Wednesday, 14 March 2018

The Salaried Dental Services: What do they do?

I've been working in the Salaried Dental Services for almost 2 years and I've had a pretty wide range of experiences. I often get asked what it's like working in the SDS (otherwise known as the CDS in England and Wales, PDS in Scotland) and there are lots of different options. Here I will outline what possibilities there are...

Special Care Dentistry

I've previous blogged about what sort of patients this involves (here). 

Special Care Dentistry as defined by NHS England, is 

'concerned with the improvement of the oral health of individuals and groups in society who have a physical, sensory, intellectual, mental, medical, emotional or social impairment or disability or, more often, a combination of these factors.' 

This can range from an elderly patient on multiple medications to a non-verbal autistic teenager. When treating these patients you provide whatever dental treatment they require - often the treatment itself is not complicated but managing the patient is. This can include behaviour management, clinical holding ,the use of the hoist, a wheelchair tip or bariatric dental chairs for obese patients. 


I often see children who have complex medical problems or special needs e.g. autism, epilespy but also children who cannot cope with treatment with their high street dentist or have complex social issues. 

Often they have rampant dental disease as I work in very high needs areas of London. We provide treatment such as extractions, stainless steel crowns and conventional restorations as well as preventative advice. We also have the means to provide more specialist care e.g. pulpectomies (if the case is appropriate). Seeing children doesn't suit everyone, but it's an excellent opportunity to develop communication and management skills in order to allow treatment. It can also be great fun!


With both subsets of patients mentioned above, there may be a need for some form of conscious sedation or in some services, general anaesthetic. 

Not all SDS provide sedation or GA - indeed mine refers all the GA to another service. Sedation can be inhalation (especially in children), IV, intra-nasal, oral or a combination. Some services are also accredited with IACSD to train those in their service in the provision of sedation. 


In some areas of the country, salaried Access clinics still exist. These are meant to serve those who find registering with GDPs difficult - this could be due to remote location or an area of high needs. 

The patients often do not have any special care need, but may have a high level of dental disease that needs addressing. These services are less likely to be in highly populated places e.g. London, where there are a higher number of GDPs.


Outreach involves going out of clinic to access patients - this can be screening in settings such as care homes, oral health promotion, use of mobile dental units (which can be for the homeless, parked in schools or areas of high need) or to local schools. 

The SDS also collects epidemiological data for BASCD e.g. in the Child Dental Surveys. You are trained specifically for this and calibrated against a national standard before screening. This can run in tandem with other oral health promotion schemes e.g. school fluoride applications. 

Some SDS will have specific oral health promotion teams that will include Extended Duty Dental Nurses (EDDNs) and hygiene therapists alongside dentists. I am the outreach dentist for my service where I head out to homeless day centres for screening, oral health promotion and treatment on our mobile dental vans. I also provide domiciliary services (See below).

Domiciliary Care

Domiciliary care (doms) involves treating patients in their homes, care homes, hospitals or day centres and provides care to those who cannot or find accessing a fixed site clinic difficult. Often, this is associated with treatment of the elderly, but not always e.g. agoraphobics, mental health problems, in-patients in hospitals. 

Doms can vary depending on the service or area you work in. Different services may have pool cars you drive (like my service), or drivers to take you out to patients. Others may expect you to use your own car or even see patients on foot. Providing care in these environments can be challenging and there are often issues to think of that are not obvious until you are in that situation e.g. risk assessing a home where the owner has 3 Alsatians, ensuring your car is insured to carry oxygen, manual handling risks when your patient lives on the 4th floor and the lift is out of order! 

There are specific doms guidance on the BSDH website.  

Prisons/Immigration Centres/Secure Units

Some services are either exclusively, or have an element of either working in a prison, immigration centre of forensic secure unit. 

There are specific challenges with working in these environments, one of which is staff safety. You will require specific conflict resolution training to work in these environments. It can be very rewarding providing care for these patients who are often forgotten and may have found accessing dentistry difficult even more their institutionalisation. 

Our service provides care for a secure mental health unit both inside the unit and also bringing patients to our fixed site clinic. Historically we have provided care both on side in a specific dental clinic and also on our mobile dental unit. Often these individuals have high levels of disease that require addressing. 

Emergency Dental Services

Historically, the Emergency Dental Services (EDS) including out of hours care for the NHS was provided by the Salaried Dental Services. Indeed, many areas of the country still operate in this way; however, there are areas that have moved away from this model and GDPs have won the tenders to operate the Out of Hours EDS (I work for such as service in London). 

Different EDS work in different ways - in some areas dentists are also involved in the triaging of patients, not only the treatment. To read about my experiences in the EDS, read my previous post here

Other Specialist Dental Services

In some areas, SDS provide the specialist contracts for primary care services e.g. MOS, endodontics, periodontics (as well as sedation as I have mentioned above). 

These are performed by specialists or practitioners with a special interest in that area of dentistry where patients can be referred to not only internally, but also from GDPs. 

As you can see, there are lots of options when deciding if you want to work in the SDS and the opportunities vary depending on the area of the country, or indeed, which country it is you work in. Look out for a future post explaining some of the advantages of working as as employed dentist rather than an associate. 

Do you work in the SDS, CDS or PDS? In which area do you work in? Would you recommend? Let me know in the comments below. 

Sunday, 25 February 2018

Published! The Dentist's Survival Guide

I've contributed to another book! 

The Dentist's Survival Guide aims to help you succeed in the current dental environment of increased regulation and litigation. 

I was approached by Stephen Hudson (who compiled the book) to write about my experiences working within the Community Dental Services and tips for young dentists on how to manage the increasing risk of litigation. In the book I describe how the re-tender and subsequent re-structure of the CDS has affected me, the patients I see and also how this impacts general dental practitioners.

Not only have I written in this book, but several other upstanding dentists have also contributed chapters and it's a very interesting read to learn from some very experienced clinicians from all sectors of dentistry.

25% of profits from the sale of the book will go towards the Dentinal Tubules Foundation - you can read more about the foundation in one of my previous posts here

Posing with my recent publications

This is second book in the past couple of months I've had the honour of contributing to (the other being a Dental Core Training book - click here for more information). 

To buy your copy of the Dentist's Survival Guide click here. It is also available on Amazon Kindle. 

What tips would you give to help survive our current environment? Have you read the book? Let me know in the comments below. 

Tuesday, 20 February 2018

Enhanced CPD: Are you Ready?

Enhanced CPD came into play at the beginning of the year, and if you still haven't heard here's what changes there's been.

The main changes are:

  1. All dental professionals must have a Personal Development Plan (PDP)
  2. There is an increase in the verifiable hours of CPD required which must be spread evenly across your 5 year CPD cycle
  3. Non-verifiable CPD is not longer required
  4. Every year, you must declare the number of CPD hours completed (even if this is 0)
  5. CPD must align with your professional requirements and developmental outcomes
  6. Professionals have to plan their CPD activity according to their individual field(s) of practice

Template PDPs and CPD records can be found on the GDC website

The number of CPD hours now stands at:

100 hours for dentists
75 hours for hygienists, therapists, orthodontic therapists and CDTs
50 hours for nurses and technicians 

If you are mid-cycle (like myself) there is a calculator to work out how many hours of outstanding CPD you require to undertake to fulfil the requirements. 

To find out more make sure you check out the FREE lecture from the master of dental education Dhru Shah on Dentinal Tubules NOW!

What do you think about the new CPD requirements? Do you think a PDP is a good idea? Let me know in the comments below. 

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