Tuesday, 28 November 2017

Careers In Special Care Dentistry: RCSEd Study Day

Thinking of a career in Special Care Dentistry? I recently attended a study day with the Royal College of Surgeons of Edinburgh which helped me understand what options there are out there in Special Care....

Routes to Specialisation

There are 2 main ways to specialise in Special Care Dentistry:

1. Special Care Registrar Training (SPR/STR)

A 3 year training pathway which may include opportunities to do a Masters in Special Care or the RCS Diploma (see below). 

These posts at the moment are released on Oriel on a regional basis but it is planned by 2018 to be a national recruitment process much like some of the other specialities e.g. orthodontics. Posts can be purely based in the community, in secondary care or a mixture of both. Following the 3 years training you will then take Royal College Exit Exams to become a Specialist (as well as completed a portfolio, competencies etc.). 

2. Special Care Academic Clinical Fellow

As above, another 3 year training pathway but divided into 75% clinical training and 25% academic. The target following any ACF post is to secure funding for a pHD and become an academic. 

The day to day timetable is very similar to an SPR. These posts are usually funded by the university rather than a deanery. 

The Royal College of Surgeons Diploma

The Royal College of Edinburgh offer a Diploma in Special Care Dentistry for those who wish to grow their portfolio and qualification in Special Care Dentistry. The diploma is available to those who can demonstrate experience in working in a special care environment for 1 year e.g. community. The diploma consists of 4 parts:
  • Log book of clinical experience relevant to Special Care Dentistry 
  • Case presentations x 2
  • 7 Unseen Cases Exam
  • Simple Best Answer Exam

The exam takes place twice a year, the next sitting is in March. For more information see the RCSEd website

Where do Specialists work?

Of course this doesn't just apply to specialists; there are plenty of clinicians with lots of experience in Special Care Dentistry who are not on the Specialist Register, especially since SCD is the newest dental speciality! In general, there are 3 environments that specialists can work:
  • In general practice (NHS or private)
  • In community dentistry/salaried dental services
  • In secondary care e.g. dental hospital
Often, specialists may divvy up their time in more than one environment. They can also be involved in other areas of dentistry e.g. commissioning, education. Broadly, most SCD specialists work within the NHS; however, there are skills SCD have that are highly valued in the private sector too e.g. sedation skills. 

SCD is a unique speciality as it encompasses all areas of dentistry. This means that specialists will have a broad range of skills in all areas of dentistry: from surgical extractions to molar endodontics! 

Many thanks to those who spoke on the day not just about careers, but some common topics that I experience (and often need help with!) throughout my day to day life in community! 

Is a career in special care dentistry for you? Are you on a specialist training pathway? Let me know in the comments below. 

Saturday, 18 November 2017

Pathway and the Faculty for Homeless and Inclusion Health: Regional London Meeting

Last week, I attended the regional London Meeting for Pathway and the Faculty of Homeless and Inclusion Health.

What is Pathway and the Faculty?

PATHWAY is the UK's leading homeless healthcare charity. They aim to integrate care within the NHS and voluntary sectors for homeless people: from GPs, nurses, housing professionals, hospitals and of course us dentists! They help with the logistics of accessing healthcare for homeless people e.g. recovering important documents, linking to community services, registration with GPs etc. 

The Faculty for Homeless and Inclusion Health is a network of health professionals working together to help those who find accessing health care most difficult:
  • The homeless
  • Vulnerable migrants
  • Travellers
  • Sex workers
It is free to join the network if you are health professional who manages these groups of people. This will help you keep up to date with current research as well as linking with other professionals in your area who also work with these people. Click here to join!

Homelessness, Physiotherapy and Autism

The regional meeting held at UCLH covered a couple of very interesting subject matters and there was lots of discussion within the audience. 

1. Physiotherapy and patients who are homeless with Jo Dawes

Jo Dawes discussed her plans to set up a research project into access to physiotherapy for patients who are homeless and how physiotherapy treatment can positively impact a homeless person's quality of life. It was interesting to compare how different cities may have different needs for their homeless populations: Jo explained how the service in Glasgow where she previously worker, provided care for their homeless population. 

2. Autism and homelessness with Dr Paula Grant

Dr Paula Grant explored the links between autism and homelessness and presented the findings of her recent research in the area. I found this talk particularly interesting as within my day to day practice, I manage both autistic patients and the homeless. She spoke of how she found that the lifestyle of the homeless has some advantages to people who are autistic e.g. not fitting into social norms, flexibility, limited interaction with others. 

Many thanks to those who spoke at the meeting and it was fantastic to meet others who are passionate about providing health care to hard to reach groups. Homeless and Inclusion Health hold an annual conference in London, March 7/8th. Hopefully I can get to go and see some of you there. Click here for details. 

Do you treat any of these socially excluded groups? Let me know how you manage these patients in the comments section.

Tuesday, 7 November 2017

3 Top Tips in Managing Autism with the National Autistic Society

At our most recent staff meeting within our community dental services we received a talk from the National Autistic Society. This post is based on that talk...

What is Autism?

  • Autism is diagnosed by observing behaviour
  • The condition is a spectrum disorder i.e. it affects people in varying degrees
  • Asperger's Syndrome is on the spectrum of autism, but it may not be recognised as a separate diagnosis  soon
  • Prevalence is 1 in 100
  • The cause of autism is unknown; there is thought to be a genetic and environmental component
  • 5:1 ratio of male to female
  • 30% of autistic people also have an associated learning disability

The diagnosis of autism is based of a triad of symptoms: 
  1. Social interaction difficulty
  2. Repetitive behaviours
  3. Communication difficulties

Considerations when interacting with Autistic patients

1. Non-verbal Communication

Autistic patients will often take the literal meanings of words or phrases and have difficulties with non-verbal communication e.g. they do not create eye contact. 

Give increased processing time for these patients, don't give them too much information at once and give instructions in stages/allow them to prepare e.g. Ben, sit in the dental chair then open your mouth then I will use this mirror to look at your teeth. 

2. Structure/Routine

Try structure the environment so they are familiar with their surroundings e.g. see them in the same surgery with same nurse etc. Try to arrange an appointment time that disrupts their day as little as possible and stick to a structured appointment. 

Encourage the parents to create a routine surrounding their oral hygiene regime and create a reward system following the routine e.g. brush teeth, add a sticker to a tooth brushing chart. 

3. Hypersensitivities

Autistic people can be very sensitive to sound, light, touch and so it's something to be aware of in a dental surgery full of foreign experiences! Be aware of use of the dental light - many autistic patients do no like it as well as loud noises like the suction or dental drill. They may also be sensitive to the taste of your dental gloves, toothpaste, fluoride varnish etc. 

For light consider the use of sunglasses. Autistic patients often have ear defenders to block out sound. If patients do not like the sound of vibration of an electric toothbrush, use of a Dr Barman's toothbrush can be useful. 

A usual acronym with interacting with people with Autism is SPELL:


Positive approach (language use, visual)

Empathy and seeing things from another point of view

Low arousal, low stress

Links and consistency

To see other tips in managing Autistic patients see my previous post. Many thanks to NAS for the informative talk!

Do you treat autistic patients? Let me know how you manage these patients in the comments section.

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