Friday, 30 December 2016

Sterling Dental Foundation Annual Ball 2016

So about a month ago, the event of the year came around again... Sterling Dental Foundation's Annual Ball.

The Bhangra Dancers from Imperial College

Following last year's massive success, raising over £15,000 in aid of Bobby's Walk, the event did not disappoint! 

This year, the cause Sterling has chosen to support if Great Ormond Street Hospital (GOSH) and as part of the usual raffle and auction prizes were various enormous soft toys which, over Christmas, have been delivered to some of the sick children and their families.  

The evening was held at a different venue this year, at Victoria Park Plaza Hotel and the venue was packed to bursting with guests supporting the charity. There were some notable guests this year who generously gave their time to show their support and also entertain us with their speeches - including Virendra Sharma MP, Nairn Wilson and our very own Bobby Grewal who is back from this infamous walk through India!

Entertainment was crammed into the evening with Flute that Groove, DJ Manny from Kudos, the Bhangra dancers of Imperial College and Elite Drummers on the Dhol we all had a whale of a time! Together with some fantastic food from Maharaja it was no surprise that by the end of the evening we didn't want the night to end! 

Unsurprisingly, from the auction and raffle prizes, quite early on in the evening we easily reached the £5000 minimum funds that Barclays pledged to match! 




And of course, who can not enjoy dressing up for the occasion?! Can't wait for next year's ball to see how we can top this years event. Thanks to everyone who helped contribute towards the evening and supporting such a fantastic cause like GOSH!


Did you go to the ball? Let me know your thoughts on the event in the comments section.


Sunday, 18 December 2016

Dental Emergencies: Top 10 Tips

I work and have worked in several different emergency dental settings. I've seen a lot of interesting cases from squamous cell carcinomas to osteomyelitis; but what have I learnt? Here are my tops tips.


1. Drain that pus!

As I'm sure you are all aware, health care professionals need to limit their prescriptions of anti-microbials (you can read more about this here). We need to achieve drainage instead of just handing out an antibiotic.

I love draining abscesses; the satisfaction of getting out lots of pus and also the release of pressure the patient feels after you've drained is fantastic. Whether you drain through an existing sinus tract, use a periosteal elevator to drain through a pocket or incise with a scalpel - it's very important to encourage the drainage and recommend the patient rinses afterwards with warm salt water. 

I know a lot of young dentists don't feel that confident with incision and drainage. This is how I usually do it:
  1. Choose the most fluctuant part of the swelling. The best ones to drain are localised (you can't really drain diffuse ones), and see whereabouts over the swelling the mucosa looks this thinnest as this is where you'll make the incision
  2. Use a cotton pledget with ethyl chloride/endofrost to wipe over the mucosa gently which will make it more comfortable for the patient
  3. With scalpel, make a small nick in the mucosa making sure you go right down to bone. Make sure your nurse is ready with the suction at this point as I'm sure you don't really want pus in your hair and it's kinder for the patient not to have to taste the pus! 
  4. Massage the swelling to help drainage and you can irrigation inside the incision with saline if required
  5. Check for haemostasis (it will probably ooze for the next day of so), give patient gauze and encourage them to rinse with warm saline several times a day to help drain any remaining infection
  6. Depending on how much drainage you've acheived and how big the swelling is (and other factors like medical history), you may consider also prescribing antibiotics. 


2. Don't rush an extraction

When I work at Out of Hours, my patients are booked in by 111 so I will be booked back to back every 20 minutes. This means that I need to be realistic about what I can achieve in an appointment (especially when patients take 10 minutes to fill in all their paperwork!).

This will limit what teeth I can take out. If the tooth is root filled or there are other factors that might make the extraction more complex, you often don't have sufficient time within that emergency appointment to complete the treatment. Also depending on where you are working, you need to be aware of what equipment you have to work with - this may also limit the treatment options you have. 

There are also other factors to take into consideration when you are deciding whether you can take out a tooth in that emergency appointment, which I will discuss in the next point. 


3. Can they consent?


As well as looking at the culprit tooth, it is very important to assess whether the patient can give valid consent in that time? This can be particulalry important if there are possible language or capacity issues, and also when patient's are in pain, their capacity can be compromised. 

In these cases I will tend to do something else to get them out of pain which is less invasive e.g. extirpation, and then advise them to see their regular dentist for a full discussion of their options. 

You sometimes need to be firm with some of these patients. I remember one patient who didn't speak English, but brought their 11 year old daughter to translate. I gathered via his daughter that he wanted the tooth removed but when I refused and suggested another option, he wasn't very happy. Cases like this would need an interpreter to help communicate effectively in order to gain valid consent. 

4. Trauma

Working in an emergency setting really tests your trauma knowledge. There is so much information to know when managing a trauma case and life is certainly made easier with the Dental Trauma Guide. If you are unsure you should always refer to this site.

Alot of the trauma I see, especially in children, the treatment is reassurance, soft diet and advising them to follow up with their GDP. But sometimes I will need to splint or even reimplant an avulsed tooth. This can seem scary, but the more you do it, the more confident you will become. 

