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CARE A Day in the life


Below are examples of ‘typical’ days for Jane who works at Sheffield Salaried Dental Care Services and Jess who works at City Health Care Partnership Dental Services Hull


Jess Jane 7:30am 8:30am


Resuscitation training and practice using the hoist with sedation team


9:30am


Urgent new patient referral – needs to start radiotherapy in 2/52. Treatment planning in liaison with oncology/ radiology


10.30am


Intravenous sedation to facilitate examination and all necessary treatment for patient with advanced Huntington’s disease


11.30am


Local anaesthetic extractions for quadriplegic patient who requires hoisting


Home visit for new patient who is repeatedly biting his lip. Patient has cerebral palsy, uses a wheelchair and communicates with a word pad. Liaison planned with speech and language therapists to determine the best treatment


1.30pm 2.30pm 3:00pm


Observe learning disability team on home visit


Lead a best interests meeting for a patient with Down’s syndrome and severe congenital cardiac disease


Observed by educational supervisor whilst providing hypnosis for an extraction, followed by a case based discussion


Inhalational sedation for fillings on a phobic patient.


4:00pm


Case based discussions with consultant and other registrar


5:30pm


Assessment of a patient with Huntington’s disease for treatment under intravenous sedation


Finish


Preparation of domiciliary equipment and travel to homeless project


Treat homeless patients with a range of social issues including drugs, alcohol and mental health problems


Q&A Carole A Boyle, Consultant in Special Care Dentistry


• What attracted you to a career in special care dentistry? I realised that I enjoyed treating people rather than drilling teeth. Unlike now, at that time there was no training path in special care dentistry so I


had to make up one as I went along. I enjoy oral surgery and conservative dental treatment and in my current job I can do both but for a very interesting group of patients. Special care dentistry is ordinary dentistry for extraordinary patients.


• What do you enjoy most about the job? I enjoy the range of patients that I see. One moment I’m talking to somebody who is extremely anxious and phobic of dental treatment but also highly intelligent and knowledgeable. The next I am gaining consent for sedation for someone with a mild learning disability. I also see patients with complex medical histories and trying to work out the best and safest way of providing care for them is incredibly challenging but also very rewarding.


• What do you find most difficult? The most difficult part of the job is engaging patients and their carers to motivate them to provide simple oral hygiene. It is upsetting to begin every treatment with plaque removal for patients with learning disabilities because their carers do not see the necessity to assist their client in brushing their teeth between appointments. It is also frustrating sometimes not being able to


provide more complex dental treatment for people who are unable to cooperate due to dental phobia or disability.


• What unique challenges do special care dental patients pose? We have to be quite ingenious sometimes in working out the best treatment plan for patients and also how to provide care. I treat patients under general anaesthesia and sometimes the challenge is getting the patient into the anaesthetic room and asleep before we can even examine them. I am quite inventive with administration of premedication. You have to be flexible and adaptable – things don’t always go to plan.


• Have you been surprised by any aspect of the job? I think the biggest surprise is that I have got to know my patients very well and have a large group that I see on a regular basis. Unlike many hospital consultants we see our patients for recall and over the years I have got to know my patients and their parents/carers. It is very rewarding when I get a hug from someone who is pleased to see me.


• What advice would you give to a trainee considering special care dentistry? I think my advice to anyone thinking about becoming a special care dentist would be to get some experience of special care. It is only when you meet a patient who refuses to let you examine them due to anxiety or a learning disability that you really understand the challenges faced by this specialty.


• What is your most memorable experience so far in the specialty? I think some of the individual people and patients that I have met. I am amazed by the patience of parents of adults with learning disabilities, where every single day is a challenge. This has made me appreciate some of the difficulties people have in accessing dental care, how lucky I am and it enriches my life knowing these patients.


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