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...

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 (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.  

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

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. 

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.