To read my previous post about how to manage dental trauma in children, click here


5. Is an X-ray necessary?

Working as a GDP, you will be used to taking x rays to confirm diagnoses and also aid in your treatment planning. But what I've learnt from working on emergency clinics is whether an x ray is actually beneficial.

If a patient comes to see you for pericorontiis, how much more information are you going to get from taking an x-ray? Moreover, are you actually increasing the amount of unnecessary radiation the patient is exposed to? If you take an x ray and then 2 weeks later their GDP also does, that's double the amount that is necessary. 

You need to think of the patient in the big picture, and not just the isolated encounter that you are seeing them in.


6. Managing children


Something I have found difficult is how much I can achieve with a child in an emergency appointment. Often they attend in pain, have not seen a dentist before (or regularly) and have a tooth that needs taking out. 

You have just met this child, it is difficult to assess how they may tolerate dental treatment. I have had very compliant children who have let me take out a tooth, but I have also had some where I have attempted to and things didn't exactly go to plan. But you often don't know until you've tried and sometimes listening to what the parents are saying to you will give you a clue. 

You also have to manage not just the child, but the parent. Often they are distressed and need lots of reassurance, but sometimes they can be quite pushy about getting the treatment done. Don't feel pressuring into doing something you are uncomfortable with or you don't think the patient will tolerate and always bear in mind safeguarding issues (read about safeguarding here)


7. Achieving anaesthesia

Achieving effective analgesia in patients with acute infections can be very difficult. It can be made even more tricky if you have a particularly sensitive or anxious patient.

If I am having difficulty, there is often other patients waiting to be seen so I send the patient out and see the next patient in line. Often, as soon as I am finished with that patient, the first one will be effectively anaesthetised for me to treat comfortably. 

Ultimately sometimes you cannot always achieve this. For these patients, antibiotics can be the only option to reduce the infection enough to numb them up effectively. The other option sometimes if when I am extirpating, even if I cannot fully remove all the pulp, quickly placing some odontopaste into the pulp chamber can give some relief. 


8. Assess that extraction

As I've mentioned above, you need to be realistic about what you can achieve in the time you have, your own skills and also the equipment you have available. 

Firstly, you need an x-ray before you even consider taking out a tooth - this may be relevant for an upper 8 for example if you cannot get a PA if a patient has a strong gag reflex. I wouldn't feel comfortable taking the tooth out without a DPT (this may not be available to you).

Learn to assess what will make an extraction difficult or lengthy. Teeth that I often take out are ones which are mobile, deciduous teeth, single rooted teeth or roots with large PA radiolucencies which have less bone surrounding them. I wouldn't feel comfortable touching teeth which may turn surgical e.g. root treated teeth, those with curved roots, lower 8s. 

If you don't assess the tooth properly, this can make your life very difficult! Something I learnt when I spent 40 minutes digging out a grossly carious UR8. 


9. Pregnancy

It shocked me initally how many pregnant women turned up at emergency dental clinics. Initally, seeing these patients used to worry and scare me, but I've learnt that the priority in these appointments is to get them out of pain as that can be harmful long term for both the mother and the foetus. 

Dentists are scared of taking x-rays in these patients, but if it an urgent situation and you require the x ray for diagnosis or treatment of an urgent issue, then it is justified. Pregnant patients often also need reassurance that what you are proposing will not harm their baby and communication is even more key. 

If an extraction is needed, if possible it can be delayed to after the baby is born; but if it cannot then you should go ahead as normal but avoid using Octapressin-containing LA as this can stimulate contractions. 


10. When to go to A and E

Patients will mostly present to you first when they have a dental problem, but there are a few rare warning signs which should point you to urgently referring a patient onto an A and E department with a MaxFax unit. 

Some of these may be:
  • Facial swelling that is affecting swallowing or breathing
  • Facial swelling with loss of naso-labial fold, eyes beginning to close, a large sublingual swelling which causes the tongue to protrude or affects speech
  • Immunocompromised patient with large facial swelling, increased temperature and feelings of unwellness or rapidly increasing in size
  • Suspicious oral lesion that you suspect to be cancerous
  • Trauma of the face/head and neck where you suspect fractures or other injuries that are non-dental or affecting airway

Overall, I really enjoy working emergency clinics and patients can be very grateful for the help you provide them in getting them out of pain. The clinics are often fast-paced and every so often you will see an unusual case that surprises you! 



Do you work on emergency clinics? What have you learnt from the experience? Let me know in the comments below.


Sunday, 20 November 2016

10 ways to make the most out of DCT

So this time last year I had just begun my Dental Core Training (DCT). The year flies by so quickly, so for those of you doing DCT, how can you make the most of it?



1. Ask for help

You applied for this additional year of training in order to develop your skills.... so you will be thrown into situations you would've never thought of being able to manage yourself. Whether that be your first night on-call in A and E, or reimplanting an avulsed tooth on a 9 year old, you need to know when to ask for help.

It's likely that initially you'll be asking for help all the time. There's nothing wrong with that, as time goes on you will learn and be more confident in managing these situations. I remember my very last day of my DCT, my consultant asked me to do a biopsy of a white patch. If you'd asked me right at the beginning of the year I would have no idea where to start but by the end of the year I had enough experience to feel perfectly capable to perform the procedure by myself. But without asking for help initially, I would never had got to that stage!


