08 • Careers
TAKING SPECIAL S
Special care dentistry trainees Jane Temple and Jessica Rowley focus on this small but growing specialty where each and every patient is unique
PECIAL care dentistry is a specialty unlike most others where every day – and every patient – presents their own unique challenges. The care offered is very much patient-led and takes a holistic
approach that considers all aspects of a person’s life and medical care. Delivering even the most basic oral care may require careful planning, a variety of sedation techniques and even unusual communication methods. As a specialty, it is relatively new and quite
small, having been approved by the General Dental Council in 2008. Dentists working in the field from 2008 to 2010 could apply for inclusion on the specialist list upon completion of a satisfactory portfolio of evidence. The first specialty training registrars were
appointed in October 2009 by the London and Oxford deaneries and were quickly joined by others across England, Scotland and Wales. There are currently 18 trainees nationally with plans to further expand the number of training pathways. According to the British Society for Disability and Oral Health, the specialty takes a holistic approach to providing oral care for “individuals and groups in society who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of a number of these factors”.
Training To enter specialty training you should have a BDS or equivalent, completed dental foundation training and it would be advisable to have one of the Royal College examinations, i.e. MJDF or MFDS. Training lasts three years, leading to a Certificate of Completion of Specialty Training (CCST).
The curriculum covers: • Biological sciences
• Concepts of impairment disability functioning and health
• Behavioural sciences • Oral health promotion
• Oral healthcare planning for individuals and groups
• Clinical special care dentistry
• Legal aspects, ethics and clinical governance
• Knowledge of research, statistics and scientific writing.
Currently, the curriculum is delivered in different ways depending on the training programme. Some trainees carry out a masters degree as an integral component, but others undertake distance learning either through the Diploma in Special Care Dentistry (DSCD), Royal College of Surgeons of England or the Bristol University Open Learning for Dentists (BUOLD). All trainees need to successfully pass the Tricollegiate Exit Exam (RCS Glasgow) in order to gain CCST. Trainees are continually assessed through
work based assessments and case based discussions with an emphasis on reflective learning. At the end of each year, the trainee must pass an Annual Review of Competence Progression (ARCP). Some training programmes are hospital- based with elements of primary care experience, but we are based in community dental services under the supervision of primary care consultants in special care dentistry. We also both work within hospital settings, giving a wide exposure and breadth of experience.
Necessary skills Working in special care dentistry requires a variety of skills, including behavioural techniques, sedation, hypnosis and acupuncture. Each day is different and each patient unique, including the way that we need to communicate with them such as using Makaton or word boards. Special care dentists need to have a
comprehensive knowledge of either the Mental Capacity Act 2005 or the Adults with Incapacity Act (Scotland) 2000 and the notion of informed consent as many patients lack the capacity to make decisions about their own dental treatment. This can be a complex area and laws vary between Scotland and the rest of the UK. Sometimes, examination of a patient is not possible without general anaesthesia or sedation, so the specialist must be prepared to treat whatever they find. For a patient who has
had little or no past dental treatment, their needs may be significant. It may also be necessary to perform a biopsy if suspicious lesions are found. This kind of treatment places demands on the dentist both clinically and physically. Other areas of special care are concerned
with treating those with medical complications such as haematological disorders or those about to start cancer therapy. These cases require close liaison with other medical professionals to provide effective and safe dental care. For oncology patients, dentistry may not be a priority but a failure to address these issues may have serious long term complications and affect the success of their treatment. The challenge here is to help these patients swiftly with kindness and understanding.
In practice Special care dentistry is a rewarding career that encourages us to adapt and strengthen our skills, while sometimes ‘thinking outside of the box’. While working with special care patients we spend a large amount of time with them and their carers and come to know them as people, not just as patients. No matter how professionally detached a dentist may try to stay we inevitably become emotionally attached to some. To enter into this specialty is to accept this
and ensure that we use these experiences positively to help us to treat patients within the context of their own lives.
Sources: • British Society for Disability and Oral Health -
www.bsdh.org.uk
• GDC curriculum -
www.tinyurl.com/boceh7p
• British Society of Gerodontology -
www.gerodontology.com
• Special care dentistry training resource:
http://stscd.com/wordpress
Jane Temple and Jessica Rowley are specialty training registrars with the Yorkshire and the Humber Postgraduate Deanery
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