Kirsty Dickson, Dental Vocational Trainee, on the policy changes needed to reshape the future of dentistry.
My career in dentistry is just beginning, and it's clear to me that it is an extremely difficult time to be a dentist. A radical change in approach by the government is needed to enable dentists to deliver the care that patients need and deserve. Prevention of future oral health issues must be made central to the care we give. This is vital for the good of public health, but also for the professional integrity of the dentistry profession.
The current system lets down patients
Attending the recent Conference of Scottish Local Dental Committees was a real eye-opener and allowed me to understand the political influences at play in dentistry. It was heartening to see so many GDPs at the conference, united in trying to understand how we can get the Scottish Government to listen to us about the difficulties facing the profession and what policy changes are needed.
"We are being prevented from doing what is best for our patients in the long term."
Even at such an early stage in my dental career, I struggle to feel that I am fulfilling my duty as a healthcare professional when the Statement of Dental Remuneration (SDR) works the way it does. We are being paid to treat - drill and fill - without any measure on quality or patient communication and education. This goes against everything I believe makes an honourable dentist and was taught in dental school; to be passionate about my patients and keeping them healthy. The conference inspired me to try and help the movement to change things in dentistry. It made clear that my frustration is a shared one; we are being prevented from doing what is best for our patients in the long term.
The SDR needs to change and soon. It is unacceptable that it doesn't allow for dentists to treat patients holistically and consider social, psychological and socioeconomic factors. These factors play a large role in understanding the root cause of their presentation and will be vital to preventing the disease they are presenting with. If someone comes in with periodontal disease, we can continue to treat it with scale and polish for years without the patient even understanding the disease process and their own lotus of control. We need the opportunity to empower a patient to address underlying issues to support oral and general health. Pushing for policy changes towards a more prevention-based approach is the single most important thing we must do as a profession.
The impact of an acute treatment focus
"There needs to be time for prevention and to treat the patient in your chair as an individual."
Most of the cases I am seeing now are emergencies and I know I am not alone in this. This situation has only been exacerbated by the pandemic. Being forced to practise in this manner is very difficult and can lead to the feeling of our profession being 'symptom care' rather than 'healthcare'.
I worry about the future of the profession if we continually cut the weed above the ground rather than taking out its roots. I am just treating acute cases and sending patients home, rather than having an influence on preventing issues from arising in the first place.
We are currently so behind with waiting lists that we have become stuck in a never-ending cycle of treating only the most acute cases, with no time for preventative care. This will continue to bite us in the long run when patients return before long with recurring problems.
In theory the NHS is an amazing system, but in practice it can be morally difficult for dentists. The system allows for equality, but people don't understand that the treatment we can deliver on the NHS often isn't to the standard we feel comfortable with. I find I don't always have the time I need to carry out certain procedures or deliver holistic treatment. This does not feel like the profession any of us imagined or wanted to go into. To keep us in the NHS, there needs to be time for prevention and to treat the patient in your chair as an individual.
"In theory the NHS is an amazing system, but in practice it can be morally difficult for dentists."
People really need more dentists, there are hundreds on waiting lists in the practice I work in alone. I'm seeing patients who have not received treatment for years. These patients need a lot of work and their complex care is often accompanied with a lot of dental anxiety. I have learnt that I would find it very difficult to be a GDP and I know a lot of people in their VT year who are feeling similarly and looking for alternatives. If this problem is not addressed, even more people will be left without access to much-needed dental care.
The way we are working now is a short-term fix. We need to completely reorient the way we treat people. Even from a financial point of view, it makes sense to spend time and money on prevention in order to reduce future costs of treatment. Oral health left without the correct oral hygiene and diet will inevitability keep relapsing and spiralling further down the restorative cycle, costing more and more as mastication, speech and aesthetics become compromised. For care to be effective, we need to build up connections with our patients, and empower them to take control of their oral health.
"I would love to see wellbeing prioritised in dentistry and for issues to be addressed on a population-wide basis."
Any future changes in the NHS must include the provision of time to build bonds and connection with our patients who need it most. Patients are in a very vulnerable position in our chairs. It's a huge privilege to give care and we must ensure patients are at ease with us.
Next year I will be going into dental core training, to learn more about the work carried out in a variety of specialties.
I truly believe that experience in a vast array of specialties will allow for an appreciation of how to work as a multidisciplinary team within the profession. It would be naïve at this stage to say I have enough experience of any specialty to know if I would like to build a career in it; so, I aim to cover as many specialities as I can over the next few years to understand how to be a good generalist and view patient care holistically.
I would also like to continue with public health research. I am very passionate about physical and mental wellbeing and how these can be influenced by adverse experiences and the socioeconomic factors related to health. I would really love to see wellbeing prioritised in dentistry and for issues to be addressed on a population-wide basis. It’s a privilege to make a difference to the lives of my individual patients, but to influence change on a greater scale for patients and dentists would be extremely fulfilling.
Dental Vocational Trainee