Toothzone Kitchley Dental ClinicXynova – a local anaesthetic used in Indian

dental clinicsLignox – Local anaesthetic sprayInjections are only used in cases when either of

the above are not effectiveDoctor is seen maintaining the full hygienic

specifications, however the nurses do not medical garments simply a traditional sari, one seen without footwear

X-rays – scanner placed next to chin and film held in mouth by dentist, no one leaves the room

Dentist do not interact much with patients – less communication which is a bad thing as increased communication improves the level of trust between doctor and patient

For root canal treatment, nurse removes and hands files by hand. Extremely unhygienic; only one sink for 3 stations

When UV-heater is used , protective facial equipment is not used by doctor/patient

When mixing adhesives nurse does not wear any gloves, not good – also cleaned the scalpel used to mix the adhesive with her hand to be used again

Power cut, no generatorNurses are actually watching procedures rather

than being an active part of it, means doctor has a lot more work to do

Modern and clean (AC makes everything more comfortable)

Nurses have proper attireLarge, open, not as crampedSeparate section for x-ray and

cleaning/sterilising equipment which is done regularly

Plastic covering on tables, better sterilisationNurses aren’t trained as well to prepare the

mould for denturesImplant patient – Israel implant used

1) Apply surgical scrub to outside of mouth, neck, etc

2) Gargle and rinse with antiseptic3) Antiseptic sucked out and applied

directly to area afterwards4) Tooth cleaned and more antiseptic

added + washed out5) Local anaesthetic injected into gum6) Flap opened in gum with razor (creates

incision which can be pulled back) blood and bone is washed with water

7) Drilling into the bone to enable a screw to be fit ready for implantation of tooth which is then tightened in with a puck wrench

8) Flap is closed and stitches applied on each side

9) Blood is cleaned off

Kings Dental HospitalAcute CarePatients who come in are walk-in because they are not registered with a NHS dentist; this means

that every patient who comes in are asked: to describe pain; how long has it been affecting; does it affect sleep; how hot/cold items affect it; underlying medical conditions; do you smoke or drink; occupation

Then inspect area, locate visually any identifiable problem; after send patient for x-ray and assess situation based on what is happening

After visit nurses wipe down and sterilise entire area as well as send equipment away to be sterilised in another section of the hospital

Filing came out and affected entire left jaw and side of head (trouble sleeping, eating); went through normal questions (was very sensitive to cold and was taking painkillers + the ‘pill’); before an x-ray was taken, possible causes was discussed with patients to prepare them for what may happen (likely to be an abscess of infection – x-ray shows decay, so temporary filling is needed but root canal must be done; by a clinic dentist) -- my job to talk to patient and to keep her calm just by chatting to her and distracting her from what is going on around her

ConsultantsPatient has an infection under the bridge which will spread if left aloneSection off the bridge and remove teeth, needs to be sectioned of in a particular place in order to

reduce the gap for more aesthetic reasons but could be sectioned off right next to the cap – whole procedure under doubt because patient had 6kg tumour removed (spleen + kidney)

The consultants job is to assess more difficult cases such as this one where the entire procedure is under doubt because the patient may be immune-compromised

Maxillofacial SurgerySurgery to correct a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and

the hard and soft tissues of the oral and maxillofacial regionMan attacked with a belt buckle which shattered palate and blinded right eye; joy when treatment

was finished

Pedodontics 5 year old patient, to sedate they use a drink that works in a similar way to local anaesthetic by

numbing the area (gums and nerves) due to age and sizeDrink is benzodiazapam which also causes amnesia and no traumaA mask is also used which covers the nose only which allows a continual supply of N2O gas to keep

the patient docile and happy; this is used with a gel to numb gum as well and then local anaesthetic so that injection doesn’t sting as much – we see how a lot of measures are needed to make the patient fully compliant and area completely numb

After this tooth is taken outCould also use the wand

Oral surgeryUpper 6 extraction – problem is the from the x-ray, the root is near the base of sinuous; so bit of the

base could come out with tooth; may need surgical extractionNeedle is put into the arm ready for sedative = ibuprofen drink givenLocal anaesthetic given (1ml to make it numb, up to 6ml before its use its questioned) and sharp

instrument checks if area numbElevators allow tooth to be loosened, care need to be taken to not loosen the other teeth and not

damage the base of sinus

Vibraject

Cheaper than Quicksleeper (intra-osseous injection) and Wand

Nerve endings associated with sensing pain is small, uninsulating and have a low signal intensity – the nerves which respond to pressure and vibration are larger, insulated and have a relatively high signal intensity

When vibration and pain signals are combined, it is believed that the vibration message carried by the insulated nerves predominates over the pain message carried out by smaller inhibitory action on the ‘pain’ pathway at the dorsal horn of the spinal cord (patient only feels vibration)

The Wand

Computer-controlled dental injection device for giving local anaesthetic-flow rate is controlled by the computer which ensures it is slow and steady – doesn’t look like a needle so makes patients less anxious first sight – precise flow and control provides a comfortable injection even in difficult areas e.g. palate and ease of use (expensive, more room, time to lean, unnecessary for most dentist)

Child Welfare

1) Assess the child

History: has been a delay in seeking dental advice for which there is no satisfactory explanation? Does the history change over time or not explain the injury or illness

Examination: are there injuries that can’t be explained? Are you concerned about behaviour & interaction with parent? Are there any signs of abuse or neglect?

