Dental Tribune United Kingdom Edition

T raditionally, all sur- geons in the UK and Ire- land are designated the title “Mr” or one of the appro- priate female equivalents. Our medical colleagues graduate with the title “Dr” until those that want to follow the surgical pathway are elected to one of the Royal colleges and become “Mr”, “Mrs” or “Miss” again. This all harks back to the days where surgery was carried out by barber-surgeons who did not have formal medical training, usually on the basis of apprenticeships. When the fields of medicine and surgery became more integrated, sur- geons kept their titles as “Mr” as a reference back to these origins. As dentists, we do not have a choice of career pathway between dental medicine and dental surgery in the same way; we all graduate as dental surgeons so by default our ti- tle is “Mr”. However, perhaps as a result of modern globali- sation, many dentists now refer to themselves as “Dr”. Upon graduating, I did exactly that; I was given a badge with “Dr Alexander Holden” written on it and shortly afterwards my bank cards said the same thing. Personal choice Although my bank cards today still say “Dr”, I do not introduce or advertise myself as this pro- fessionally; my patients know me as Alex and my referral letters are sent from Mr Hold- en. This is simply a matter of personal choice; I am a dental surgeon, not a dental doctor. I would be quite happy to be in a practice where other dentists chose to call themselves “Dr” but as I am devoid of a doctor- ate, I will stick to “Mr”. Although I do not use it, I feel that it is important for den- tists to be able to use the cour- tesy title if they wish; medical doctors in this country do not graduate with a doctorate in medicine so it is purely a cour- tesy title for them too. My views go beyond this non-objection in that I feel that perhaps den- tistry is currently lacking a coherent career pathway for young dentists and this should be considered as a further pos- sible change to dentistry in the UK. The pathway has suffered somewhat of recent times; typ- ically dentists would graduate, complete VT and then after a period as an associate, buy into a practice. Now that being a practice owner does not neces- sarily pay more than being an associate and the prices cor- porates are willing to pay for practices is greater than that which new buyers can afford; the traditional career pathway is somewhat scuppered. Com- bine this with the possibility of a new contract in the NHS and direct access which will poten- tially favour the use of DCPs over associates for some roles and the old career pathway might be considered well and truly closed. Change for better DF1 and DF2 (Dental Founda- tion) were credible and valid steps in attempting to make dentistry similar to medicine in its initial stages after gradu- ation. I strongly believe that the new change has been for the better as now DF1 is more holistic in its view of dentistry; VT could perhaps be accused of being prescriptive of a ca- reer in practice whereas DF1 is more exploratory of dentist- ry as a whole. Holistic is an interesting word to choose as it could equally apply to the new direc- tion dentistry is following. As a profession we are waking up to the idea that dentistry is more than just what we can do in the dental surgery; our reach and arguably our responsibility stretches beyond, now looking at patients as more than just a mouth and re-evaluating our place in healthcare in general especially as in many cases we will see patients more often than their medical GP will. To this end, is it possible to consider a similar dichoto- my in dentistry as there is in medicine? This is especially pertinent as now restorative dentistry is moving towards more minimally invasive tech- niques and a chemothera- peutic approach with fluoride application than the more tra- ditional ‘drill and fill’ surgical approach. The research into peri- odontal disease is highlighting ever more that periodontitis is more of a multi-factorial, sys- temic condition than we once considered it to be; no longer is it simply because patients don’t brush their teeth (al- though oral hygiene is by far the most important factor in chronic periodontitis.) The links between coronary heart disease, diabetes and other systemic, inflammatory and immunological conditions is not simply one way. This sure- ly calls for us as dentists to be more holistic in our approach? Dichotomy To recognise this new dichot- omy of practice, will we see a change in dental education, so that dentists graduate with more of a general orientation like medics, to then become either more like dental physi- cians or alternatively dental surgeons? The days of the gen- eralist seem to be numbered; the new contract may well favour the specialisation of dentists to new degrees, with DCPs becoming more respon- sible for generalist work. With the increasing em- phasis upon skill-mix and an increasing political pressure to save money, just how long will it make sense for us to be as generalist as we are now? We are not currently in a situation where the technol- ogy and materials are suitably tested and developed along with teaching and research, for this dichotomy to be fully realised. It does however seem to be inevitable that the more research takes us towards re- generative and preventative dentistry, the more the role of the dentist will change from surgeon to physician. It is already the case that dental public health (very much non-surgical in ap- proach) is a specialty exam- ined and gained from the Royal Colleges of Surgeons, not from the Faculty of Public Health which is part of the Royal Col- lege of Physicians. This is sim- ply due to an anomaly created by how the dental specialties are organised. This raises a question of how it can be jus- tified having separate dental public health specialists when the determinants for oral dis- eases and most chronic diseas- es are common to one and oth- er? It would actually be much better to have one overarching specialty of public health that covered the health needs of the oral cavity as well as the rest of the body. Refocus This need for a holistic ap- proach is possibly more obvi- ous in the specialty of dental public health, but I do believe that as we move further into the future and the surgical management of caries and oth- er oral disease becomes less and less invasive, perhaps we need a similar re-focus of how dental training is organised, our affiliations to which facul- ties are appropriate and per- haps even a serious discussion about how we define ourselves as professionals. DT Alexander Holden looks at what is in a name... Dr.Dentist About the author Alexander Holden is dentist in NHS general practice who is also un- dertaking further training in law and dental public health ‘I feel that it is im- portant for dentists to be able to use the courtesy title if they wish’ Can graduates follow the ‘traditional’ career pathway? February 25- March 3, 2013 8 Comment United Kingdom Edition