Dentistry in the UK is provided to patients in a primary care setting. Applicants should understand the meaning of “primary care.” This is when patients have direct access to a dentist in the community, where you can contact the dental practice yourself and book an appointment with the dentist without needing to be referred by a healthcare professional.
As a dentistry student or a graduate you should understand that the most important three “stakeholders” in NHS dentistry are the patients, Lawmakers (government), and the dentists.
The present NHS dental contract was legislated by the government in 2006 regarding courses of treatment. This contract breaks down the treatments into three separate bands:
- Band 1. Routine dental examination, scaling of calculus and polishing, and X-ray imaging;
- Band 2. All of the above, in addition to restorations or fillings;
- Band 3. All of the above, in addition to crowns, dentures and bridges.
These bands are weighted for their required time, complexity and resources. As you can see the higher the band, the more complicated the course of treatment. The bans are weighted with a numerical value called the unit of dental activity (UDA).
- Band 1 is worth 1 UDA;
- Band 2 is worth 3 UDA;
- Band 3 is worth 12 UDA.
Dentists are paid by the NHS according to their UDA, with each UDA being around £24.00. Hence, practices usually have a target UDA to reach every year that is set by the government. Usually, a target of around 7000 UDA is set for a high street dental practice that has to be met each year. It is the responsibility of the dentist to allocate the payments they receive for UDAs to their expenses, such as staff salaries, laboratory costs, and equipment and so on.
Various criticisms have risen due to this system causing ethical dilemmas. The contract states that no matter how many restorations the dentist performs on a patient, they will only receive 3 UDAs only. A dentist will get paid the same amount for a patient that receives 3 restorations as another patient receiving 1 restoration. This has given rise to questionable behaviour where dentists do one treatment per appointment, rather than dealing with all the restorations needed by the patient. Ethically, patients should be prioritised over profit, however, dentists also need to make a living – it’s a slippery slope.
The patients must pay dental charges towards their NHS treatment:
- £21.60 for band 1 treatment;
- £59.10 for band 2 treatment;
- £256.50 for band 3 treatment.
The Steele Review published in 2009 made some recommendations to improve the dental contract, which were piloted in test sites. The new recommendations aim toward improving patient care and encourage dentists to take more patients.
The new recommendations include making the salary of the dentist based on the number of patients they have, not just the number of UDAs provided. It’s also advised that dentists become more responsible in providing high-quality care and treatments that last longer by promoting longer appointment times. Further, preventative care should be made a priority rather than focusing on diagnosis and treatment only.
Many dentists also provide their own private treatment where they can set their own charges based on time, resources and costs. Most treatments are available under the NHS apart from a few cosmetic or overly complicated treatments.
A recent idea introduced by the National Institute for Health and Clinical Excellence (NICE) recommended that routine check-ups must be determined subjectively depending on the patient’s clinical risk factors.
Primary care dentists are advised to perform a “risk assessment” and advise patients on when they should return for a checkup. These assessments are based on a traffic light system of Green, Amber and Red zone depending on the patient’s oral health. For example, patients with who have 4 or more tooth decay instances are in place in the red zone and must have check-ups every 3 months. Amber is for those with 1 instance of tooth decay, and green is for patients with no decay who are advised to have check-ups annually.
Where to draw the line?
Many vulnerable people are given access to free healthcare such as pregnant women, patients in the hospital, patients referred for hospital treatment. Patients who receive state benefits could be eligible for free treatment. It has been a challenge for the government and dentists to decide on whom to provide free dental healthcare. Where do you draw the line if the patient cannot afford it? Some dentists have argued that UDA rates should be based on income.
The NHS saves money and time by having patients referred to primary care dentists to deal with clinical issues early on. Unfortunately, access to dentistry has become more difficult for patients.
Ethics in Dentistry
Dentists face ethical dilemmas every day. It is very important that dentists always do what is morally right. The core principles are:
As a dentist, you have a duty to respect your patient’s right to self-determination and safeguarding their confidentiality. You must seek the consent of the patient before proceeding with treatment.
Nonmaleficence – Do not harm – “Primum non Nocere”
The dentist must avoid causing any harm to patients by keeping your knowledge up to date and knowing your limitations and when it’s time to refer patients to a specialist.
Beneficence – do good
As a dentist, you must act in the benefit of patients and the public at large by providing competent and timely delivery of dental care.
Justice – fairness
Dentists must be fair when dealing with patients, colleagues and society.
Veracity – Truthfulness
Dentists must respect the position of trust between patient-dentist relationship s, being truthful in communications and ensuring intellectual integrity.
Post-Graduate Dental Specialties
After 6-years of studying dentistry and graduating as a dentist, you must go through 2 years of dental foundation training (DF1 &2) then specialise. There are 13 specialities according to the General Dental Council (GDC):
- Special Care Dentistry;
- Oral Surgery;
- Paediatric Dentistry;
- Restorative Dentistry;
- Dental Public Health;
- Oral Medicine ;
- Oral Microbiology ;
- Oral and Maxillofacial Pathology;
- Dental and Maxillofacial Radiology.
Governance of Dentists
Dentists must keep their knowledge up to date for the entirety of their career, in order to give patients the best possible treatment and care. Dentists should have 250 hours of continuing professional development every 5 years.
The GDC is working towards introducing a system of revalidation assessments, to ensure the dentists meet the satisfactory standard to maintain their registration with the GDC.
Clinical audits of dental practices are carried out by consultant dentists. This is an assessment of the dental care provided to patients based on the agreed national standards. This process identifies any gaps in treatment and helps improve the quality of care provided.
The Care Quality Commission ensures that dentists abide by a comprehensive quality assurance system developed across all of healthcare.