Talk to the child: ask them about the cause of any injuries, listen and record their words, allow child to talk and volunteer information about abuse – don’t ask leading questions

2) Discuss with experienced colleagues (dental/paediatrician/child protection noise/social services (informal discussion))

3) Provide urgent dental care, talk to child and parents and explain your concerns: inform them of your intention to refer and seek consent to sharing information, if consent is withheld, discuss with defence organisation or senior colleagues before proceeding; refer for medical examination/keep clinical records only

4) Refer to social services, in writing within 48 hours5) Further action later; confirm referral has been received and acted upon; arrange dental

follow-up as indicated; be prepared to write a report

NHS 2011 “no decision about me without me”

Dentist rewarded for quality of care rather than number of patients and treatments they do

Linking dentist income to number of patients registered with them (not number of treatments provided)

Make dentists more accountable for providing high quality and long lasting treatments (e.g. fillings & too canals) and supporting dentists to take time to advise patients on preventive care – take personal info (diet/smoking/drinking) and give risk assessment by Red/Amber/Green – focus on prevention

Defining more clearly the rights that patients can expect when they register with an NHS dentist, both for urgent treatment and continuing care

In addition, dentists can carry out private treatments for patients. Dentist set their own charges for provate treatment and is usually based on time spent and costs involved. Most treatment is available to patients under the NHS, but some complex treatments and cosmetic are not under NHS

Patients don’t need a check-up every 6 months. National Institution of Clinical Excellence (NICE) suggested that recall should be determined for each patient according to risk – dentist should carry out risk assessment before they advice patients on when they should return for routine dental examination

Changes are result of Steele Review in 09 which came up with these recommendations. Piloted in 70 sites in England “prevention of oral health through prevention of disease”

NHS reforms 2006

Band 1 (examination, scale, polish, x-ray) £17; Band 2 ([1] + fillings or restoration) £47; Band 3 ([3] + crowns & dentures) – extra band 4 for urgent treatment (examination, x-ray, dressings, re-cementing, crowns, 2 extractions, 1 filling) = £17

Each band is weighted for complexity of course of treatment and is created by assigning a numerical value to each band – numerical value is known as UDA

Paid according to number of UDA’s they provide, £24 per UDA (from this the dentist has to meet their expenses e.g. lab cost, staff salaries & other expenditure)

Dentist has target of ~7000 UDA per year, band 1 = 1; 2 = 3; 3 = 12

Paid for work so is fair and efficient but forced to treat more patients and therefore there is nudge economics in place (minimum to hit band/incentive to do less): people who need treatment therefore may not get it (ethics). So although its simple, it isn’t fair e.g. 10 restorations have same weighting as one

PCT’s being abolished and replaced by funding from a national body

DH – PCT (£6m) – Reality (£4.8m) as patient pays for the remaining £1.2m & gvt. assumes that you collect this charge, so is unregulated

Members of a dental team: Dentist; nurse; technician; maxillofacial surgeon; orthodontic therapist; receptionist; hygienist (treat tooth and gum problems and focus on prevention – sealing and polishing teeth and applying topical fluoride and fissure sealents; in hospital help with surgery); therapist (carry out assessment, radiographs, dental education, routine restoration, extracting deciduous teeth, pulp treatment, dental block analgesia under supervision, emergency replacements of crown and filling)

NHS

Very safe contract to have, only is regulated by amount of tax income received

Key ‘stakeholders’ are patients, government and dentist and each wants slightly different things

Tax income is based on earning so is justified in that respect; under 2006 reforms it was not justified in its entirety

Root Canal

Form of endodontic therapy (sequence of treatment for pulp of a tooth which = elimination of infection and protection of decontaminated tooth from future microbial invasion.

1) Numb tooth with novacain2) Place rubber dam to isolate tooth and keep it saliva free (no contaminates)3) Create the access cavity for entry to nerve space by using dental drill which will extend into

interior of tooth to pulp chamber (on posterior tooth (molar), access is made on chewing surface and front have on backside)

4) Cleaning using files (in a twisting motion) of increasing diameters, goal is to increase overall dimensions of root canal as some contaminates are embedded within canal’s walls, this enlargement assists cleaning and shaping goals – whilst doing this the dentist will periodically flush out tooth to wash away debris and contaminants (sodium hypochlorite is most common irrigation solution) Dentist’s goal is to clean entire length of each tooth’s root canal (but not beyond). As a means, the dentist will place a file in tooth and take an x-ray which will show if it extends whole way

5) Sealing tooth immediately or after a week (temp needed) – common use is rubber compound gutta percha which comes in performed cones whose dimensions match size of files that have been used to shape tooth’s canal. A pasta can be used with it and is applied to a cone’s surface before it is placed into a canal, several cones may be needed and can be applied using a gun – then place a temp filling to seal access cavity

6) Permanent restoration is needed as procedure isn’t finished, place crown to strengthen fragile tooth which also prevents coronal leakage – bacteria finding a way back into root canalled tooth

Nurses’ perspective: job is to keep patient calm and happy; be defensive when nerve is inflamed as patient is likely to lash out; when giving injection also put cap back on and instruct dentist to do same (HIV is serious).

Upper uses longer needle and Lower uses shorter; leathermix is anti-inflamatory used after root canal

Dental domains

Caries – tooth decay is an irreversible infection, usually bacterial in origin that caused demineralisation of hard tissue (enamel/dentin) and destruction of organic matter of tooth by production of acid by hydrolysis of tooth

Perio – study of structures of teeth, disease, conditions that effect them as well as periodontin – result of a coalescence of bacterial plaque biofilm accumulation of gingival (soft tissue lining)

Soft Tissue – Tongue (hairy tongue); palate (if hardens before birth – cleft)

Tooth Surface Loss (acid erosion)

Implants

Function as a artificial tooth root on top of which a dental prosthesis can be placed e.g. crown, bridge or denture – most common that’s placed Is the endosseous root form implant which are

screw shaped and positioned into jawbone (refers to how implant is embedded in the jawbone and penetrates through gum tissue, it is also similar in shape to natural roots)

Implants are osseo-integreated implants as there is a direct fixed connection between the dental implant and living bone – no intervening layer of connective tissue at light microscopic level

Fixtures are constructed out of titanium and typically have a hollow or solid, cylindrical/screw –shaped design. Manufacturers utilise proprietary surface treatment with implant fixtures e.g. surface often grit-blasted/etched/plasma sprayed to increase surface area or greater contact between bone and implant

Could also be coated with a biocompatible bone regeneration material (e.g. hydroapitite which 50% of bone is made up off). Coating enhances Osseo process by allowing it to occur at a more rapid rate – optimal surface prep is still debatable

The dental implant abutment (stub position above gum line) has crown or bridgework that implant support rests on top off – attached 3-6 months after placed

“The artist is the creator of beautiful things...to reveal art and conceal the artist is art’s aim...the moral life of man forms part of the subject-matter of the artist, but the morality of art consists in the perfect use of an imperfect medium” – Oscar Wilde

Dentistry is a profession and not just a job because it is a paid occupation that requires prolonged training and a formal qualification

Qualities that a dentist should posses

Duty to respect the patient’s right to self-determination and confidentiality Do no harm to patient by keep up to date with procedures and skills current. Being fair in dealing with patients, colleagues and society Being truthful, respect the position of trust inlaid by the patient – communicating truthfully

without deception and maintaining intellectual integrity

Dentist should be effective communicator; empathetic; be manual dextrousIn UK the General Dental Council is statutory body which regulates profession by marinating standards and ensuring the public is protection.

