A RECENT report on child health published by the Audit Commission highlighted the fact that 53 per cent of children living in deprived areas of England have poor dental health as measured by levels of decay in comparison to 18 per cent of those in more affluent areas. The most recent survey of decay levels in school children in Scotland found that 36 per cent of children in primary 1 had dental caries, however for those living in the most deprived areas this rises to 54 per cent. It’s a gap that has widened alarmingly over the last few years and one that health and social care services across the UK have pledged to address.
Among the professionals at the frontline of this challenge are specialists in paediatric dentistry. It is a fascinating specialty that encapsulates practice, teaching and research in comprehensive therapeutic oral healthcare for children from birth through adolescence, including care for those who demonstrate intellectual, medical, physical, psychological and emotional problems. As evidenced in reports from NHS careers, the number of trainees and consultants in the specialty has enlarged considerably over the last 15 years and continues to grow.
Paediatric dentistry is unlike any other dental specialty in that it covers all aspects of oral healthcare for children from restorative care to minor oral surgical procedures to interceptive orthodontics. Paediatric dentists often work closely with paediatricians, surgeons and anaesthetists as part of a team in the overall care of children with complex medical problems. They also work with other agencies such as health visitors and social workers in managing vulnerable children.
Among the variety of different roles carried out by specialists in paediatric dentistry are:
• providing a full range of oral healthcare to anxious children and those with special needs
• specialised management of children with oral and dental developmental problems
• managing the damage sustained to teeth and the mouth following traumatic injury
• contributing to multidisciplinary care of children with complex problems, e.g. cleft lip and palate, hypodontia and those with medical conditions which oral health may have an impact on.
A range of skills and attributes are required to be successful in paediatric dentistry. First and foremost, you must obviously enjoy working with children and be able to effectively communicate with them. The British Society of Paediatric Dentistry (BSPD) also lists:
• Excellent evidence-based clinical skills.
• A broad understanding of dentistry as a whole, with a willingness to develop specialised knowledge.
• Good interpersonal communication skills with parents or guardians, other members of the dental team as well as with children and adolescents.
• Willingness to be a team-player who is able to both follow guidance and lead the dental team.
• A keen interest in continuing your own personal career development.
To be recognised as a specialist in paediatric dentistry in the UK you must be registered on a specialist list held by the General Dental Council. This requires a Certificate of Completion of Training (CCT) in paediatric dentistry which can be achieved by applying for a specialty registrar training post on a recognised paediatric dentistry training programme. Posts are available in the hospital dental service as well as with a number of programmes linked with the salaried dental service. There is also the opportunity to apply for an academic clinical fellowship programme which provides both a clinical and academic training environment designed to provide support for individuals who have potential for development as a researcher.
To get onto a specialty programme you will need to demonstrate broad experience in general dentistry including hospital, community and general dental practice. A two-year foundation training programme or an equivalent scheme would give the desired range of experience. In addition, a maxillo-facial post is highly desirable as is some additional experience of treating children.
To make your CV more attractive it would be helpful to carry out some audit projects during your early training and to have one or two published articles to your name. You can also attend local British Society of Paediatric Dentistry meetings to learn more about the range of the specialty and meet colleagues with similar interests.
To qualify as a specialist you must successfully complete your supervised training programme and pass the Membership in Paediatric Dentistry examination. It is expected that a trainee who enters a full-time paediatric dentistry programme with no relevant prior training in the specialty will become qualified in three years. Part-time specialty training is also possible and would usually be completed in around five years.
Specialists in paediatric dentistry may work in the salaried health services either as a community-based specialist or as part of a team in either a district general or a children’s hospital. Paediatric dentistry specialists are also employed in university dental teaching schools and hospitals involved in the teaching of undergraduate and postgraduate students and specialty trainees. Many working in these environments will have undergone a further period of supervised training leading to their appointment as a consultant in paediatric dentistry. There are also opportunities in a number of other areas including independent practice, both private and NHS. To find out more speak with the paediatric dentistry consultants and specialists at your local dental school and hospital. The local postgraduate deanery can provide information on the application process and you can also find out more on the website of BSPD (http://www.bspd.co.uk/) and those of the UK Royal surgical colleges: Edinburgh, Glasgow and England.
Graeme Wright is a specialist practitioner in paediatric dentistry and National Treasurer of the BSPD
Julie McNicol, SGDP and honorary SpR in paediatric dentistry
What attracted you to a career in paediatric dentistry?
I was always attracted to paediatric dentistry from my early undergraduate experience and teaching. The speciality provides an opportunity to deliver a diverse range of treatments in patients with a developing dentition. I find treating children can be as rewarding as it is challenging!
What do you enjoy most about the job?
I thoroughly enjoy communicating with children and their families. We largely rely on families and carers to bring the child for treatment and therefore a truly holistic approach has to be adopted when planning their care. I enjoy the opportunities which are available in delivering care utilising behavioural management techniques, sedation or general anaesthetic. Additionally, the speciality supports the provision of oral and dental care for the medically compromised child. The opportunity to contribute to their care and to work closely with medical colleagues is extremely gratifying.
What do you find most difficult?
During the years of my training, I have seen development to some aspects of service and reduction to others. There is an increasing challenge to deliver care to children with an overall reduction in staffing within salaried NHS services. Consequently, patients are assessed in a timely manner however there can be delays receiving and completing treatment. This can be very frustrating for patients and clinicians alike.
What special challenges do children pose as dental patients?
Children can present a range of challenges either due to their stage of development or behavioural issues often linked with dental anxiety. In addition we rely on the primary care giver to engage in the treatment plan for any behavioural modifications, e.g. changes to dietary or tooth brushing habits, and in this sense our speciality is quite unique. Often managing the child within the family unit can present most challenges if the parent or care giver is unaware of their importance in the successful outcome of the child’s treatment.
Have you been surprised by any aspect of the job?
Almost on a daily basis I am surprised by the quirks and humour that children bring to the job. Furthermore, it can be quite surprising when young pre co-operative children manage certain treatments or return for review appointments following some months and often, due to further maturity and development, have significantly improved compliance.
What advice would you give to a trainee considering paediatric dentistry?
It is an extremely rewarding speciality to work in and lends itself to careers in both primary care and hospital settings. Excellent communication skills are required and broad-based early postgraduate training is essential. The opportunity to treat children in general practice as well as in community or salaried posts allows the acquisition of knowledge and skills for treating a range of patients with differing co-operative abilities.
What is your most memorable experience so far in the specialty?
As a SpR in paediatric dentistry we participate in audit projects and are encouraged to have an area of research interest. In our training we are encouraged to present our topics and attend national, European or international conferences to expand our knowledge on practices elsewhere and to develop links with other trainees. A particular memorable experience was the opportunity to present at the European Academy of Paediatric Dentistry in Dubrovnik in 2008. It had an excellent scientific meeting and the social events within such a spectacular setting with good friends will never be forgotten.