DENTAL imaging is not a particularly new field. The earliest dental X-rays date back to 1896, less than a year after physicist Wilhelm Röntgen took the first “medical” X-ray of his wife’s hand. Yet in recent decades the field has seen an explosive growth in technology.
Today dental patients benefit from a range of diagnostic imaging techniques including computed tomography (CT) and cone beam CT (CBCT), magnetic resonance imaging (MRI), sialography and ultrasound. It is the role of the dental and maxillofacial radiologist to utilise these various diagnostic imaging techniques in order to assess the anatomy and pathology of the face, neck and head.
Dental and maxillofacial radiology (DMFR) is one of 13 dental specialties overseen by the General Dental Council and requiring registration on a specialist list. In its booklet Careers in Dental Surgery, the Royal College of Surgeons of England states that the specialty requires in-depth knowledge in a variety of areas, including:
• anatomical features as they appear on images taken using various imaging techniques
• interpreting images of diseases, disorders and conditions that affect the teeth, jaws, oral cavity, facial structures and the head and neck
• the provision of therapeutic radiology appropriate to specific conditions affecting the head and neck region
• using evidence-based knowledge of good clinical practice and diagnostic methods to justify the use of appropriate imaging.
Most dental radiologists work in dental schools or hospitals and require a good clinical background in order to treat patients in close collaboration with colleagues in other medical and dental disciplines.
Entry and completion of CCST
To join the UK specialist register in dental and maxillofacial radiology requires a Certificate of Completion of Specialist Training (CCST) which demonstrates satisfactory completion of training in all aspects of the curriculum. Entry to a UK training programme in DMFR is highly competitive and follows a two year period of postgraduate foundation training which may include vocational training (VT) but should also include training in secondary care in an “appropriate cognate specialty”. Candidates for specialist training will usually be expected to possess an FDS, MFDS or MJDF of the UK Surgical Royal Colleges or an equivalent qualification, or an appropriate higher degree and/or experience in dental and maxillofacial radiology or a related discipline.
Completion of the curriculum as set by the Royal College of Radiologists should normally require four years of full-time training in an approved deanery programme. Each trainee is issued an RCR Specialty Trainee personal portfolio and logbook at the start of training and must undergo an annual assessment (ARCP) to confirm satisfactory progress.
Training schemes are centred on dental hospitals and schools, with appropriate rotations to teaching hospitals, district general hospitals and specialist hospitals. Candidates are required to pass examinations for a Diploma in Dental and Maxillofacial Radiology (DDMFR) of The Royal College of Radiologists. There are also workplace-based assessments. Dentists can apply for flexible or part-time training if there are “well-founded individual reasons”.
Before acquiring a CCST the trainee will be expected to be capable of providing an independent diagnostic dental and maxillofacial radiology service offering specialist advice to clinicians with direct responsibility for the treatment of patients. This includes running a department with appropriate knowledge of the spectrum of staffing issues, radiological techniques and safety issues.
Dental radiologists working in a hospital setting handle referrals for radiographic services beyond the scope of general dentists and other specialists. These must be checked and approved along with appropriate protocols for the investigation selected. A clinic list may be as varied as carrying out a CBCT evaluation of a prospective implant site to a sialogram to assist in the location of a salivary gland obstruction.
Research and training are also common aspects of the job. Dental radiologists are heavily involved in both undergraduate and postgraduate teaching as well as undertaking research or other original work. Clinical audit is also an important part of the job.
For more information on career prospects in dental and maxillofacial radiology go to the website of The British Society of Dental and Maxillofacial Radiology.
• Careers in dental surgery. 2012 The Faculty of Dental Surgery. The Royal College of Surgeons of England.
• Curriculum for Specialist Training in Dental and Maxillofacial Radiology. 2010 Royal College of Radiologists and British Society for Dental and Maxillofacial Radiology.
Mr Donald Thomson, consultant in dental and maxillofacial radiology at Dundee Dental Hospital
What attracted you to a career in dental radiology?
I enjoyed radiology and radiography as an undergraduate and I was always interested in anatomy and pathology. This interest in radiology continued after graduation, particularly as part of the oral medicine and oral surgery posts.
What do you enjoy most about the specialty?
It is rewarding to bring together various parts of the diagnostic puzzle and be able to arrive at the final diagnosis. I particularly enjoy the investigation of some of the rarer conditions which affect the teeth and jaws, and over the last few years CBCT has played an increasing role in this. There is still a lot of patient contact but not usually on a recurring basis.
What do you find most challenging?
Although there is a tendency to think of a radiologist as someone who sits in a darkened room, there is a lot of interaction with other clinicians. There can be some confrontation when a particular investigation cannot be justified but you should be able to explain your reasoning.
Have you been surprised by any aspect of the job?
As most dental and maxillofacial radiologists work in dental hospitals, I was always aware that teaching would be a large part of my job. I was surprised by the actual amount of undergraduate and postgraduate training of dentists that is expected.
What personal attributes do you feel are important in dental and maxillofacial radiology?
An ability to think logically and also laterally and an ability to communicate effectively are all important.
What advice would you give to a student or trainee considering the specialty?
I do not think that you can have too much experience of clinical dentistry before considering the specialty. Clinical experience greater than that obtained in dental foundation training is advantageous and broad experience of as many of the dental specialties as possible is required. Many of the cases requiring more complex investigations are referred from oral medicine and oral surgery clinics and experience of these specialties was invaluable to me prior to embarking on my career in DMFR.