AN estimated 45 per cent of UK adults suffer from moderate to severe periodontal disease, according to the most recent Adult Dental Health Survey1. Extrapolating from this number the authors of a 2014 BDJ article estimated that the number of specialists required to meet the periodontal treatment needs of the UK population was around 2,200 at minimum2. But in 2014 there were only 318 dentists on the GDC specialist list in periodontics.
“There is clearly, therefore, a need for an increased number of specialists in periodontics,” they concluded.
No doubt demand will only grow as the number of people over age 65 increases and advances in dental treatment mean that more people remain dentate into old age and therefore potentially susceptible to gum disease. All these factors make periodontology an important and promising career option. It is already a discipline widely regarded as the foundation to restorative dentistry.
Periodontology is the study of the specialised system of hard and soft tissues that support the teeth and maintain their position in the jaw – otherwise known as the periodontium, which includes the gingiva (gums), alveolar bone, cementum and the periodontal ligament.
Periodontists specialise in the prevention and treatment of diseases of the periodontium. All dentists are trained in the diagnosis and treatment of periodontal disease; however, severe or complex cases (BPE 4) should be treated by an appropriately trained individual and may be referred to a periodontist, who has undertaken recognised postgraduate training to develop special expertise in this area. The field comprises a range of management modalities, from non-surgical treatment of periodontitis to surgical treatment, including mucogingival surgery for recession defects. It also includes additional training in implantology to offer dental implants as an option to replace missing teeth.
Entry and training
Periodontics is one of 13 specialties where practitioners in the UK must be registered on a GDC list in order to be called a specialist. To become a specialist you must complete a training programme approved by the GDC, leading to the award of a Certificate of Completion of Specialist Training (CCST). A formal curriculum, set by the GDC and delivered by postgraduate centres in conjunction with deaneries, outlines the required training and methods of assessment of specialty trainees in periodontics.
The minimum requirement for entry to specialty training in periodontics is two years of postgraduate foundation training or equivalent, which may include a period of vocational training (VT) and also a period of training in secondary care in an appropriate specialist environment. Successful foundation year training might include membership of the dental faculty of one of the UK Royal Colleges of Surgery but this is not essential and candidates may be able to demonstrate competence in different ways. Some training in surgical dentistry would be considered desirable.
To qualify as a specialist in periodontics normally requires three years (4,500 hours) training whole-time or the agreed equivalent in a part-time programme. The programme content should be apportioned approximately as 60 per cent clinical, 25 per cent academic and 15 per cent research. Training may be flexibly delivered through a variety of methods including a taught master’s degree programme or through a workplace-based programme (specialty practice or hospital-based training). In either case it remains mandatory for trainees to demonstrate certain minimum outcomes in the requisite skills with tracking of the learning process.
Training will include:
• guided theoretical learning
• validated self-directed and independent study
• technical skills development through the use of systematic simulation laboratory exercises clinical skills development through supervised clinical practice
• research exposure through participation in a research project (clinical, experimental or literature research) which is reported formally in a thesis or equivalent written report, or as a manuscript prepared for submission or as a published paper.
Specialty training takes place within programmes approved by a relevant postgraduate deanery and each trainee will tend to have a designated lead trainer (educational supervisor) who will co-ordinate the training and assessment throughout the period.
Periodontists often treat more problematic periodontal cases such as severe gum disease or patients with a complex medical history. Periodontists offer a wide range of treatments, such as root surface debridement, pocket reduction surgery, regenerative procedures, root resections, crown-lengthening surgery and mucogingival surgery. In addition, periodontists are specially trained and well suited in the surgical placement of dental implants.
More information on periodontics as a career is available via the following links:
• British Society of Periodontology: www.bsperio.org.uk
1 Steele, J. & O’Sullivan, I. (2011) Adult Dental Health Survey 2009. The Health and Social Care Information Centre.
2 Griffiths G S & Preshaw PM. Manpower planning in periodontology – how many specialists do we need? BDJ 2014; 217: 399-402
Q&A Dr Manoj Tank, 3rd year specialty trainee registrar in periodontology at Guy’s Hospital
What attracted you to a career in periodontology?
I was initially inspired by a teacher of mine whilst at the University of Bristol who allowed me to assist him during some pocket reduction and root resection surgicals. This opened up the specialty as more than just root surface debridement. Once I truly understood that periodontology encompassed both non-surgical and a variety of interesting surgical procedures, I knew this would be perfect for me.
What do you enjoy most about the specialty?
My favourite aspect of periodontology is the delicate soft tissue surgery. There is so much skill involved in how we raise minimally invasive flaps and how we can manipulate soft tissue to do exactly what we want it to do. I also thoroughly enjoy periodontal plastic surgery for treating recession defects, whether that is via free gingival grafts, connective tissue grafts or even with the use of acellular dermal matrix grafts for multiple recession defects.
What do you find most challenging?
The challenge in this field is not always mastering your clinical skills, especially when it comes to your regular ‘bread and butter’ non-surgical treatments. You have to train yourself (no one can do this bit for you) to become an effective life coach for most of your patients. Getting them to understand they have periodontal disease in the first place can be a challenge as it is typically a painless disease. Added to this, modifying their oral hygiene regime can hit you with some resistance, especially as their parents taught them how to brush since early childhood!
Have you been surprised by any aspect of the job?
The main surprise so far has been how much research really goes into the field of periodontology. It’s amazing how many periodontal journals there are, as well as how many high quality scientific papers come through every month. There is research on absolutely everything: treatment techniques, grafting and regenerative materials, periodontal medicine, stem cell biology – the list goes on!
What personal attributes do you feel are important in periodontology?
The specialty is a very friendly one, and you would certainly feel this if you were to join us at our British Society of Periodontology (BSP) conferences. I think that inherent attribute paves the way for you to become a successful periodontist, as the patient interaction is so key in achieving high quality treatment results, as well as helping to build your referral base with local dentists.
What advice would you give to a student or trainee considering the specialty?
To know if you want to specialise in a certain field of dentistry you firstly need to experience it in some way. Consider visiting a local specialist in both primary and secondary care settings. If that inspires you then join the BSP and ask to join our new Early Career Group (ECG). We can provide more information about different career pathways in periodontology, as well as give you the opportunity to meet like-minded colleagues, specialty trainees, academics and recently qualified specialists. We meet at every BSP conference and also ensure we arrange a great informal dinner out too!