2. Research

In a lot of DCT settings there will be opportunities to get involved in academia and research. Ask consultants and other staff if there is anything you can get involved in and ask early as often these projects can go on for some time...if you leave it towards the end of the year you may not have enough time!

Or even better, think of research you can lead. Again going back to my first point, ask for help! Writing up papers isn't easy and you'll need lots of guidance!


3. Posters

There will also be lots of opportunities to create a poster. If you're thinking of specialising, posters are a must!

There are lots of different options for posters: case presentations, audits, research projects, questionnaires. You should look at what conferences are coming up and if they are looking for posters because if you do the poster before, sometimes it doesn't quite fit with what societies are looking for. 

To read about some of my previous posters click here and here


4. Presentations

During DCT you can also develop your presentation skills. This may be in the form of giving presentations at your local group (we used to take it in turns to do lunch and learns each week), regionally or even nationally. 

As part of your deanery, there may be days where you can present a case or an audit and I would encourage you to do this! Again, it looks good if you want to specialise, but also builds your confidence and improves your presentation skills. During my DCT, as well as the lunch time presentations, I presented an audit at a trust audit meeting, at our local departmental meetings as well as at a London Deanery DCT presentation day. 


5. Teaching

Depending on your post, you may be able to get involved in the teaching of other members of staff. This might be dental undergraduates or other staff like trainee nurses. This could be a good opportunity if you think you'd like to become involved in teaching in one way or another e.g. undergraduate teaching, DF trainer. 

Teaching also helps you see things with fresh eyes and ask questions on why you do things. It's easy to get into habits and routines and forget why we might place an elevator in a certain position or how you might take a secondary impression. When someone asks you specifically why you're doing that it refreshes your own knowledge.


6. Networking

As part of your DCT you will come into contact with lots of different clinicians, some will be very prestigious professionals who you can learn so much from. Get to know them, ask their opinions not just clinically, but professionally in terms of career advice. They will have a wealth of knowledge to share!


7. Keep a hand in primary care

During my DCT I still kept up my skills in dental practice by working at weekends. I can imagine if you have long hours in Maxfax this may be difficult but even spending a couple of weeks locuming somewhere would be great. 

This keeps up your experience working in dental practice (as it's very likely you'll end up there in the end), can keep your speed up, understand how a business works as well as keeping that performer number active!


8. Make the most out of working in a large health care setting

Working in a hospital whether its a district general, a university teaching hospital or in a community setting has it's perks. You will work within a large team and be surrounding by a support network of staff. For example, when a patient is being challenging you can call other members of staff for help.

You can also learn from other departments or staff members; ask to shadow on other departments or work with other members of staff. For example, my oral surgery GA list ran alongside a special care list. A few times when we finished early or the list was cancelled, I asked to assist with the special care list instead (which is something I'm really interested in). 


9. Get second opinions

Again, you will be surrounded by many different clinicians with different levels of experience and opinions. Ask them what they would do! Even if you're pretty sure what your clinical opinion is, it's interesting to learn the different approaches to the same situation and you could learn some useful tips!


10. Record your clinical work

Make sure you record all your clinical activity! When you apply for other posts like more DCT posts, speciality training posts or posts in the community, they frequently ask for numbers for certain procedures. Make sure you record the procedure and whether you observed, assisted or performed with/without supervision.

Also if you are doing any form of sedation, download the SAAD logbook and get your cases recorded. You need to have at least 20 cases and then you can perform sedation in other settings! 


Most of all, make sure you enjoy your year! You have fantastic support throughout the year from the deanery, your peers and your local hospital team. Make the most of all the opportunities that arise during the year!



Sunday, 6 November 2016

EACMFS and BAOS: Posing with Posters

September was a month of poster presentations for me...



EACMFS

The sun was shining for the European Association of Cranio Maxillofacial Surgery and they could not have picked a better venue; the QEII conference centre opposite Westminster Abbey!

I was only there for a day, but the conference was running all week and the programme was packed with prestigious speakers, presentations from across Europe and some that were not so medicine-based. The first lectures I went to were talking about human factors in surgery where there were presentations from people who help control the traffic above UK air space!

There were some really packed sessions about MRONJ, head and neck cancer and cleft palates; it was hard to decide which room to go in! 

The posters themselves were a little different to what I have seen before: they were interactive presented on TV screens where you could display your poster or search through them. This did mean that you didn't have to worry about printing your poster or putting it up! 

My poster was a case presentation about Brown Tumours. To read a copy of the poster, click here


Posing with my interactive poster!


BAOS


Later on in the month, I headed up to Edinburgh for the British Association of Oral Surgeons annual conference. This was a bit of an excuse for a reunion with Guy's Oral Surgery department (having only been away from them for a couple of weeks!). 

Our poster was presented the traditional way and we had to sneak on our poster onto hand luggage on our flight up! There was a range of posters presented from E-Cigarettes to the use of social media in the dental profession. 

