2015
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4
Let’s Talk About Mouth Cancer
6
A Review of the Young Dentist Conference 2015
8
Stop, look and listen
10
[email protected]
The early years of dentistry
12
www.dentalprotection.org
How to be a stress-free foundation trainee
14
Dental Protection Limited serves and supports the dental members of MPS with access to the full range of benefits
of membership, which are all discretionary, and set out in MPS’s Memorandum and Articles of Association. MPS is
not an insurance company. Dental Protection® is a registered trademark of MPS.
MPS1678 02/15
Dental Protection Limited serves and supports the dental members of MPS with access to the full range of benefi ts of membership, which are all discretionary, and set out in
MPS’s Memorandum and Articles of Association. MPS is not an insurance company. Dental Protection® is a registered trademark of MPS.
Leave your mark on the world during your elective
Dental Protection Limited is registered in England (No. 2374160) and is a wholly owned subsidiary of The Medical
Protection Society Limited (MPS) which is registered in England (No.36142). Both companies use Dental Protection
as a trading name and have their registered office at 33 Cavendish Square, London W1G 0PS.
0800 561 1010 | dentalprotection.org | theyoungdentist.com
Dental Protection Limited is registered in England (No. 2374160) and is a wholly owned subsidiary of The Medical Protection Society Limited (MPS) which is registered in
England (No.36142). Both companies use Dental Protection as a trading name and have their registered office at 33 Cavendish Square, London W1G 0PS.
Contents
Cover and contents photos © MPS/Paul Cliff 2015.
1781:04/15
3
Hannah Darby studied at
Leave your mark
on the world during
your elective
the University of Sheffield
and graduated in 2014. She
is currently halfway through
her first year of foundation
training in London on the
South East scheme
Hannah has written this article to share her
elective experience and inspire other young
dentists to embark on a journey of a lifetime.
I
took my dental elective in Arusha, Eastern
Africa; the home to almost 1.3 million
people, Mount Kilimanjaro and the world’s
greatest safari park. This article outlines the journey
my friends and I went on and four reasons why other
young dentists should follow our footsteps and create
memories to hold with them for the rest of their lives.
It was a hot, dry day in Eastern Africa: roads were busy
with dala dalas, salesmen were bartering with each
other for the lowest prices of goods, young men were
gathering to show off their breakdancing skills, and
mothers were admiringly seen carrying their weekly
shopping in banana baskets on their heads. A group of
medical volunteers and I jumped into the nearest dala
dala and headed off for our standard day of working in
one of Tanzania’s busiest hospitals, Mt Meru Regional
Hospital.
We were able to do our dental elective in Arusha,
Tanzania thanks to ‘Work the World’, who have been
arranging elective programmes since 2005. They
provide accommodation, food, safety, lessons in the
local language and fantastic day/weekend trips,
meaning that you can tailor your experience to gain
what you want out of your trip. As well as all of these
benefits you are able to stay in a house full of other
healthcare volunteers from all different areas of the
world.
Clinical experience
The World Health Organisation has suggested that the
dentist to population ratio should be a minimum of one
dentist to 7,500 patients. However, in Tanzania the ratio
is one dentist to 120,000 patients meaning the dentists
see large amounts of patients and large parts of the
population are not seen. In Tanzania, not only are caries
rates high but there is also a large amount of fluorosis,
perio and trauma, meaning dentists are in high demand.
4
The dental wing of Mt. Meru Hospital was run-down
to say the least, with limited equipment, materials
and staff. The patients queued outside patiently, men
holding their jaws in agony, women with facial swellings
nurturing their babies and sick children, waiting silently
for treatment. The dentist in charge was named Beatus;
he was a lovely man, very welcoming, professional and
caring. Beatus had trained for five years in Dar es Salaam
and his daily work consisted of several extractions,
root fillings or surgical procedures, all of which we were
there to help with. We were handed aprons, masks,
glasses and gloves and told to take a chair and see the
emergency patients one by one. The clinical experience
was phenomenal; I would never have thought so many
extractions could have been done in one day, both
simple and difficult. My confidence rose continuously
and I began to feel excited about extractions rather
than worry like I had done at dental school. Men, women
and children all came with different problems for us to
deal with (with the occasional assistance from Beatus,
of course).
