Mark J Hunter, specialist endodontist, teacher and secretary of the British Endodontic Society
• What attracted you to a career in endodontics? I was encouraged by a teacher who was aware that I had an aptitude for doing endo. I discovered an area of dentistry that was challenging, intriguing and
captivating. To save teeth that would otherwise require extraction is matched only by the privilege we have as dentists to relieve a patient of one of the worst pains that can be suffered.
• What do you enjoy most about the specialty? I enjoy treating the person who owns the tooth. It is not just about doing a challenging and intricate procedure, it is about taking an often frightened patient and delivering them through the process with a positive experience. Winning the trust of another is where the greatest return is to be had.
• What do you find most challenging? Gaining sufficient experience to be confidently effective is one of the early challenges we all face. Once this has been achieved, the biggest continual challenge is to gain and maintain the patient’s trust. If a patient is struggling to let you get on, it can prevent you from performing at your best. This is why endodontics is very much a team effort with you, the patient and your assistant. I can’t over-emphasise the value of a good assistant. Sure, there are technical challenges such as sclerosed canals, 90 degree curvatures with a small arc of radius, previous misadventures, fractured instruments, ledges and blockages. These can be overcome, but not if the patient is unwilling to let you get on with it.
benefit from much experience gained during postgraduate training. Referral endodontic practice works side-by-side within general dentistry, however it is often necessary when patients are being treated for complex restorative work. The specialty relies on a number of key
pieces of equipment including an endodontic microscope, a torque controlled motor for engine driven rotary nickel titanium instrumentation, digital X-ray equipment, an electronic apex locator and obturation devices and systems. These can involve a considerable financial outlay but are advantageous to ensure efficient endodontic treatment – it is well worth seeking advice before making any big decisions. It must be said that a good trustworthy assistant is perhaps the most valuable element of a successful practice, more so than any of these devices and pieces of equipment.
Membership of professional organisations such as the British Endodontic Society offer a chance to maintain your professional skills and keep up-to-date with the latest developments in the specialty, as well as to share ideas and expertise with fellow dentists and specialists.
• British Endodontic Society - www.britishendodonticsociety.org.uk
• GDC specialist lists and curricula - tinyurl.com/lp7s728
• Have you been surprised by any aspect of the job? I have learned that complacency can teach one a harsh lesson. Positive outcomes cannot be assumed and you should always expect the unexpected. When you see a lateral canal filled very nicely, ask yourself how much skill really went into filling this and how much was down to good luck? Doing endo can be a humbling experience. When things don’t go according to plan, don’t try to cover up, always keep the patient informed, be open, honest and realistic.
• What personal attributes do you feel are important in endodontics? The most important attribute for achieving good outcomes is patience, both with the patient and yourself. If you are performing urgently or under pressure, then this tends to give a poorer outcome. A better outcome can often be had by returning to a case at a later date rather than trying to complete it in a hurry. Missing or difficult to negotiate canals one day can seem much easier to manage when one is refreshed at a subsequent visit. The other great attribute for doing good endo is empathy. Letting patients know they can stop treatment if the need arises helps them to feel more relaxed and in control.
• What advice would you give to a student or trainee considering the specialty? Total commitment is required for endo as it can be tough. Don’t specialise too soon – I feel I’m a better endodontist because I have a facility and ability in other areas of dentistry. (It relates back to the idea that we treat the person who owns the tooth, not just the tooth.) A good endodontist will have a range of early dental experience such as extracting teeth, making dentures, recognising and treating soft tissue disorders as well as treating difficult uncooperative children to name but a few. You also have to be good at giving local anaesthetic, as well as
restoring the tooth for the referring practitioner with a core or perhaps a post-retained core foundation. It helps to be a good diagnostician which means being able to listen and, when things don’t make sense, to stand back and admit that we don’t quite know what is going on. Endo is a wonderful, challenging area of medical expertise and intrigue, with ongoing scientific advances on many fronts, and countless gadgets and gizmos to help you on your way.
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