Our poster was presenting an audit on antimicrobial prescribing in Guy's Acute Dental Care department and we had 6 cycles of data in total! 

To see a copy of my poster, see here

Poster number 2!

Both conferences were a great way to catch up with people as well as a fantastic learning opportunity!




Tuesday, 25 October 2016

What is Success? DGGS Prize Giving

So a couple of weeks ago, I was the guest speaker at my former secondary school's prize giving evening. 


It was a bit weird going back to my school almost 10 years since I left. The place - Dover Grammar School for Girls, hadn't really changed too much since I left although most of my former teachers have left. 

I was asked to talk about success and to motivate the current students. This was probably the biggest crowd I've ever spoken to, certainly about something other than dentistry! But what did I decide to talk about to a crowd of teenagers?

I wasn't exactly a model pupil while I was at school, but I don't think that's what will make your life and career successful. Life is more exciting and interesting if you follow your own path and think outside of the box. Think back to your early school life...who would you have guessed would be invited back to your school to speak? The surprising choices and decisions in life are often the most rewarding.

Growing up should not be stressful. The amount of young teenagers I have seen with jaw pain as a result of grinding/clenching their teeth as a result of stress is shocking! I know there's lots of pressure to do well academically (something particularly pertinent in a Grammar school), but the years spent growing up with the protection of adults should be spent having fun, making mistakes and experiencing new things. 

Working hard is important too but it's even more important to have a balance between studying and spending time on your hobbies or socialising with friends or exploring new places. 

Hopefully my speech went down well, I really enjoyed being able to speak at an event like this, perhaps a year or so ago I would not have had the confidence to do so. Public speaking is a really good skill to have, especially if you're involved in professions like teaching. If any of you have the opportunity I would definitely say YES!

Thanks to DGGS for inviting me to speak and for my lovely flowers that caught a lot of attention on the train back up to London!

To read a copy of my speech see here


Sunday, 16 October 2016

10 Things I've Learnt from Oral Surgery Dental Core Training

Following my previous post about what I learnt from my restorative dental core training (see here) I thought I'd write about what I 've learnt from oral surgery...



1. Communication in TMD patients

TMD was something I saw lots of during my 6 months on oral surgery but also on acute clinic. It's easy to disregard TMD as a condition with little serious consequence and therefore when you explain the diagnosis to the patient, it's easy to come across as a little flippant or not taking the patient's problem seriously. 

In fact, the pain and problems patients can present with can be debilitating for a patient - either in constant pain or have severe trismus. TMD is one of those conditions where a patient may not be accepting of the diagnosis and therefore treatment can be less effective. Patients often expect a quick fix; a magic pill to solve their problem. Treatment of TMD is prolonged and often complete resolution isn't always possible. 

It's important to communicate this to the patient from the offset. If I had a patient who wasn't very confident in the TMD diagnosis I was lucky to have colleagues on hand to give a second opinion to convince the patient. 

To read more about the management of TMD, see one of my previous posts here


2. MRONJ

I worked on clinics where we saw patients who had established medication-related osteonecrosis of the jaw as well as referrals from GDPs seeking advice regarding extractions on these patients. 

I now feel like I understand the risk of MRONJ in patients more clearly - more specifically those at most risk are not the osteoporosis patients who have been taking oral alendronic acid but patients who are having frequent IV infusions bisphosphonates or taking denosumab. 

I've also learnt that for these patients you may do treatments you otherwise would have thought hopeless in order to avoid extractions for example root treating a wisdom tooth or endodontic treatment of an unrestorable root remnant. 

To read more about MRONJ see my previous post here


3. Keep going with that tooth!

You know that feeling when you're not getting anywhere with that extraction? Whether it be a huge molar with bulbous roots surrounded by dense bone, or a fractured apex sometimes you feel like giving up?

But what I learnt from spending all that time on oral surgery is to keep going! It's hard especially when you have a nervous patient to not expect the tooth just to pop out but sometimes it takes some patient and perseverance. 

Keep going! Sometimes it's good to take a break and come back with a fresh pair of eyes to something or get a second opinion. This means that you need to book in sufficient time for the procedure and therefore be able to assess the complexity of the extraction from clinical and radiographic examination.



4. When to get out a handpiece

So following on from the above point, no matter how much you go at something with your luxator or forceps, you just need to get out the handpiece. It also may speed things up or make it easier for you, for example, sectioning a molar that's been root treated. 

Some other situations where a handpiece may help is where you need to create gutter around the tooth in order to make an application point or sinking a fissure bur into a root to allow you to use a cryers to hook the root out. 


5. Suturing

Looking back to when I started my core training, I  was so cack-handed when it came to suturing. It would take me longer to suture up a socket than to take a tooth out! I struggled with the dexterity but also the positioning of the needle and how to manipulate the needle holder.

A lot of the extractions I did were on patients with complex medical histories, most commonly on anti-coagulants so that meant that I sutured a lot. My skills improved so much and I learnt how to do other types of suture not just simple interrupted: cross mattress, horizontal and vertical mattress, continuous locking. Now I feel much more confident and enjoy suturing!