Experience a different culture
Following our time in Arusha we travelled to the Masai
village of Engaruka. This unique opportunity to spend a
week within the heart of a tribe, living with a local family
and sharing their traditions and ways of life was one like
no other. Here, as similar to the other villages, there was
just one doctor and unfortunately no dentist or dental
facilities. This meant that any dental treatment had to
be carried out in Arusha – a six-hour coach ride away.
We spent our days diagnosing dental problems, giving
oral hygiene information and recommending treatment
options. We spent our evenings drinking Konyagi (the
local spirit) with the warriors and making bracelets and
dancing with the mamas. It seems so surreal to think
about it, as the way this community live their lives and
the beliefs and traditions they hold could not be more
different from here in the UK.
Make a difference
The highlight of the whole trip (apart from the safari experience
– a must for the to-do list) was the visit to a local school within
the Masai village. The children there, as well as the rest of the
tribe, had never received oral health education, with some
children stating that they had only ever cleaned their teeth with
leaves. This had resulted in a caries/perio endemic and the lack of
dentists and knowledge meant that this could not be prevented or
treated. We took along a doctor to translate into Swahili and gave
thorough oral hygiene information to the children. Toothbrushes
and toothpaste were distributed and after giving a demonstration
on the bass technique for brushing, the children were led outside
where they all practiced to perfection. The children were so
pleased with their new brushes and newfound knowledge that
they can hopefully pass on to their families and friends so that
the whole community can benefit. The feeling of humbleness and
reward was overwhelming.
See the world
I would urge anyone to take the opportunity whenever possible to
travel to Africa and volunteer, even if just for a short period of time.
If, as a student, you get the chance to go on an elective I would
strongly recommend this part of the world – not only is it beautiful
with some outstanding scenery and natural wildlife, but I have
never and will never meet a more welcoming, happy and grateful
community. The experiences mentioned were a select few from
a long list, other highlights included trips to local orphanages, a
weekend on the paradise island of Zanzibar and a jeep ride around
the Serengeti and Ngorongoro Crater spotting the 'big five' and
several other of the world’s animals in their natural habitats.
Dental Protection provides
you with the opportunity to
take your membership overseas.
5
Let’s Talk About
Mouth Cancer
Empowerment
Journey
Ewan MacKessackLeitch is a CT2 in
Paediatrics at Dundee
Dental Hospital
ttracted to the
marquee by one
of the volunteers,
the participant enters and
can follow the footsteps
to find out about mouth
cancer, their risk and how
to look for it. On arrival
they would be asked to
complete the baseline
knowledge questionnaire.
From this they moved to
the Info Zone where the
models and information
leaflets were on display.
Any questions about
risk factors or local
dental services could be
answered. The iPads had
videos and slide shows
detailing the risk factors and
signs and symptoms of mouth
cancer to look for. Finally
they could practice an oral
self-examination guided by
a volunteer. The thorough
logical self-exam process
followed the five steps in
the poster. Now armed with
this knowledge, a campaign
leaflet with the selfexam steps and further
information and online
resources was given.
Every journey starts with
the first step and following
these red footprints they
will be empowered to
check for mouth cancer in
their own mouth and know
when to seek a professional
consultation.
A
Ewan tells the story of the first year of Let’s Talk About Mouth Cancer – a campaign in
Edinburgh set up by young dentists to improve public awareness of mouth cancer and
empower people to seek early referral should a suspicious lesion be noted.
L
ike many good stories, this
starts when a boy met a
girl and something sparked.
However, it was not romance that
burned but rather the flame of an idea.
Niall McGoldrick and Orna Ni Choileain
were LDFTs working in Edinburgh when
the idea took hold. Armed with this
and encouraged by their tutor, Jennifer
Harding-Edgar, they approached me
when I was working as an SHO in the
Edinburgh Dental Institute. I took the
idea to Stephanie Sammut, an StR,
and Professor Victor Lopes of the Oral
Surgery Department.