Negatives of Dentistry: stressful; hard to make patients understand reality of situation when it is incredibly important; unrealistic explanations & dentist has to explain this whilst being empathetic and caring

Risks: Unprotected contact with patient fluid; needle stick injuries; exposure to radiation; back pain

NHS minister: Barry Cockcroft, most senior dental advisor

Oral Microbiology

Mouth is colonised a few hours after birth by aerobic and facultative anaerobic bacteria (function in both environments)

Eruption of teeth allows for development of a complex ecosystem of a microorganism

Around 700 different species colonise the mouth & healthy mouth depends on maintaining an environment in which these organisms co-exist without damaging oral structures

Streptococcus mutans are facultative anaerobes that synthesis dextrons which is main component in plaque

Colony density increases 50% in presence of high dietary sucrose able to produce lactic acid from most sugars – most important organism in aetiology of carries

Streptococcus Oralis – 50% Streptococci in plaque and heavily implicated in 50% of cases of infection endocartitis (infection in inner lining of heart)

Brushing

Brush before breakfast as it rids mouth of plaque that has built up during night’s sleep, and also, brushing before helps protect teeth from foods that you are most likely to add sugar too which attack teeth in a way that is harmful to brush after as some foods soften surface enamel so brushing can further erode and destroy tooth surface

Hep B

Infectious liver disease by Hep B. Enters via bloodstream/direct contact with infected blood/punctures of skin/splashes to minute scratches/mucus membrane

Smoking

Exacerbates periodontal disease and adversely affects Rx outcomes

Amalgam

Alloy containing mercury (50%), silver (~22-32%), tin (~14%), copper (~8%), and other trace metals. In the 1800s, amalgam became the dental restorative material of choice due to its low cost, ease of application, strength, and durability.

Recently however, its popularity has diminished somewhat. Concern for aesthetics, environmental pollution, and the availability of improved, reliable, composite materials have all contributed. In particular, concerns about the toxicity of mercury have made its use increasingly controversial. Due to a worldwide plan to phase out the use of mercury, Norway, Denmark, and Sweden have deliberated in 2009 a ban of mercury dental amalgam in their countries.

Amalgam is "tolerant to a wide range of clinical placement conditions and moderately tolerant to the presence of moisture during placement". In contrast, the techniques for composite resin placement are more sensitive to many factors and require "extreme care". These are some of the reasons why amalgam has remained a superior restorative material over resin-base composites. The New England Children's Amalgam Trial (NECAT), a randomized controlled trial, yielded results "consistent with previous reports suggesting that the longevity of amalgam is higher than that of resin-based compomer in primary teeth and composites in permanent teeth. Compomers were seven times as likely to require replacement and composites were seven times as likely to require repair.

(Compomer = dental composite & glass ionomer cement; Synthetic resins evolved as restorative materials since they were insoluble, aesthetic, insensitive to dehydration, easy to manipulate and reasonably inexpensive; bond chemically to dental hard tissues and release fluoride for a relatively long period)

Encapsulated amalgam should be used in preferences to non-encapsulated. Use should be confined to impervious surfaces where any spillage will be limited, ideally a lipped tray lined with foil. Staff

should wear gloves when handling Hg-containing substances. Waste should be stored in a sealed, labelled container containing solution to suppress mercury. Disposal of amalgam/mercury and capsules should be by a licensed person.

Smoking

Exacerbates periodontal disease and adversely affects treatment outcomes: Chewing tobacco increases likelihood of oral cancer x4 as it releases a variety of chemicals into the body and often causes mouth sores, cracked mouth and gums

Have more calculus; nicotine causes vasoconstriction so blood circulation decreases by 70% - tobacco is toxic so destructive to cells & tissue

Cancer

Oral cancer may appear as white patch (or could be renal failure or form of leukoplakia – any other disease not associated with any physical or chemical agent except the use of tobacco)

~2% of all malignant tumours in MEDC but ~30-40% in Indian subcontinent – preventable in 75% of cases & mortality ~ 50%

‘Site’ – floor of mouth most common when combined with ventral surface of tongue creates horseshoe area – 75% of carcinomas & 95% patients are >40 years

Seen as painless ulcer or swelling for >3 weeks & pain is a late feature when lesion becomes superinfected or during eating of spicy food

Trismus

Inability to normally open mouth due to one of many reasons. Periocoronitis – inflammation of soft tissue around impacted third molar; inflammation of muscles of mastication and can occur after surgical removal at third molar but is usually resolved on its own after 2 weeks.

Abscess

Pus enclosed in tissue of jaw bone at apex of an infected tooth’s roots and originated from a bacterial infection that has accumulated in soft, dead pulp of tooth – untreated tooth decay, cracked teeth or extensive periodontal disease

Treated by antibiotics and draining, if tooth can be restored then root canal; unrestorable must be extracted followed by curettage of all opical soft tissue

If untreated, severe abscess large enough to perforate bone & extend into soft tissue, eventually becoming osteomyelitis (acute or chronic bone infection) and either spreads internally/externally based on location of infected tooth/thickness of bone

Cyst

Periapical cyst is most common & caused by pulpal necrosis. It appears as radiolucency (dark patch) on radiographs around apex of root – caused by root infection by carious decay, the necrosis causes a release of toxins at apex of tooth leading to periapical inflammation – formation of inflammatory scar tissue called periapical granuloma further necrosis

Cyst is a closed sac having distinct membrane and composed of air, fluids or semi-solid materials

