The security levels and resident population of each location varies dramatically. Generally, the common themes are individuals with high clinical dental needs, poor socio-economic background and high levels of mental ill health.
Dental care is provided in line with government regulations; occasionally with visiting specialist dental services, and external referral pathways matching those available in the local community for the area.
Usually the dental team will work within healthcare and so will have the benefit of sharing care directly with the wider medical, detox (drug and alcohol) and mental health teams.
Pros and cons of working in prison dentistry
Caring for these patients can be highly rewarding. Although usually basic dentistry, the impact dental teams can have on oral and general health is significant, both for the individual patient and their families.
Whilst the clinical dentistry is relatively routine, it is necessary to have excellent diagnostic skills and experience dealing with severe infections and surgical extractions. The individual patients will often have complex medical and psychosocial histories and so clear communication, coupled with confidence in explaining procedures and obtaining valid consent, are vital.
Patients will vary in age, ranging from children to the elderly, depending on establishment, so research and understanding the population being cared for will dictate the clinical and interpersonal skills needed by the clinician.
Although litigation and complaints will generally be higher than in general practice, with robust systems and direct management, the impact on daily working life can be minimised.
Career pathway
Although not a specialty in dentistry, prison dentistry does benefit from Dentist with Special Interest (DwSI) status, with the Faculty of Dental Practice publishing guidelines for appointment in 2007. See the Primary Care Commissioning (PCC) website.
With changes in commissioning dental care, this has not been adopted widely and many dentists work within prison part time, either employed by community dental services or contracted by private providers. Some dentists hold their own NHS contracts, but this is becoming less common.
Prison healthcare is often commissioned as part of the whole healthcare contract, so it is very important to make sure you know who holds the contract and who is your line manager. This can become important in case of breakdown or repairs and to ensure all guidelines for infection control, GDC and NHS regulations are followed. Dentists working under an NHS dental contract in prisons are entitled to an NHS pension and you should make sure that your individual contract ensures that you receive NHS pension contributions.
As with any dentist post, these are advertised in the usual dental journals and online sites, together with some recruitment agencies.
If possible, try to gain some work experience in a number of establishments to ascertain if working in a secure environment is something that you wish to do, and ideally identify the type of population you are most comfortable treating.
Prisons have generally faced public sector funding cuts and many are overcrowded. Personal security is essential and understanding the risks that can occur, together with how to mitigate them, is part of working in this environment.
Clinically it is important to be confident and competent in general dentistry. Usually there will be no support on site and referring patients outside can be very difficult. Patients will be demanding and even threatening, so personal confidence and an ability to de-escalate volatile situations is vital. Security clearance will be required. It is also essential to have a full induction to the establishment and research it personally before starting work.
