Career: On the right track

Orthodontics is the largest of the dental specialties and no wonder. Last year nearly one million people in the UK underwent orthodontic treatment and it’s not only children. More adults than ever before are attending orthodontists to improve their smiles.

The specialty can be defined as the branch of dentistry concerned with the growth of the face and the correction and prevention of occlusal abnormalities. Treatment aims to mitigate the effects of occlusal variation on facial appearance and the health and function of the masticatory system.

A dentist with a BDS or BChD and an interest in orthodontics can consider a number of training options. These include attaining some limited additional training to work as a primary care dentist carrying out straightforward orthodontics in a general practice, or undertaking more extensive training to become a specialist working in an orthodontic practice, hospital, university, the armed forces or a community dental service.

Specialist training

In order to be accepted onto an orthodontic training programme as a specialist registrar you will need to gain a broad experience of dentistry either in a hospital, community and/or general dental practice setting. Places are very competitive and therefore you would be advised to spend time post-qualification developing your CV and gaining varied clinical experience during either your vocational training (VT) or general practitioner training (GPT) years.

The MJDF/MFDS/MFD examination is no longer an essential requirement to enter specialist training but the majority of applicants will have this diploma and you would be advised to complete it. In addition, you should try to get one or two articles published in good dental journals, carry out some audit projects and present at meetings. These activities will help when applying for a specialist training post.

You can apply for specialist training at the Universities of Belfast, Birmingham, Bristol, Cardiff, Dundee, Edinburgh, Glasgow, Leeds, Liverpool, Kings College London, Manchester, Newcastle, Sheffield, Queen Marys and Westfield or University College London, Eastman Dental Institute. Applications are made through the local postgraduate deaneries.

The courses take three years (or equivalent part-time) and comprise clinical training and academic study. After three years you will sit the Royal College examination for the Membership in Orthodontics (MOrth/IMOrth) and, if successful, will gain a Certificate of Completion of Specialist Training (CCST). This will allow you to be included on the specialist list and be known as a specialist in orthodontics. Trainees are also required to study for a higher degree, such as the MSc, MClinDent, MDentSci or DDS, during their training.

After qualifying, there are a number of career options open to specialists. You can work in a specialist practice, usually as a performer (previously known as an associate), and eventually a partner or a principal. There is the further option to work under an NHS contract in primary dental care or undertake treatment privately or a combination of both.

Salaries range from £30,000 per annum for an associate orthodontist (a selfemployed orthodontist working in a practice owned by someone else) to over £150,000 per annum for those who operate their own private practices. The average income for an orthodontist is just under £90,000.

Other options

Alternatively, you may decide to become a salaried specialist in the community dental service which provides treatment for special care patients. You can also opt for a hospital setting and work towards becoming a consultant orthodontist which involves a further two years training as an FTTA (fixed term training appointment) and sitting the FDS Orth exit fellowship. Finally, there is the option of an academic career which involves at least four years training post-membership in a hospital/university. During this time you will undertake FTTA training and do a PhD degree and could eventually become a professor of orthodontics.

Orthodontics in primary care dentistry

Not all orthodontic work is carried out by specialists. It is possible for primary care dentists to train for one session per week over three years, as a part-time clinical assistant, in order to be able to carry out straightforward orthodontics for patients in general practice. Such training programmes are mainly intended for dentists working in areas without a specialist orthodontic practice. Course places are limited and you will not hold a specialist qualification at the end of this additional training.

For individuals interested in becoming a primary care dentist with a special interest (DwSI) in orthodontics there is a three year part-time BOS/FGDP(UK) training programme in orthodontics leading to a Diploma in Primary Care Orthodontics RCS(Eng).

More detailed information on training pathways in orthodontics is available from the British Orthodontic Society website (www.bos.org.uk). The BOS is the umbrella organisation for all dentists with special additional training in orthodontic treatment and it offers on-going learning and support for the profession and funds research into new treatments. Useful information about general professional training and orthodontic training can also be found on the Royal College of Surgeons of England website (www.rcseng.ac.uk).

Q&A Hemendra Shah, FTTA in orthodontics at Bristol Dental Hospital and Royal United Hospital, Bath

What attracted you to a career in orthodontics? As an undergraduate training at Bristol Dental School, I was exposed to a lot of clinical orthodontics and was very fortunate to be able to treat a number of cases during my fourth and final year. This initially stimulated my interest in this specialty. I undertook my elective, investigating the provision of cleft lip and palate care in Sri Lanka, which further motivated me to go on to specialise in orthodontics. My vocational training practice did a lot of orthodontics inhouse, and with encouragement from VT trainers I was fortunate to continue an active interest in the subject during VT.

What do you enjoy most about the job? I find my job very rewarding. You meet such a variety of patients working as a hospital orthodontist, and it is extremely satisfying to see the happiness that orthodontic treatment can produce not only in the smile of an individual patient but also in the confidence that brings.

Are there any downsides? The current dental contract does not allow for VTs to try their hands in simple orthodontics which I feel is a shame. My vocational training allowed me to build upon the experience I had as an undergraduate dental student and gave me a taster of treating orthodontic patients in the primary care setting.

What have you found most challenging in your training? Orthodontic specialty training was an intense three years. The run-up to the MOrth examination was challenging, trying to complete a range of cases with different malocclusions in time for the examination. But this was the same for everyone taking the examination, as orthodontic treatment on average takes two years, and these are the first ever set of patients that you have treated.

What about the job has most surprised you? As a hospital orthodontist, I was surprised at the amount of management training that we are required to undertake in preparation for a consultant role.

What advice would you give to a young dentist considering orthodontics? Before applying for an orthodontic specialty registrar post, it is worthwhile getting a broad base of experience during dental foundation training. Vocational training will give you an insight into how dentistry is delivered in primary care, and once you have your VT number, you are eligible to provide NHS orthodontic treatment in primary care, if that is the career in orthodontics you wish to pursue. SHO jobs in maxillofacial surgery, paediatric dentistry and restorative dentistry will provide you with invaluable experience in these branches of dentistry, since a proportion of the cases you will treat during your training and beyond will require multidisciplinary care.

Try and get some experience doing orthodontic treatment or visit local orthodontic hospital departments and specialist practitioners to try and get a feel of what is involved in performing the role of an orthodontist, since orthodontic experience is limited during undergraduate training relative to the other dental specialties.

My final piece of advice would be to identify any weaknesses in your CV and use the time during your foundation training to participate in audit, research, teaching and any opportunities to publish articles, for example case reports.

What is your most memorable experience so far? Every day produces a memorable experience in orthodontics. A majority of my caseload are multidisciplinary orthognathic and hypodontia treated with a combined team approach. My most memorable experience is the first orthognathic case that I treated. It was a class 3 case that required a bimaxillary osteotomy, and following two years of treatment, it was rewarding to see the dental and facial changes that were achieved, and the happiness that the treatment produced for the patient.