Treated by root canal and cutting into it

Chronic gingivitis

Inflammation of gingival tissue, not associated with alveolar bone resorption or apical migration (plaque-induced gingivitis)

Could also be due to malnutrition/medication – characterised by swollen gums, bright red or purple gums, gums that are tender or painful to touch or even bleeds

Private Dentistry

Materials used and services offered e.g. teeth whitening/veneers

BDA don’t provide recommended scale of patient charges for private dental treatment

Spend more time with patient, and can offer payment plans

Dentist benefits

Satisfaction of looking after people; intellectual fulfilment; relationships with patients; visible changes

My negatives

Lose track of long term goals over short term needs; too trusting of people; perfectionist; time management could be better

Books are judged by their covers, houses are appraised by their curb appeal, and people are initially evaluated by how they choose to dress and behave. In a perfect world this is not fair, moral or just. What’s inside should count a great deal more; and eventually it usually does – but not right away. In the meantime, a lot of opportunities can be lost – Bixler, New Professional Image

Root Form Implants

Root form implants are the closest is shape and size to the natural tooth root. They are commonly used in wide, deep bone to provide a base for replacement of one, several or a complete arch of teeth. After application of anesthetic, your dentist will expose the area of the jawbone to be implanted and prepare the bone to accept the implant. The number of incisions and bone preparations depends upon the number of implants (and teeth) being placed. The implant is carefully set into place and the gums are closed with several stitches. The healing period usually varies from as few as three months to six or more. During this time osseointegration occurs. The bone grows in and around the implant creating a strong structural support. In fact, this bond can be even stronger than the original tooth’s. When healing is complete, your implant is uncovered and an extension or abutment is attached to it. Now the implant and abutment act as a solid unit ready to support your new tooth or teeth.

Plate Form Implants

Plate form implants are usually used when the bone is so narrow it may not be suitable for the root form implant and the area is not suitable for bone grafting. The plate form implant is flat and long so it can fit into the narrow jawbone. After application of anaesthetic, your dentist will expose the area of the jawbone to be implanted and prepare the bone to accept the shape of the implant. The number of incisions depends upon the number of implants being placed. The implant is carefully set into place and the gums are closed with several stitches. Like root form implants, there is usually a healing period for osseointegration, although some plate form implants are designed for immediate restoration.

Subperiosteal Implants

With very advanced jawbone resorption there may not be enough bone width or height for the root form or plate form implant. In these cases the subperiosteal implant may be prescribed. The subperiosteal implant is custom made and designed to sit on top of the bone, but under the gums. There are two methods for its placement.

The "dual surgery" method. After application of anaesthetic, your dentist will expose the jawbone and take an impression or model of the bone using special materials. This model is used by a dental laboratory to carefully create the custom implant to fit your jaw. A second procedure is then carried out where the jawbone is exposed

and the implant placed. The gums are closed with several stitches and replacement teeth are put into place.

For the "single surgery" method your dentist will order a special CAT scan of your jawbone. Using the CAT scan data and advanced computer modelling techniques, a model of your jawbone is constructed. This model is used by a dental laboratory to fabricate the custom subperiosteal implant to fit your jaw. A surgical procedure is then carried out where the jawbone is exposed and the implant placed. The gums are closed with several stitches and the replacement teeth are put into place.

Why do you want to do dentistry?

My interest in dentistry stems from childhood where I often found myself in a dental clinic due to my previously awful teeth! But through several years of treatment - including orthodontics to correct my overbite and large spaces between my incisors – I was left with a much more aesthetically pleasing set of teeth which I was astounded at, especially when seeing a before and after picture; I left the clinic much happier in my appearance and with a greater level of confidence. These were benefits which I wanted to impose onto other people’s lives.

Through clinical work experience I was able to appreciate the fine intricacy of the work that dentists do and appreciate how - although clichéd - it does in fact combine the science with an artistic flair

(in an example of a restoration, it is artistic in the way the dentist applies the materials in the appropriate proportions so that essentially the result is “invisible” and looks almost natural; it is scientific in the thought process at each stage as various factors have to be considered such as: how to mix the materials; the thermal capacity – how they would be effected by temperature change -; anatomy of the tooth; compressive flexibility of the material and the modulus of elasticity.)

I continued this work experience in India and at Kings Dental Hospital in London where I was able to fully understand how dentistry operates in different health systems, the importance and value of teamwork and how dentistry is an umbrella term for a wide array of different specialties such as oral surgery, maxillofacial, periodontics, orthodontics, etc.

In conclusion, through my own personal experiences and time in practices, I was able to gain an understanding in the dental field and therefore enhance my interest in it.

Why Manchester

Well I can assure you it wasn’t simply because I support Manchester United football club, although it might be nice to see them play once in a while!

I started to consider going to this university because I heard the course was centred on problem-based learning which to me seemed like a more independent and fulfilling way of learning. I generally find myself understanding more through case studies and small group sessions which is something I encounter at my geography lessons in school and my chemistry lessons outside of it. Also I liked the fact that clinical experience starts in the first term which seemed exciting to me.

So after learning a little about the course itself I found the open day to be an incredibly important deciding factor for me as I loved the fact that it is a city campus with the dental school integrated into the campus rather than being completely separate; so essentially means that I can imagine myself living in the area for five years and really feeling part of the university.

My final reason is slightly odd in retrospect but I remember the presentation given by the dean intriguing me greatly. This is especially when he showed an example of a patients who had all of his teeth removed to make way for implants. This made me think whether root form implants were the best decision for putting in dentures or because it was the entire mouth perhaps plate form implants or subperiosteal implants may have been a better option. At that point all the benefits of coming to Manchester amalgamated in my mind and I decided at that exact moment that I would like to come to the university.

What qualities do you think a dentist should possess and how do you think you display this

Empathy and emotional intelligence: an dentist should be able to put themselves in the shoes of their patient, this is important when dealing with the most terrified patients so that you can help them be at ease I have often been described as calm and caring (it’s actually what my name means in

Hindi) and I feel I somewhat displayed this in my time as a sergeant in cadets; at the recent annual camp I was in the position of head of my contingent which put me in charge of 9 younger cadets through various activities and challenges. This was a hard balance for me to maintain but an example of me attempting to tackle this is from the plight of one cadet called...

