THIS is a new era for public health. That is the bold announcement made by the Department of Health in a recent government report which promised the specialty a “higher priority and dedicated resources”.
In its 2011 report, Healthy People, Healthy Lives, the DoH sets out its vision for the dental public health (DPH) workforce in England to “increase its focus on effective health promotion and prevention of oral disease, provision of evidence-based oral care and effective dental clinical governance.”
Particular focus should be given to improving children’s oral health, the report adds, with DPH specialists also called on to “make a vital contribution” to the new primary dental care contract prioritising preventive care.
Similarly, increasing prominence has been given to dental public health and preventive treatment in Scotland, reflected in national initiatives such as the Childsmile programme.
Entry and training
Dental public health is a small specialty, defined as the “science and practice of preventing oral diseases, promoting oral health and improving the quality of life through the organised efforts of society”.
It is overseen by the General Dental Council and DPH specialists must be registered on its specialist list. The GDC approves the curriculum for specialist training and the award of the Certificate of Completion of Specialist Training (CCST) requires evidence of satisfactory completion of training in all the aspects of dental public health that are outlined in the curriculum.
Those entering specialty training must have at least two years’ post-qualification dental foundation training. It is helpful but not essential to hold diplomas of membership of the Joint Dental Faculties (RCS England), the Faculty of Dental Surgery (RCS Edinburgh/RCPS Glasgow) or the Faculty of Dentistry (RCS Ireland).
Full time specialty training (for those with no prior training or experience of the specialty) can be completed in four years. One of those four years consists of academic study in a recognised course, i.e. a masters in public health/dental public health, which should include an appropriate dental module. Less than full time training is an option for dentists with “well-founded individual reasons” for not pursuing full time training.
Other learning takes place in the workplace and from peers and can be undertaken principally within the NHS or on an academic training pathway.
The 2010 Specialty training curriculum – dental public health from the Royal College of Surgeons of England details the following key areas of good practice:
1. Oral health surveillance
2. Assessing the evidence on oral health and dental interventions, programmes and services
3. Policy and strategy development and implementation
4. Strategic leadership and collaborative working for health
5. Oral health improvement
6. Health and public protection
7. Developing and monitoring quality dental services
8. Dental public health intelligence
9. Academic dental public health
10. Appropriate decision-making and judgement
11. Appropriate attitudes, ethical understanding and legal responsibilities
12. Role within the health service
13. Personal development
The curriculum is delivered through “learning experiences in a variety of geographic locations and within various healthcare organisations”. These include clinical commissioning groups (CCGs), health boards, local authorities, public health observatories and government office and university departments of dental public health/public health.
It adds: “Learning from peers will occur at dental public health and public health meetings locally, regionally and nationally. Opportunities such as journal clubs and specialty audit provide specific learning experiences and should be part of every training programme.”
Dentists are assessed throughout training by various means including a personal development portfolio, workplace-based assessments and specialist examinations. They must also pass the intercollegiate specialty fellowship examination (ISFE). The curriculum emphasises that “the assessment process is initiated by the trainee” who will be expected to identify opportunities for assessment throughout their training.
Towards the end of training, trainees can undertake special interest placements which might include attachment to the DoH or British Dental Association; working with the Ministry of Defence for the Defence Dental Agency; overseas projects; or a communicable disease attachment with the Health Protection Agency and primary care organisation on-call (for those interested in a career in general public health).
Postgraduate dental deans are responsible for monitoring trainees’ progress through the ARCP process and will ultimately recommend the award of the CCST to the GDC. If the GDC accepts the recommendation, it will add the dentist’s name to the specialist list upon receipt of their application form and payment.
Roles in DPH vary from an NHS consultant post to a university academic job and work with health charities such as the Global Child Dental Fund. They do not involve one-to-one care of individual patients. The Royal College of Surgeons of England describes it as “an applied and not just theoretical subject which should stimulate research, appraise such research and apply the findings to practice.”
Most DPH consultants work in health service commissioning organisations such as CCGs or health boards. They are often asked to provide impartial advice on the many aspects of dental and oral health, on the provision of evidence-based oral and dental care and effective dental clinical governance. Objectives include tackling inequalities in oral health, ensuring public access to prevention and treatment, improving the quality of dental services and patient safety and supporting dental teaching and care services.
DPH academics focus on research and development projects that may spark debate or influence clinical practice, as well as assisting in the development of government oral health programmes.
• Royal College of Surgeons of England, 2010: Specialty training curriculum - dental public health
Joanne Curran is an associate editor of SoundBite
Q&A Jennifer Rodgers, consultant in dental public health with NHS Forth Valley
What attracted you to a career in dental public health?
While I had always enjoyed clinical dentistry and had completed VT and spent a number of years in oral surgery, dental public health seemed very different to all the other clinical specialties. It is a non-clinical specialty and in the simplest terms, concerned with improving the dental health of populations rather than individuals. The training programme looked interesting, working across two health boards and gaining experience in many different aspects of the specialty, such as health promotion, health protection and NES. The training also gave the opportunity to study for a master’s degree in public health at the University of Glasgow and to be awarded an ISFE at the end of training.
What do you enjoy most about the specialty?
The specialty involves working with people from all branches of dentistry as well as the medical specialties, and other agencies such as education, local authority, councils and the Scottish Government. This is an ever-changing career where there is no time to get bored. It is a very diverse job which can differ wildly from day-to-day, and the ongoing work projects are of a very differing nature.
I work hard to continue my links with oral surgery and general practice but that is unusual within the specialty.
What do you find most challenging?
It is a small specialty with few like-for-like colleagues but we have a close network and supportive working relationships.
Have you been surprised by any aspect of the job?
What personal attributes do you feel are important in dental public health?
It is important to be a rounded person with a good understanding of all aspects of dental services and a good basis in both primary and secondary care dentistry. There is a need to empathise with dentists and the public alike. You must be approachable and engaging and able to work well with people from all walks of life.
What advice would you give to a student or trainee considering the specialty?
It is a good idea that during the early training years the individual has experienced work in as many sectors of dentistry as possible.