamic post, moving around, rather than staying in one place all the time. To get there, you basically need your BDS or equivalent qualifications.

So it’s a post-graduate specialty training. Initially, after BDS, all dentists these days have to do dental foundation, which is one year in general dental practice. Following that, you need to take dental core trainee posts within oral surgery or oral and maxillofacial surgery, within a hospital basis. And that really gives you an idea of whether this is the right thing for you. So you are exposed to a bit more than the surgery would be, perhaps, at undergraduate level. If you make a decision to follow that career, then you need a couple of other years of dental core training under your belt, and then you apply for a specialty training post. They are relatively low in numbers nationally currently.

They hope to grow. But they are very competitive, and so anything more that’s extracurricular than those dental core training years that you can bring will be advantageous. So you need audits and research, and any other clinical experience and expertise that you can contribute. Once you get onto a training programme, it’s three years to become a specialist in oral surgeries. That allows you to call yourself a oral surgeon, and work independently as an oral surgeon. If you want to maintain a hospital career and become a consultant, then you’d need a further two years. And then once you’ve finished training, you’d apply for consultant posts. Hi, I’m Nicholas Martin. I’m a Specialist in Endodontics.

Endodontics is the study of what goes on inside the tooth, and what goes on inside the tooth are diseases, and problems affecting the pulp of the tooth. Now the pulp is a piece of little tissue, soft tissue, that lives right in the middle of the tooth, and that, to most people, is referred to as the nerve. Today, endodontics has really come of age, and has become much more sophisticated, and much more predictable in its outcomes. Most dentists can actually do endodontics.

Most dentists are trained to do so, and will certainly know about how to look after the life of the pulp, so that it doesn’t become damaged when they do any form of treatment, or any types of fillings or crowns. They want to make sure the pulp doesn’t become inflamed, because the pulp becomes damaged or infected, then there’s significant consequences to the tooth, in terms that it becomes weaker. When the treatment becomes more complicated, because the anatomy of the root - there’s sometimes a twisty little very fine root - or sometimes the axis is more challenging, or the infection is more persistent, then it is referred to an endodontist.

And the endodontist will look after doing the specialist root canal treatment, amongst other things, but the specialist root canal treatment. So what makes an endodontist? An endodontist is a dentist, so five years of dentistry in the United Kingdom, and beyond that is a specialist training pathway. So there might be some hospital ground, basic general hospital training, and then approximately three or five years of further, very disciplined hospital curriculum-based training to become an endodontic specialist. And that is how somebody like myself ends up spending a significant amount of time looking after little pulps in little teeth. I’m Sandra Zijlstra-Shaw. I coordinate the undergraduate periodontology course, and I also teach the postgraduates periodontology. Periodontology itself is about treating gum disease.

It’s one of the commonest diseases that human beings get, and what we do is not just scales and polishes, and the actual mechanics of treatment, but we’re actually talking about teaching the patient, helping patients, to take care of their own disease, to look after their own oral health. So it’s actually quite interesting and it’s very patient focused. How do you become a periodontologist? Well, the first thing you have to do is to train to be a dentist. Then you have to go out into practice and get some practise. And then you come back and you do the specialist training, and that’s usually the restorative specialist training.

So you would do other things, such as crowns and bridges, as well as dealing with gum disease. Once you’ve done that specialist training, then you can move on to do things like periodontal surgery, which involves surgery of the gums, some periodontal plastic surgery. So it becomes quite interesting at that point, from a technical point of view. So you’ve got the patient-centeredness, you’ve got the technical side, and all in all, it’s quite an interesting thing to do. My name is Philip Benson. And I’m an orthodontist, and my job title is Reader in Orthodontics and Honorary Consultant. Orthodontics is the specialty in dentistry that deals with crooked teeth.

So we use braces to straighten the teeth, correcting malocclusion, which is anything to do with crooked teeth. Well, I’m quite fortunate in that I have quite a varied clinical commitment. So I do quite a lot of teaching, as well as seeing my own patients. I specialise in treating patients who have got missing teeth. So I work quite closely with a restorative dentist, with children who’ve got missing teeth, to make it easier for the restorative dentist, the person who supplies bridges and implants, to replace the missing teeth, to make it easier for them to include their restorations, their implants and their bridges.