By being effective communicator: and delivering information in a succinct and informative manner helps to ensure that the patients understand clearly the nature of procedure as I found from my work experience that patients are more at ease when they know exactly what is going on and for what reason; also by talking in a calm, friendly manner to the patient may again puts them at ease and make the experience as pleasurable as possible At my workplace, etc

Most importantly a dentist needs to be manually dextrous: as if you take away the verbal communication and interaction, what is left is a complex procedure that requires intricacy and precision coupled with a steady hand and a keen eye for detail in order to complete the job

Leadership qualities mixed with the ability to work in a team: etc etc

What fascinates me especially about Dentistry is the artistic quality of the work: theintricate precision with which dentists operate, and the complexity of the tasks required on a daily bases. This is done whilst also remaining empathetic to patients, and building uptrust-based relationships with them which I learnt were key qualities required in order to besuccessful in the field.

Moreover, my work experience in dental practices in UK, India as well as King's College Dental Hospital has provided me with a greater insight in this field. By talking with various doctors, nurses as well as observing in the different departments such as: maxillofacial surgery, orthodontics and dental surgery. Through this, I was able to fully grasp the scope that dentistry provides; this further enhanced my enthusiasm, as the opportunities after the five-year course are so vast.

I also believe that dentists provide a significant public service, as I have seen that, through small changes, they impose a great change in an individual's life as often after treatment - such as the application of prosthetics - the patient's quality of life would improve. These are the attributes of Dentistry that have compelled me to pursue the career.

As a senior prefect in my sixth form, I help to keep the daily operations and events in the school running smoothly; whilst as a student I greatly enjoy my A-level subjects as my proficiency with sciences helped direct me towards dentistry. Furthermore, I chose to study Geography because I enjoy the subject; through it I have become more proficient in my analysis and research skills. This combined with the ability to congregate disparate ideas, allows for the production of rational arguments; which I believe is a skill essential to dentistry.

Outside of the classroom I participate in numerous activities. My employment in ExploreLearning as a tutor and my voluntary work at disabled children's' homes in UK and in India -with 'IPOP' and 'Shine Education Trust' - incorporate the need for me to educate and mentally stimulate children, whilst also communicating with them as a peer in order to increase their confidence and improve their life skills. I have therefore learned via the direct supervision of children in these circumstances how to be responsible and caring, which I believe are traits a dentist should possess.

I am an apt member of a team, as I have competed for my school in Eton Fives and Cricket which are both team sports that require a great level of communication and physical ability. I excelled especially in Eton Fives: by winning a regional competition and placed 3rd in the national championship; I also immensely enjoy my time on the cricket pitch and look forward to the possibility of joining the university teams.

As a Sergeant in my cadet force, I have taken responsibility for younger cadets in educating them in discipline and respect under the banner of military skills; being in charge of nine cadets at the annual camp gave me the opportunity to strengthen my leadership attributes whilst also building friendships with those in my squad. It was an incredibly hard balance but I believe I excelled and earned the respect of my cadets.

Outside of these activities I take pleasure in sketching and playing guitar; I am currently working towards the grade 5 exams but also enjoy learning classic rock riffs.

I am a caring and organised student, and I am motivated by the sincere desire to pursuesomething for which I have a great passion. I hope to help maintain a good quality of life inpatients through prophylactic treatment, technical ability and problem solving. Through myinquisitive mind and thirst for scientific knowledge I relish the chance of being a life-longlearner and in the future help the profession advance through research whilst also being ahighly skilled practitioner providing immediate and long-term care.

Course description

The Bachelor of Dental Surgery (BDS) programme prepares students for careers in the modern world of dental practice by combining clinical studies with basic and advanced dental sciences. Once students have mastered basic competencies in the University's skills facilities, they rapidly move on to treating patients in both the Dental Hospital and local outreach clinics.

BDS Dentistry is taught in a top-ranked institution proud of its facilities, research reputation, student support, excellent innovative programme and student-centred curriculum. The programme aims to develop professional and ethical dentists who can:

Take a patient-centred approach to clinical care within the dental team Apply the skills, knowledge, behaviours and abilities to practise safely and efficiently Be a reflective practitioner committed to lifelong learning

Special features

Enquiry-based learning (including problem-based learning) Outreach community clinics Emphasis on research throughout the programme Early clinical experience Opportunities for interdisciplinary learning between students of dentistry and student

professionals complementary to dentistry e.g. student dental hygienist/therapists/technicians

Opportunity to undertake an intercalated BSc

Module details

The Manchester Dental Programme has been designed by the students and staff of the School of Dentistry to provide an integrated, enquiry-based five-year programme building on and incorporating the School's existing high-quality learning/teaching, expertise in problem-based learning (PBL) and well-established outreach courses.

A key feature of the programme is integration between theory and practice, and early learning and teaching in the clinical context is central to this. Clinical subjects are taught alongside the basic dental science subjects. This allows links to be made between the relationship of disease processes to body structure and function, and the behavioural sciences to patient treatment. From the first year of the programme, students study and practise aspects of clinical dentistry. The programme is designed around five themes:

1. Human Health and Disease2. The Mouth in Health and Disease3. Clinical Competence:

o Diagnostic Skillso Manual Skills and Dexterityo Problem Solvingo Patient Management

4. Scientific Understanding and Thought5. Team working, Communication Skills, ICT, reflective practice

Dedicated teams have worked to develop these themes, and the years shown below, to ensure that students' knowledge and skills develop over the five years of the programme.

Course content for year 1

Basic building blocks:

Orofacial Biology 1 Healthy Living 1 (a healthy body) Team Working, Professionalism and Patient Management 1 Patient Assessment 1 Disease Management 1

Course content for year 5

Moving to professional competence:

Team Working, Professionalism and Patient Management 5 Preparation for Independent Practice The Complex Patient

Career opportunities

BDS Dentistry graduates have opportunities to work in general practice, the community dental service, hospital practice, university teaching and research, various individual organisations and the armed forces.