6. High risk 8s

What is a high risk 8? I remember just giving the risk for every patient prior to extraction of all lower 8s. But actually does this risk apply to all wisdom teeth?

Wisdom teeth were properly the most common teeth I saw referrals in for and often we saw the more complex ones. A good paper to read regarding ID nerve injury is by Carrio (2010) which includes the signs you can see on a radiograph that may indicate high risk:

  • Darkening of root
  • Deviation of root
  • Deviation of canal
  • Interruption of tramlines
  • Narrowing of root
  • Narrowing of canal
  • Bifid root apex
At Guy's, the staff there are major advocates of coronectomies as a treatment option of high risk 8s. This was just a theoretical treatment option until I did my core training and now I understand the indications and complication of this treatment option which may minimise the risk of nerve injury.  



7. Sedation

During my core training , we offered IV sedation to patients for treatments. I really enjoyed sedation as it can work very well for patients who are particularly anxious or to help you manage difficult procedures or where access if difficult. 

IV sedation doesn't always work - I've had patients who become more agitated under sedation or those who have vomited on me but the majority of the time it works very well and predictably. 

I've also learnt how you need to explain the difference between sedation and general anaesthetic. Patients sometimes don't perceive there is a difference especially because of the amnesic effect of sedation. More than once patients arrived expecting to be put to sleep. If you over-sedate the patient then of course they may go off to sleep but you're aiming to keep verbal contact with the patient so they can obey instructions. 


8. Who is eligible for implants?

Seeing patients who had resections as part of their cancer treatment really puts into perspective who should be eligible for implant reconstruction under the NHS. 

Someone who's had half their mandible resected from an ameloblastoma, their quality of life would be improved significantly with some implant reconstruction. 

Other instances where implants may be provided under the NHS are:
  • Trauma
  • Hypodontia
  • Implant supported overdentures in those in severely resorbed mandibles or those with severe gag reflexes
Each patient will have their funding approved by a set committee, although standards vary from trust to trust. 



9. Anticoagulants

All practitioners are aware of Warfarin and how to manage patients who are taking this blood thinner. But now there are newer drugs like clopidogrel, dabigatran, rivoroxiban which cannot be monitored in the same way as warfarin i.e. with an INR.

There's not too much different we do to manage these patients for surgery, except we provide local measures i.e. surgical and suturing and good post-operative instructions. A lot of GDPs referred in these patients for relatively simple extractions wheres sometimes their treatment can be done in primary care. 

A good reference for help with the management of these patients is the SDCEP guidelines, click here


10. Post-op pain


The amount of patients I saw for problem appointments following surgery who attended because they were worried about the pain or swelling they were experiencing. A lot of the time this pain or swelling was completely normal and was not the result of a post-op infection or dry socket. 

I don't think patients appreciate the amount of normal pain or swelling they will experience after surgery, especially if it's all 4 wisdom teeth!  We need to explain to our patients what is a normal amount to expect and how to manage this - this should be done as part of the consent procedure! 


If you have any questions please don't hesitate to get in touch!


Thursday, 6 October 2016

Dental Foundation Training Interview Tips

So the past 2 weekends I've been running a course to help prepare final years for the upcoming dental foundation training interviews...


These 2 days were a fantastic way to meet final year students and guide them through the process of DFT applications and interviews.

I received some great feedback from the delegates:

'Course was run extremely well - wide range of topics covered and it was delivered extremely well'

'Found the mock interviews very good - The refreshments provided were great and the practice was lovely. Thanks Natalie :)'

'Really enjoyed the course, learnt a lot from it - probably more than what the uni teach! More aware of what the course consists of, now feel and know how to go about working for this'

Some delegates came as far as Newcastle and Glasgow to come down to the course! The day involved a morning of teaching and going through common scenarios and previous questions. The afternoon involved group work followed by mock interviews and an SJT.

If you missed out NOT TO WORRY! If you're looking for some help see my previous posts on DFT preparation here, or if you'd like me to send you one of the delegate packs from the course send me a message here and for a small fee I can post one to you. The pack includes the following:
  • DFT booklet (pictured above) including all the information you need for the interviews 
  • Mock SJT
  • Mark schemes for the interview stations




If you have any questions please don't hesitate to get in touch!


Friday, 16 September 2016

How to get a Job...

It's that time of year where people are moving positions....but what is the best way to find a new job?



It's not as easy getting a job as you thought when you started dental school, especially if you want to work in places like London or Manchester. 

Things are getting more and more competitive with an influx of dentists coming overseas and from the EU but don't fret....there's lots of ways to get a job! 

CV

Firstly, if you are looking for a job you will need a CV. Many of you may have not had to make a CV before with DFT and DCT jobs not requiring them. Concision is key! And always remember to write a unique cover letter for each job application stating why you want the job you're applying for! 

To see more about writing your CV, see one of my previous posts here

Word of Mouth

A really good way of finding a good job is by word of mouth. A lot of the time, jobs aren't always advertised but it's through people and word of mouth how posts are filled. This may be by asking people you know such as your trainer or mentor if they know anyone who's looking, or it may be physically going round to practices in your area handing out your CV and asking to talk to the principal or practice manager. 