The idea, fuelled by their undergraduate
experiences of a mouth cancer
screening programme in Cork Dental
School and student-run Mouth Cancer
Awareness Weeks in Dundee Dental
School, was to create an Edinburghbased campaign to raise awareness of
the increasing rates of mouth cancer.
The campaign group, ‘Let’s Talk About
Mouth Cancer’, was born.
Once together, the group dreamed a
little bigger and decided that rather
than just raising awareness of this
nasty cancer, they should be more
proactive and directly involve the public.
Furthermore, educating the dental and
other healthcare professionals would
be essential to help reach the aim of
improving mouth cancer prognosis by
early detection.
The first event was held from 11-13
February 2014, in a marquee in Bristo
Square at the heart of the University
of Edinburgh campus. This three-day
mouth cancer screening and public
awareness campaign was supported
by NHS Lothian, the Minority Ethnic
Health Inclusion Service (MEHIS),
the University of Edinburgh and the
Department of Oral Surgery from the
Edinburgh Dental Institute. More than
6
600 members of the public engaged
directly with the campaign and in total
455 people were screened – a rate of
one person screened every one minute
20 seconds. In the evenings, free CPD
lectures emphasising the importance
of prevention and early detection
of mouth cancer were delivered to
105 local dental professionals by
Professor Victor Lopes, Consultant
Oral and Maxillofacial Surgeon. The
campaign was hugely successful and
was featured on the STV 6pm News,
BBC Radio Scotland and in articles in
the Scotsman, Herald, Courier and BBC
News website.
Following this success a further two
events were held in 2014. The first,
a smaller mouth cancer screening
and awareness stall at the Edinburgh
Canal Festival, where 117 people
were screened in an afternoon – all in
the back of a gazebo! Then a 24-hour
screening and awareness marquee on
the Meadows on the weekend 9-10
August during the Edinburgh Festival,
which was coupled with a simultaneous
24-hour fundraising tandem bicycle
ride. This time 155 people were
screened and the sun shone for most of
the day.
The events of the first year were only
possible thanks to the support of the
Ben Walton Trust (SC024990), Dental
Protection and other dental sector
sponsors who helped to fund the
costs; and the contribution of many
volunteers from the EDI including
the undergraduate hygiene/therapy
students.
These campaigns won Orna and Niall
the NHS Lothian Celebrating Success
Awards Voluntary Service Award
2014, but this was only the beginning.
In September 2014 the group gained
charitable status (SC045100) and
planned the next moves to further their
now official aims:
• to improve the prognosis of a patient
diagnosed with mouth cancer
through early detection
• to support research into improving
diagnostic tools
• to raise awareness of mouth cancer
amongst the general public
• to share knowledge and good
practice amongst healthcare
professionals.
The screening performed was not just
a clinical check but was used as an
educational intervention to teach the
participant signs, symptoms and risk
factors for mouth cancer. To evolve this
and try to make it more sustainable,
the charity’s focus changed. Oral
self-examination for mouth cancer is
now taught, in order to remove the
paternalistic element and to empower
the public instead.
Utilising more technology this year,
on 10-12 March the Let’s Talk About
Mouth Cancer marquee returned
to Bristo Square. The layout was
different; no “clinical” areas, instead
three zones that mapped the patient’s
empowerment journey. On entering
the marquee, a short survey to assess
knowledge of mouth cancer was
completed, then in the Info Zone there
were models, leaflets and interactive
iPad demonstrations of the risk factors,
signs and symptoms and facts about
mouth cancer. The final part of the
journey was a guide through an oral
self-examination at the specially
constructed Mirror Zone.
The survey was completed by 304
people and these, plus a good number
of others, took part either in selfexamination demonstrations or came
to find out more about mouth cancer.
Follow-up questionnaires will be sent to those who took
part to see if this intervention has heightened awareness of
mouth cancer and if they have subsequently self-examined.