Current topical issues in dentistry are surrounding facial aesthetics using Botox. Further training is essential for dentists to do this work. Not many people are supportive of dentists undertaking these procedures.
System fluoride (ingestion via food or water)is a timeless controversial issue. Fluoride is absorbed into the bloodstream and bonds with bones and teeth, or to developing tooth buds in children. The reaction initiates replacement of the hydroxyapatite enamel crystalline structure with a stronger fluorapatite structure that is more resilient to decay. Some claim that introducing fluoride into public water supplies is a form of mass medication alleging that it is poisonous. Try to think about how the ethical topics you read about earlier are relevant here such as “patient autonomy.”
Interview Question: What makes a good dentist?
Dentists must have a sharp perceptual ability and manual dexterity. You will be working in small confined spaces so you must be able to cope with this. People who have decided to study dentistry can improve these skills by applying their hand-eye coronation in video games or by building small models.
Meticulous attention to detail is a skill that dentists use every day. You must keep accurate records about your patients, especially what drugs they take as this influences how you plan treatment. Dentists need to be detailed when modelling a tooth after a restoration so it looks as natural as possible.
Communication and interpersonal skills are some of the most essential when conveying information between a multi-disciplinary team in healthcare and a patient. It is also essential that dentists are personable in the way they communicate with patients to keep them at ease. Effective communication skills also include being an active listener so the patients are comfortable with you, and accept your advice and proposals for treatments.
Empathetic individuals make the best dentists because they try to understand how the patient is feeling. This makes it easier to create a healthy life-long patient-dentist relationship. This skill can be developed by volunteering to assist vulnerable individuals who require care, patience and consideration.
Dentists are generally very charismatic individuals because of their developed emotional intelligence. Dentistry seems great from the outside, but dealing with people has its challenges. You will be confronted with stressful situations, difficult people and anxious patients. You must be able to deal with scenarios in a professional yet empathetic way. Learning to respond to social cues and body language will help you succeed in your future career.
Interview Question: Why dentistry?
When you’re asked this question, you want to sound enthusiastic and knowledgeable about why you have thought long and hard about diving into a career in dentistry.
Dentistry is a branch of healthcare where you can be in the front lines leading the process of prevention, diagnosis and treatment. You must show that you understand the distinct differences between medicine and dentistry. This can be demonstrated by applying what you saw in your work experience at the dental clinic. Some people grow up observing a dentist in the family, others arrange shadowing sessions with a local dentist and so on. It’s important not to be negative by putting down a career as a general doctor; instead, you should focus on the positives of dentistry. We’ll compare the two careers later on. Working in healthcare means that you must be ethical and moral in your approach, while still having the end goal as what is in the best interest of the patient.
Dentists must work in a multi-disciplinary team with effective communication to serve the patient. The dentist works hand in hand with the receptionist, dental nurse, hygienist, laboratory technician and so on. This can be demonstrated by talking about teamwork activities that you’ve been involved in. It’s always best to talk about team-based sports. Admission teams really like sporty people because it illustrates many good skills like time management, organisation and hard work. Don’t worry if you’re not sporty, you can always talk about another extra-curricular activity or job that involves working as a team.
Another quality dentists have is caring for other people. Talk about how you enjoy helping people and contributing to the community. You’re a compassionate person who wants to positively influence the world and make a difference. What better way to do this than alleviate people’s pain and improve their wellbeing? It’s always good to demonstrate that what you’re saying is true by talking about how you’ve used your skills and time in the past to help others. Many students volunteer in charity shops, old people’s residence homes, and disabled children’s schools. Talk about activities that show that you helped people voluntarily, not out of obligation – like helping a family member! Caring people are good listeners who will empathise with the patient and their problems no matter how small they may seem to you.
A dental student will need to be creative, yet logical and constructive in their approach. Dentistry is a blend of science and art. Your job as a dentist is to strategically create a treatment plan, model and carve teeth resulting in a confident patient with a beautiful and natural smile. You must have some flare of creativity and this can be shown by talking about artistic activities that you love doing in your free time. You will learn pre-clinical science in the first few years at a dental university that will later help you use manual and cognitive skills when providing treatment to patients. As a dental student, you’ll be taught via problem-based learning, where you must be methodical and analytical to arrive at the most suitable solution for your patient.
Don’t worry if you feel like you are weak in one of these areas, in fact, dentists must be able to determine their weaknesses and strengths. Once you’re aware of your weaknesses you should strategically begin to work on improving these areas by reading up and applying these skills in a real-world setting. Nothing gets in the way of a hardworking, ambitious and determined dental student who wishes to improve themselves in order to be an amazing dentist. After all, dentistry is a lifelong career with post-graduate continuous professional development (CPD) in improving soft skills and academic knowledge.
How will these qualities make you a good dentist?
Studying dentistry is a difficult course and career path, and you must acknowledge this in your interview. It has its challenges, stressful and problematic situations. As a dentist, you are responsible for your patient and your multi-disciplinary team. Most dentists run their own practice so you must be methodical in patient treatment plans, such as ordering equipment, communicating with labs, managing staff and HR.
Career Options as a Dentist
You can stand out from the crowd by showing that you’ve thought long term about Dentistry and the career paths a Dental degree will lead to. Most dental students go on to general dental practice in the community. Other career paths include:
- Hospital practice;
- Specialising in a specific field of dentistry;
- Salaried services;
- Consultancy work for NHS and healthcare bodies;
- Medico-legal work regarding the laws and regulations in Dentistry.
However, when you apply, you should always have a backup plan in case you get rejected from medical schools in the UK.
Why not secure your future by applying for a dental school in Europe as well? We’ve had hundreds of students who’ve made this decision and have been ever thankful after. Had they not applied they would’ve been forced to take a gap year.
Secure your dream and apply for dentistry in Europe today!