The former may not always lead to a job immediately, but it creates a good impression so that a position ever arises, they may remember you!

Networking Events


Similar to word of mouth, attending local networking events and CPD or seminars is a great way to meet people which may lead to job opportunities. 

Remember however, it's important to not come across in a way that will make them think you're only looking after yourself! Meeting them in these situations may also help you get a feeling about what it may be like working with these people and if they have similar values to you. 

BDJ jobs

Probably the site that everyone turns to first. Whether this be via the BDJ website, or flicking through the back of the magazine itself. 

Be aware that practices have to pay more the more information they put. So the advert that you apply for if may be slightly different to what you may expect e.g. multiple sites or working different days. 

Recruitment Agencies/Other sites

There are a few other sites you can register with where you may find a position.

If you are looking for a hospital/community position searching NHS Jobs is a really good site. They also email you with alerts of positions that come up as well as integrating training positions that link up to Oriel e.g. STR or DCT. 

There are also agencies you can register with. They mostly deal with corporates and they usually advertise on BDJ jobs also e.g. Medicruit.

Social Media

There is the obvious platform of Facebook that may help. There are multiple dentist groups as well as dedicated job groups to help you search and people often post on these groups if positions come up. If you are friends with a few people in the industry you can of course post a status about how you're searching for a job (although you may not always want to publicise this!). 

As well as this, there is Linked In (remember to update it similar to a CV) where you can connect with recruiters. 

Recently, Dental Circle has also started a jobs section of their site so you can search there also. 


Most importantly when you're looking for a job is not to settle for the first one you are offered if you don't think you'll be happy there. You will be spending a lot of your time at work, so if you're working at a practice that you don't enjoy or you don't fit in the team very well your life could be miserable! It's normal to have to see 4 or 5 practices before you see one you could imagine working in (I am quite picky!). Remember that an interview is as much as you assessing them than them assessing you. Ask to meet the staff of the practice and introduce yourself and have a look around the practice. 


I hope this helps! Good luck with all your job searches and if you have any questions, leave them in below. 

Sunday, 4 September 2016

Capital Dentistry: Living and Working in London

It's been 2 years since I upped sticks and moved down to London. But what is life like as a dentist in the capital?



As many of you may be aware, I moved down to London after graduating in Newcastle to start my foundation training. Having moved about a far bit throughout my life, I didn't find the transition too difficult although in the 2 years I've been here I still seem I've kept some of the northern twang I picked during my 5 years in the North East!

If you have lots of friends who aren't dentists, you may notice a trend of them all moving down south after graduation to start grad schemes or internships. As dentists we have the luxury of being able to move to pretty much anywhere in the country as we are not tied to the big financial hubs of the big cities. I've noticed that quite a few of my fellow dentists choose to live in the capital for a few years before moving back to where their family is or where they grew up, mostly because of the huge financial investment it is to live somewhere like London. 

No longer can I get a pint for less that £4, and it's very normal for over half your salary to go on rent. Is it worth it? I definitely think so....


Foundation Training

DFT spots in London are highly contested and students need to rank pretty high in order to be offered a place; however there are lots more places in London (there were around 110 or so when I was doing it) and the training days and courses you get to do are pretty decent!

Because the London Deaneries (North Central, North East, North West, South East, South West) all come together for some of their training, the conferences we attended as study days were very well organised and were on the level of national conferences with incredible speakers (look back through my blog to see some of the summaries of these days). As part of the North East scheme, I also had the opportunity to publish a poster and present it at one of these conferences (see my blog post about this here). 

The training you receive in practice can vary. I had a fantastic year and I have friends who also learnt so much from their practices especially when they were in high needs areas. I did also hear some not so great feedback from my peers when they were in practices who were very financially driven, especially the more central they were where having a trainee was more a financial decision than a educational one. This shouldn't put you off training in London, it's important to pick your training practice for the right reasons (see my post about this here). 


Networking

Simply because there's so much going on in London, meeting other dentists is so easy! I can imagine if you work is in Cumbria or Truro that it can be easy to become isolated in your practice. But here there are always dental events going on; from conferences to study clubs to social events! If you've also gone through a training programme in London (DFT, DCT, MClinDent etc.) you will naturally be involved in group of peers as well as teachers and trainers. 

Having these people to turn to when you need support or advice I feel is crucial to help maintain your confidence as a dentist as well as providing the best care for your patients. Having people about you can turn to to help can give you real peace of mind. 

Meeting others also helps you to develop your own ideas about your career and may even open up other professional opportunities!


Life as an Associate

There are many unique aspects of general dental practice when you live in London.

One is living in such a multi-cultural place. You may work in an area with a high population of a certain ethnic group, or you may get a wide mix of patients. It is a regular occurrence for me to need the services of a translator to help with things. You also learn about different cultures and how this may impact their dental care. 

Whilst I worked in Whitechapel, I did a crown prep for a Bengali lady and was shocked when I looked in the book later on in the day to see her fit appointment was in 5 weeks time! It was only when I spoke to the receptionist that I realised it was because Ramadan was coming up which the patient was observing. Surprisingly, my temporary crown did last until that fit appointment, but after this I checked with all my patients to see if they were fasting if they needed follow up treatment!