Further specialisation and training are frequently required. Graduates wishing to work in general practice are required to undertake a year of mandatory vocational dental practice working under the supervision of an experienced dentist in a recognised practice. Travelling fellowships and government posts may offer opportunities overseas. The qualification is recognised throughout the European Union and in many other countries.

What our students say

'The best thing about studying Dentistry is being able to interact with so many different types of people during the clinical years, and being able to make some difference in their lives'. (Janelle Bryan, Bachelor of Dental Surgery)

Teaching and learning:

Enquiry-based learning (EBL): In EBL, the tutor establishes the task and helps the process, but students pursue their own lines of enquiry, drawing on existing knowledge and identifying their own learning needs. Through EBL, students participate in a wide range of different learning activities including PBL sessions, small-group seminars, themed theatre events, case-based activities, computer-assisted learning (CAL), the use of web-based resources and project work. The emphasis on EBL means that traditional lectures do not form a major part of the programme.

Projects: During the programme, students complete a research project and a clinical case presentation.

Problem-based learning (PBL): This features interdisciplinary cases where learning is driven by the need to acquire knowledge in order to understand a particular clinical problem or scenario. This approach involves a mixture of small group and self-directed learning, with the tutor acting to support the student rather than teach.

Lecture/symposium: These are interdisciplinary-themed theatre events combining presentations, clinical case presentations and interactive exercises.

Technical/laboratory: Classes in life science laboratories, the anatomy dissection room and our clinical/technical skills facilities are timed to complement the knowledge students acquire through EBL. These are designed to equip them with the competencies they need to treat patients during each stage of their development as student dentists.

Clinic: Students will undertake clinical experience in a range of environments (dental hospital, outreach community clinics) working in a dental team.

Coursework and assessment

The programme has been carefully designed to ensure that assessment is appropriate in terms of both timing and quantity, and that there is consistency of assessment methods throughout the programme.

These will include multiple choice questions, assessed projects, presentation of completed cases with companion oral examinations, objective structured clinical examinations (OSCEs) incorporating clinical competency tests, peer assessment and reflective journal writing. A 100% attendance record is expected for all teaching elements unless there are valid reasons for absence. Students with poor attendance records may not be signed up to sit the end-of-year exams in any year of the programme.

Integration and early clinical experience: The integration of non-clinical and clinical aspects of the programme means that the relationship of science subjects to the treatment of patients and disease elimination is immediately apparent to students. This philosophy allows for the rapid transfer of relevant research findings to the clinics. Students are introduced to the clinical environment in the first semester of Year 1.

Outreach clinics: This programme emphasises exposing students to dentistry outside the confines of the School and Dental Hospital through its custom-built community clinics. Treatment needs are high, there is no shortage of patients and students gain valuable experience of working as part of a team including dentists, dental nurses, hygienists, therapists and receptionists. The School's students consistently give this experience the highest rating.

Teamwork: The importance of teamwork is emphasised on the course. Alongside the BDS programme, the School of Dentistry provides a BSc programme in Oral Health Sciences which trains dental hygienists/therapists. There are close links with the Dental Hospital's School of Dental Nursing and nearby Manchester Metropolitan University's long-standing programmes in Dental Technology.

Students drawn from different years of the programme and from dental care professions, such as student dental therapists and student dental technicians, work as a team to meet the treatment needs of shared patients. This helps students to experience true teamwork in a dental context throughout their time in Manchester.

Facilities

Excellent clinical, library and IT facilities are available to support learning. The John Rylands University Library is the third-largest academic library in Britain. In addition, the School of Medicine houses a separate medical library.

IT facilities are provided within the John Rylands University Library and at the School's own multimedia cluster.

The School's skills facility and technical-skills teaching areas support the acquisition of clinical skills. Clinical facilities are renewed on a rolling programme.

Intercalated Degree Option

Intercalated degrees are a chance for Dental students to interrupt their BDS course for one year between Years 2 and 3 to complete the final year of a BSc Honours degree internally within the University of Manchester. The degrees offer students the opportunity to study in depth either a subject already covered in part by the BDS course, or a new area in which they may be particularly interested.

Anatomical Sciences

Biochemistry Biomedical Sciences Cell Biology

Health Care Ethics and Law

History of Medicine Medical

Biochemistry Neuroscience

Pathology Pharmacology Pharmacology and

Physiology Physiology Psychology

Course description

The Bachelor of Dental Surgery (BDS) programme prepares students for careers in the modern world of dental practice by combining clinical studies with basic and advanced dental sciences. Once students have mastered basic competencies in the University's skills facilities, they rapidly move on to treating patients in both the Dental Hospital and local outreach clinics.

BDS Dentistry is taught in a top-ranked institution proud of its facilities, research reputation, student support, excellent innovative programme and student-centred curriculum. The programme aims to develop professional and ethical dentists who can:

Take a patient-centred approach to clinical care within the dental team Apply the skills, knowledge, behaviours and abilities to practise safely and efficiently Be a reflective practitioner committed to lifelong learning

COURSE DETAILS

5 year full time course (1st year entry) integrating enquiry-based learning (EBL), including problem-based learning (PBL), and early clinical experience

Teaching

Much of the pre-clinical teaching will be taught at the Stopford Medical Building, with clinical teaching based at the Dental Hospital.

Teaching is based on enquiry-based learning and problem-based learning. Students work together in small supervised groups to cover various case-based topics to indentify the key learning objectives. Through EBL, students undertake self-directed learning to acquire the knowledge necessary to understand a particular clinical case or scenario. This is supplemented with lectures and symposia, small group seminars, as well as interactive learning via the university’s ‘blackboard’ e-learning portal and Computer Assisted Learning (CALnet).

Students receive practical teaching in the anatomy dissection room and histology laboratories to aid knowledge and understanding of the human anatomy and disease.

Students will also undertake research projects, in particular, a Critically Appraised Topic (CAT), in which a clinically relevant question is answered by looking at the existing published literature and available evidence.

Course topics

During the 5 year course, topics covered include human anatomy and physiology; health and disease; clinical competence involving diagnostic skills, manual skills and dexterity, problem solving, patient management; scientific understanding and thought; team working, communication, information and communication technology (ICT), and reflective practice.