You have to do five years of undergraduate dental training, and then you have to get some experience of general dentistry. So I did a combination of working in a general dental practice, as well as in hospital. I worked at Great Ormond Street with children who have cleft lip and palate, and quite severe problems with their head and neck. And then you have to do a three year full time orthodontic course, treating 100, 120 patients from start to finish. And then if you want to stay in hospital or university, you have to do a PhD, which takes three or four years, as well as further clinical training to become a consultant. Hello.

My name is Paula Farthing, and I’m a Consultant Oral Pathologist in the School of Clinical Dentistry in Sheffield. Have you ever wondered how a dentist knows what’s wrong with you? Well, what they do first of all is ask lots of questions. This is called taking a history. And they’ll ask about your medical history, and that’s important because sometimes a medical history will have manifestations in the mouth. And sometimes it also affects what treatment a dentist can give you.

The next thing the dentists do, will ask you lots of questions about what’s wrong with you, how long you’ve had it, what problems you’re getting, and sometimes they ask you whether your parents ever had anything like that, or whether it’s been in the family. After they’ve done that, then they’ll examine you. And first of all, they examine you extra-orally, and that means looked at your face and your neck, and sometimes they’ll feel it. And then they look inside your mouth, and they will examine all the soft tissues, which is the palates, the floor of your mouth, your tongue, your cheeks, and they look at your teeth as well.

Now most of the time, the dentist will be able to know what’s wrong with you just from looking, and from the history that they’ve got, but sometimes they don’t know what’s wrong. And when that’s the case, they have to take a bit of tissue away. And that’s called a biopsy. So they usually only biopsy the soft tissues, and they hardly ever biopsy teeth, but they sometimes biopsy jaw bones. And that’s where I come in, because I’m a pathologist, and my role actually is to look down the microscope and see what changes have occurred in the tissue.

And I compare that to normal, and then I write a report and send it to the dentist, who then knows how to treat the patient. So after they’ve taken the biopsy, they put it in fixative so it doesn’t decompose, and they produce a slide like this, and that’s what I look at down the microscope. OK, so in able to be a pathologist, you have to do a dental degree, and then do general professional training in general practice, and also in the hospital in oral medicine, oral surgery. And then after that, you have to sit professional exams, and then it’s a five year training to become an oral pathologist. Hi. I’m Simon Northeast.

I’m a Senior Clinical Teacher in Restorative Dentistry, and I work in the Academic Unit of Restorative Dentistry in Sheffield University. I’ve been employed by the university for a good number of years. And my discipline, really, is one which integrates the disciplines of endodontics, periodontics, and prosthodontics, in the management of patients who require cross treatment in these different disciplines. And it sometimes encompasses other people, such as oral surgeons and orthodontics, in the management of patients who have difficult dental problems, and severely compromised dentitions, in particular, who could not easily be managed in either general dental practice or specialist dental practice outside in the private world, if you like.

The training pathway for this particular specialty is rather unique in the UK, in that in most other countries, the mono specialties of endodontics and prosthodontics would link together to manage the treatment of these patients. But this is regarded as a specialist pathway in the UK, within the hospital environment. And it’s quite a long training pathway, involving at least a minimum of two or three years of doing general dentistry, and getting higher training and higher qualifications, first of all. Followed by entering a job as something like a specialist registrar, working in the NHS, although there are also training programmes in the university.

You can work as a lecturer, and train at the same time, for a period of five years for restorative dentistry, where you would study the specialties of endodontics, periodontics, and prosthodontics, and how these integrate into the management of patients, for example, who have cleft palates, or who’ve had tumours or severe trauma, born with other congenital defects, and severe problems with their teeth, which gives rise to really difficult issues of management, and particularly the ability to work with other teams as well.

So it’s quite a broad spectrum, but the emphasis on the integration, and on an approach which has a broad understanding of all these other disciplines, and understanding these specialties, which is why the training pathway is longer than a mono specialty of, say, doing endodontics, where you’re studying the problems of root canal therapy and so on.