Because of high concentration of dentists applying for associate positions in London, the UDA rates can be lower than in other areas of the country. This is an important thing to consider together with the high costs of living in London, can you survive on £9/10 a UDA? 


Further Training

Having multiple large institutes and dental hospitals in London (Kings, Guys, Barts, Eastman) really helps if you are looking for further training or postgraduate qualifications. It also helps that there are lots of district hospitals not only within London itself, but also at its suburbs which are easily commutable (for example, Addenbrookes in Cambridge is only 50 minutes away from Kings Cross station).

This also means there are more jobs in hospital or community settings if you're interested in that aspect of dentistry, but also almost every private postgraduate course you can find has a London date if you want to develop your skills in practice.



Living in London isn't for everyone no matter how much I sell it. Commuting on a busy tube isn't fun, but the benefits of living somewhere where there's always something to do and so much to see definitely outweigh it in my opinion! It's hard for me to imagine living anywhere else!


Have I convinced you to move down to London? Leave your comments in the section below. 


Wednesday, 3 August 2016

My Dental Portfolio: What Should I Include?

It's getting to that time of year where it's job switching time. Some of you may be looking to compile your portfolio, but what should you include?


Why do you need a portfolio?

This really depends on where you see your career heading. I would compile one if you are the early stages after graduation as you never know where your own path may take you. 

Portfolios are a must if you are applying for training posts in hospitals and certainly if you ever apply for speciality training. They are also useful for community posts and many practice jobs, especially if you are working in a high end practice where there may be lots of cosmetic treatment in demand. 

There are various showcasing sites where you can post cases such as Denteez (see my post about the site here) or Dental Circle.  These can be effective for clinical cases, but there are various other means to construct your portfolio including electronic based such as. ePDP or eLogbook

I also have a paper based portfolio - the simplest way to keep everything in one place!


What should you include?


1. CV

- I'm sure many of you will have compiled a CV before. If you're unsure, why don't you see my previous post about how to build your CV here

2. Clinical Governance

- This can include audit titles, appraisals, CPD relevant to clinical governance (safeguarding, BLS, complaints management, cross infection).

3. Log Book

- This will be the numbers of different procedures you have observed, assisted, performed (under supervision and independently). This may be a list you have compiled yourself, or via ePDP or eLogbook

4. Personal Development Plan

- On our ePDP during DFT, there was a personal development plan. It's good to continue this after you finish foundation training as it shows reflective practice as well as identifying your strengths and weaknesses and how you can improve. As well as what areas you would like to improve e.g. molar endo, demonstrate how you plan to improve these i.e. action points. Include historical action points that you have completed. 

5. Case Portfolio

- Include before and afters of cases you are proud of but also self-critique your work again to show reflective practice. Examples can be composite cases, crown and bridgework, endodontics, removable prostheses etc. 

6. Qualifications

- Include copies of your certificates e.g. BDS, BSc, MFDS, MJDF etc. 

7. Audits

- Include copies of write ups, posters or presentations. See my previous post about audit here

8. Research

- Again include copies of write ups, posters or presentations.

9. Presentations

- Include copies of presentations but also list the presentations including location/conference and whether local, regional or international. You can include presentations at university and include talks in your practice, any case presentations, posters etc. 

10. Publications

- If you've been published in a peer-reviewed journal great, but if you've written any articles on any websites e.g. theyoungdentist.com or Dentistry FMC, include those too!

11. CPD and Courses

- You can include certificates if you like but certainly a list with number of hours and whether verifiable/non-verifiable. 

12. Appraisals and Feedback

- Written feedback from educational supervisors is great as well as feedback from patients. 

13. Memberships and Supporting Documents

- The boring bit of the portfolio e.g. BDA, GDC, Dental Protection etc. Also include any memberships to specialist societies or journals. 


If you'd like to take a look at part of my portfolio, click here.


I hope this helps! If you have any questions please post below. Good luck in your future careers!


Wednesday, 27 July 2016

Resolving Complaints and Risk Management with the DDU

Sterling Dental College launched it's new events season and to kick off we had Diana Read, Dental Liaison Manager from the DDU speaking about risk management and how to resolve complaints. Here is a summary of her talk. 



Patient who complain are looking for one or more of the following:
  • An apology
  • An explanation as to what went wrong
  • Compensation or free remedial treatment
  • Assurance that the practice will change things 

But what are the most common causes of complaints?



  • The attitude and manner of dental professionals or the wider team
  • The availability of NHS treatment
  • The cost of treatment
  • Failure to diagnose and treat disease or other problems
  • Pain suffered by the patient
  • Poor aesthetics after treatment
  • Failed restorations or endodontics

How can I reduce the risk of a complaint?


1.  Communication

Communicating effectively is key! This includes fully explaining diagnoses, proposed treatment and any relevant risks to the patients in the way they understand. Written information is useful when appropriate e.g. post-operative instructions, treatment information etc. 