Clinical experience

Clinical experience is obtained in the University of Manchester Dental Hospital, Manchester Royal Infirmary, and in local community outreach clinics.

Undergraduate students are introduced early to the clinical environment; first year students regularly shadow and observe students from older years, and are also taught basic clinical skills such as dental charting.

From year 2, students are introduced to the university’s newly refurbished technical skills laboratory where they will learn key technical skills and manual dexterity practising on phantom heads before treating patients in the restorative clinic within the Dental Hospital. Students are paired up and take it in turns to carry out treatment and nurse for each other, teaching valuable skills in team-working.

From year 3 and 4, students will start clinical placements in local outreach community health centres around Manchester, some of which specialise in paediatric dentistry, in which students will provide continuity of dental care for patients whilst working with trained dental nurses. Students will also have the opportunity to observe and carry out procedures under sedation and general anaesthesia at the Manchester Royal Infirmary Day Case Unit.

Students also gain experience in different aspects of dentistry by completing rotations at the various departments in the University of Manchester Dental Hospital including, but not limited to, the Oral Medicine department, where students will develop their history taking and diagnosis skills; Oral Surgery department carrying out extractions and simple surgical procedures, as well as assisting Senior House Officers (SHOs) and consultants with more complicated surgical procedures; and Radiology department where students are taught by radiologists how to take and develop radiographs as well as integrating the diagnostic skills and theory.

As part of the Medicine and Surgery course in year 4, students will complete a two week attachment the North Manchester General Hospital as well attending symposia and lectures delivered by resident doctors and specialists which will integrate their teaching with clinical experience. On completion on their two week attachment, students must complete a case report which will further integrate their medicine and surgery learning.

Dental students will also have the opportunity to work with other members of the dental team such as qualified and student dental nurses, dental technicians, and student dental hygienists / therapists.

Assessment

Each student is assigned a personal tutor who they will meet with regularly on a one-to-one basis to monitor progress as well as setting personal targets for the student to achieve. Progress is continuously monitored throughout the course with logbooks, which monitors attendance, manual skill, professionalism, and knowledge, as well as a series of core competencies that the student must have carried out and be deemed competent in, in order to progress through the course.

Students are assessed by projects such as coursework, case reports, and presentations, and by formal examinations such as Multiple Choice Questions (MCQs), Short Answer Questions (SAQs), oral examinations (vivas), and Objective Structured Clinical Examinations (OSCEs) incorporating clinical competency tests, examination of knowledge and communication.

Other details

Outstanding students also have the opportunity to take an extra year study to undertake an intercalated BSc (Hons) degree.

Students who decide not to continue studying dentistry may exit after year 3 with a Bachelor of Dental Science BMedSci (Dent) degree, providing they have successfully completed assignments and have an acceptable academic performance. After successful completion of the 5 year course, graduates will be awarded a Bachelor of Dental Surgery (BDS) degree

Caroline Jackson

Bachelor of Dental Surgery

Why dentistry?I've wanted to be a dentist since I was five years old and I don't really know why. My mum says that I always really looked forward to going for my check up. I've never had any fillings so, perhaps, I wouldn't have been quite so keen if I had! I would always ask my dentist loads of questions and he always says that a five-minute check up would take 15 minutes with me because I would want to know what everything was!

When I was 12, I got my front tooth knocked out playing hockey and my dentist put it back in; it went black for about three weeks but stayed in and eventually went back to two shades darker than its normal colour. I remember thinking it was so cool that teeth could be saved like that and, from then on, I was determined that I was definitely going to do that one day. I'm so lucky to be able to do the job that I've always wanted to do. I absolutely love it. No two days are the same and I get to meet and treat some really interesting people including one premiership footballer!

Problem-based learning in dental education: what's the evidence for and against...and is it worth the effort?

Australian Dental Journal [2007, 52(1):2-9] All Australian dental schools have introduced problem-based learning (PBL) approaches to their programmes over the past decade, although the nature of the innovations has varied from school to school. Before one can ask whether PBL is better than the conventional style of education, one needs to consider three key issues. Firstly, we need to agree on what is meant by the term PBL; secondly, we

need to decide what "better" means when comparing educational approaches; and thirdly, we must look carefully at how PBL is implemented in given situations. It is argued that PBL fulfils, at least in theory, some important principles relating to the development of new knowledge. It also represents a change in focus from teachers and teaching in conventional programmes to learners and learning. Generally, students enjoy PBL programmes more than conventional programmes and feel they are more nurturing. There is also some evidence of an improvement in clinical and diagnostic reasoning ability associated with PBL curricula. The main negative points raised about PBL are the costs involved and mixed reports of insufficient grounding of students in the basic sciences. Financial restraints will probably preclude the introduction of pure or fully integrated PBL programmes in Australian dental schools. However, our research and experience, as well as other published literature, indicate that well-planned hybrid PBL programmes, with matching methods of assessment, can foster development of the types of knowledge, skills and attributes that oral health professionals will need in the future.

The introduction of problem-based learning (PBL) into any programme demands a period of adjustment on the part of faculty. Similarly, students new to PBL take time to adapt to what is, for the majority of them, an unfamiliar mode of learning. At Manchester, closed loop PBL is used throughout the first and second years of the dental programme; the method is interdisciplinary; there are no subject boundaries. Dental students work in groups of between 10 and 15, facilitated by a tutor from the Department of Biological Sciences, to research topics and share information in a mutually supportive environment. Each week a different problem forms the focus for learning. In this paper, we seek to describe the measures introduced in response to student feedback collected via routine meetings with the senior tutor, after meetings with their academic or personal tutors and through discussion at the staff students' committee, which we at Manchester have taken to facilitate the process of adaptation to PBL. Changes have been made in the areas of recruitment, pre-admission interviewing, induction (development of an induction booklet and communication skills module) and tutorial support (overhaul of personal tutor system and introduction of peer-assisted study (PAS) and personal and academic development programmes (PADPs)). Feedback on these changes, gathered via the routes described above, has been positive and continues to be central to our processes of development in these areas. Although the various ways in which PBL has been implemented worldwide may place limits on the transferability of our methods, this paper serves to illustrate some of the means available to support students in the transition to self-directed learning. The latter is not only an essential component of PBL but also something we should be seeking to foster in all students, no matter what philosophy and method of course delivery are utilized.