2. Staff Training

It's important for everyone in the team, not just the dental professionals, to be familiar with the practice complaints procedure and know how to respond in an appropriate manner when there is a complaint

3. Review Systems

Every practice should have clear arrangements in place to provide leadership and a clear line of accountability for responding to complaint. There should be a complaints manager who is accessible to the public. The complaints procedure needs to be demonstrated to the primary care organisation if the practice holds an NHS contract. 

4. Learn from your Mistakes

Mistakes happen occasionally but it's important to admit them straightaway and learn from them. If things don't go to plan, it's useful to have a practice adverse incident reporting system in place to allow for all the team to learn from others mistakes. If something does go wrong, make sure you explain it to the patient straight away, be ready to apologise if appropriate.

5. Keep Clear Contemporaneous Notes

These are vital for good patient care and can help in the event of complaint or claim. Ideally, notes should be made at the time of consultation or treatment. 


What happens if a patient complains?


DO

  • Deal with the complaint promptly
  • Be accessible
  • Be professional and fair at all times
  • Listen
  • Explain what happened
  • Admit errors and complications
  • Express sympathy and empathy
  • Be prepared to make changes to your practice
  • Make offers of restitution

DON'T

  • Hide
  • Procrastinate
  • Argue
  • Lose your temper
  • Issue threats
  • Withhold facts
  • Be 'economical with the truth'
  • Lie
  • Alter records
  • Refuse to compromise

And remember, your defence society is always on the end of the phone! Let them help you manage the complaint and hopefully resolve the situation!

Thanks to Diana and Sterling College for the event! There are lots more free CPD events coming up - see the Sterling College Facebook page for more information.


Please leave your thoughts and comments in the section below



Sunday, 24 July 2016

Hospital vs. Practice - What's the Difference?

So I work in both a hospital environment and in practice. But what are the main differences I've noticed?



Patients

This can vary depending on your practice or what area of hospital you work in. Some of the main differences I've noticed are:
  • Patients can be more accepting of your clinical opinion in hospital. This may be because they perceive to be in a specialist environment, or when finances are not coming into play they don't feel begrudged at the treatment you recommend as there is no financial implication for them
  • Patients can be more patient in hospital (mind the pun!). There is an expectation that it is usual to wait around in hospital, especially if it's a walk in service. In practice I felt like patients are more aware of timings. 
  • Some patients are more difficult to manage in hospital. This is as a result of being a secondary care service where GDPs can refer in patients. Whether it be because of the treatment they require, their medical history, or if managing them or their expectations are more challenging

Time

As I've mentioned above, I think running late in hospital in general is more accepted than in practice. Moreover, depending on the environment you work in, there may be other colleagues who can help you out if you run over. Certainly at Guy's, when I run late, patients can be seen by my fellow DCTs if they have a gap or are running early. 

Alongside this, the time pressures of practice do not really apply in hospital. In practice, generally I have 20 minute slots for extractions compared to at least 45 minutes in hospital. Some of this is down to fact I do more complex surgery in hospital and also the logistics of setting up your surgeries and sourcing equipment. 

When you work in practice, if you see more patients, you get financially rewarded for this work. You don't have that pressure in hospital. This does not mean you don't work hard in hospital, but it certainly takes the pressure off especially if you're a GDP with a high UDA target!


Colleagues

Again this can depend on your individual environment. Practices in general are smaller with fewer colleagues compared to secondary care. 

This can be a good thing, it can be a bad thing. If you are a dentist practising solo in a surgery and get stuck or need assistance this really limits your work. Having a second set of eyes I feel are invaluable - whether it be a second opinion on a radiograph or reassuring a patient that a tooth really is unrestorable. 

Being in a hospital environment you also get to learn from so many different clinicians with different styles of working. This can help you develop your own style of dentistry and it also means there is always support for you if things go wrong. 

However, working within a big team does have some disadvantages. Sometimes you may be placed to work with a nurse you may not get along with or who doesn't know the way you work. You can also become a bit of a number in the system if you're working in a large organisation where your own say in how things are run isn't really taken into account which may be an issue if you're unhappy with your workplace. Working within a small practice you may have more say in things like ordering in the materials you like to work with. 

Of course a lot of what I've just said are generalisations and entirely dependent on working environment you are in!

Treatments

Especially for younger dentists, the more targeted support you get through a hospital training post allows you to provide more complex treatments under supervision. 

You can also provide treatment for those who aren't suitable to be treated in primary care, whether this be down to a medical problem or a behavioural one. 

You are also not limited to the treatment that a patient can afford since in secondary care they do not pay for treatments. This means you can do full arch composite build ups or Gold restorations for example, which some patients wouldn't be able to pay for out of their own pockets. This means you can devise an ideal treatment plan without having to take into consideration a patient's financial background. 

But working in hospital tends to narrow your field of dentistry into a certain area. If you do an Oral Surgery post you may be excellent at extractions at the end, but picking up a handpiece to do a crown prep may feel alien. 



These are just some of the differences I've noticed between my different jobs in hospital and in practice. Of course some of these are generalisations so please don't take offence if they don't apply to your situation! I am aware there are large practices out there and again some small hospital units. I certainly feel getting experience in both areas can only be an advantage to help you decide your own career path in dentistry!


Please leave your thoughts and comments in the section below



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