Providing support for problem-based learning in dentistry: the Manchester experience: Gillian Hoad-Reddick, Elizabeth Theaker

Description of course

In 1994, a new problem-based leaning (PBL) curriculum for year 1 medical students was introduced at the University of Manchester. The use of PBL has continued into the clinical clerkships. Year 3 of the curriculum is based entirely in a clinical environment with PBL groups meeting in three teaching hospitals. During this year, all students undertake two integrated 14-week modules with overarching themes. Each week, groups of eight students discuss a trigger problem connected to the relevant theme. The steps the groups use in the PBL process have been amended to encourage students to link their discussion with clinical experience.

Evaluation

At the end of each module, all 309 students were requested to complete an evaluation questionnaire. The response rates were 80% (n=247) and 89% (n=275) for the two core modules.

Results

The students have remained ‘happy with the way the course is going’ (83% at the end of module 2). They were also asked to rate a number of statements on a 5-point Likert scale (5=strongly agree). Concerning PBL, the students remained confident about working in a group (median 4), producing a set of learning objectives (median 4) and linking clinical experience with other knowledge (median 4). However, there were changes over the year. Fewer students agreed at the end of module 2 that ‘the working problems were stimulating’ (P=0·002) or ‘motivated them to learn’ (P < 0·001), but the clinical firms were seen as providing more appropriate experience (P=0·01) and being aware of the new curriculum and responding to it (P=0·018). We also surveyed the PBL tutors and had 65 returns from 78 people involved in the 38 PBL groups in year 3. The great majority of these are doctors employed by the National Health service. Virtually all the responders were happy to continue being a tutor (97%) and would recommend it to a colleague (93%).

Conclusions

The evaluation has been positive with PBL having been successfully implemented in a clinical environment. We have identified significant changes over the year, which we need to address as we consolidate the curriculum.

Birmingham

University guide 2011: Dentistry

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1 Birmingham 100 96 97 86 8.6 5 468 6 100

First and second years

The pre-clinical programme in your first and second years is modular in form and based on the interdisciplinary study of the different systems of the human body. Subjects include: anatomy, physiology, biochemistry, oral biology and pharmacology. The emphasis is on small group teaching and self-learning.

There are modules on Biological Sciences and on the Principles of Learning. You also take modules on Clinical Dentistry and Behavioural Science in preparation for your first contact with patients, which take place early in the third year.

The last term of the second year is spent, largely, developing the practical and academic skills related to treating your first patients. This involves working on manikins in the Phantom Head laboratory and preparing teeth for filling with restorative materials. Students also work with and on their peers within the year, to practise taking their medical histories, examining their teeth and gums and learning about giving local anaesthesia. This practical work is supported by the academic study of radiography, oral pathology, restorative dentistry and prosthodontics.

Third, fourth and fifth years

You begin treating, under supervision, your own patients in the first term of your third year. Your clinical teaching at the Birmingham Dental Hospital also gives you a chance to gain extensive and varied real-world experience.

The clinical programme covers specialist subjects such as paediatric dentistry, restorative dentistry, dental prosthetics, and oral medicine and surgery. You also extend your practical experience with the clinical practice programme. Here, you take responsibility for your own patients’ treatment by running what amounts to your own mini-practice within the Dental Hospital. In this way you learn to apply specialist teaching within the framework of whole-patient care and teamwork.

Alongside your clinical work you continue with programmes in oral biology and pathology. As part of your study of medicine and surgery you spend some of your time in residence at a general hospital. You learn about the social and psychological side of patient care while developing your interpersonal and communication skills. You also gain an appreciation of the factors involved in controlling dental disease, together with epidemiology, statistical techniques, and key ethical and medico-legal issues that surround the practice of dentistry.

Our practitioner attachment scheme ensures that you also spend time with general dental

practitioners. Visits to specialist dental units and the community dental service are also organised separately. As you near the end of your clinical course you have time to pursue your own elective programme of study – a topic of personal interest, which you research on your own. This may provide an opportunity for you to study for a while abroad.

Your final year of study consists of a common core of academic work and clinical dental practice. You may also select a special study module for in-depth work.

Teaching and assessment

Teaching is delivered mostly in small groups throughout the programme. Specialist groups may be as few as four to 12 students, while clinical practice is usually in groups of around 20. Tutorial staff gives you immediate feedback on your clinical work and we discuss and mark your treatments on the spot.

You also have written examinations and tests, along with continuous assessment. Our aim is to enable you to monitor your progress at all times. You have a personal tutor to provide academic guidance and support, and a welfare tutor to support your personal needs at every stage in your university career.

Research:

Biomaterials – particularly, mechanistic research on adhesive, ceramic and tissue engineering scaffold materials and their performance

Primary Dental Care – including innovative introduction of practice-based research networks facilitating translational research within the primary care setting (now adopted in a $70 Million initiative by NIH in the US)

Tissue Injury & Repair – including novel stem cell and signalling solutions to dentine-pulp regeneration and development of new diagnostic and therapeutic strategies for periodontal diseases, based upon improved understanding of their patho-biology.

Our pioneering research on dental regeneration has two central themes – the stem / progenitor cells involved in the regenerative events and the matrix-mediated cellular signalling processes. Selection and isolation of stem cells with dentinogenic potentiality (Smith, Cooper) now provides us with a valuable approach to clinical translation of this research for new regenerative therapies, which will be further facilitated through our development of a novel growth factor-hydrogel capable of inducing de novo dentinogenesis (Smith).

The mechanistic basis for use of calcium hydroxide in pulp capping regenerative therapies has long been unclear, but our pivotal demonstration of solubilisation of matrix-bound growth factors and modulation of pulp gene expression by calcium hydroxide now provides clarification of this (Smith, Cooper).

Largest dental society in the UK; Annual Ball; sports day events; Staff-student football match; music societies; talent shows; random other social events

Muay Thai Boxing; Brumski & Board; Skydiving; Hindu; Break dancing; Rock; Article 19 (Guild Theatre Group); Cricket; Football; Wing Chun