On two evenings a free CPD lecture “Empowerment
in Mouth Cancer: Your Patient, from Diagnosis to
Rehabilitation” was delivered to 114 dental and healthcare
professionals. This session was delivered by four speakers
who each had a different perspective of the mouth cancer
treatment journey: an oral and maxillofacial consultant, a
mouth cancer patient, a head and neck cancer nurse and
a restorative dentist. The feedback was very positive from
those who attended, especially the interview of the patient.
The March event cost more than £3,500 and was only
possible thanks to support from dental sector sponsors,
donations and a £2,500 bursary won by Orna and Niall
from the Association of Dental Groups' award for the “best
voluntary scheme to promote and deliver improvements
in oral health 2015”. Again, volunteers from the School of
Hygiene and Therapy and dental CTs were essential to the
success.
Between events, Let’s Talk About Mouth Cancer continue
to raise the profile of mouth cancer and its early detection
online. A dedicated website, Facebook page, Twitter feed
and YouTube channel provide information and references
for the public and health professionals. Recently, videos
demonstrating how to perform professional head and neck
and oral self-examinations have been released. In four
months the videos have been viewed more than 5,000
times.
Looking to the future, the charity is an intellectual partner
for the Global Oral Cancer Forum and hopes to spread
the idea of teaching self-examination and learn from
other groups around the world. More public awareness
events and CPD lectures are planned as is research into
the efficacy of these. If you would like to find out more or
get involved visit the Facebook page or website: www.
letstalkaboutmouthcancer.co.uk/
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The story doesn’t end here, this is only the beginning.
Hopefully the charity will continue to grow, the profession
and public will talk more about mouth cancer, and detection
and prognosis will improve.
Let’s Talk About Mouth Caner is a Scottish Charitable
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Find out more about mouth cancer
with our risk management module 24
7
Natalie Bradley qualified in June
2014 from Newcastle dental school.
Here she provides a summary of
the talks given at the Young Dentist
Conference on 14 February 2015
A Review of the
Young Dentist
Conference 2015
T
he Young Dentist Conference is a really
informative day with lectures that were
highly topical for young dentists like me.
This year’s Conference was held on Valentine’s
Day. There was a great turnout despite this, and
missing out on any festivities was well worth it,
with talks from some big names in dentistry. In
addition, there were a number of stands were set
up during the breaks from the Armed Forces, My
Dentist and the Dental Property Club, to name a
few, which provided a great opportunity to meet
and network with fellow dentists.
Here is a brief summary of each of the talks that
were held on the day:
Are you referring to me? Endodontics
with Dr Simon Stone
Root canal treatment often strikes fear into the
heart of young dentists and recognising which
cases are suitable for us to treat is a skill, which
we all need to know, so that patients are able to
have realistic expectations in terms of whether
their tooth can be saved or not.
The predictability of root canal treatment is
determined by the pre-treatment assessment,
the preparation, irrigation, disinfection,
instrumentation and sealing of the pulp space
and the coronal restoration. Difficulties young
dentists may face include, deciding whether
the tooth is restorable and managing patient’s
expectations.
Beware if a patient presents with an odd history
e.g. changing nature of pain, abnormal radiation.
In these cases you should consider other possible
diagnoses such as TMD, phantom tooth pain,
trigeminal neuralgia and cracked tooth syndrome.
When should I refer?
Sometimes, things do go wrong. If you have
trouble providing effective treatment, or even
if you'd like a second opinion then referral is a
sensible option.
8
Are you referring to me? Oral
Surgery with Julie Cross
Like endodontics, oral surgery can be a
source of anxiety for young dentists. It
can be difficult to assess what treatments
you are competent to perform in practice,
and those which should be referred to
secondary care.
• Patients with a medical risk for
XLA e.g. bisphosphonates, post
radiotherapy
• Anterior/premolar teeth are
prioritised (often 7s are not
accepted)
• Important teeth with strong long
term prognosis (>2mm ferrule,
prognosis of endodontics better
than prosthetic replacement)
• Trauma and its sequelae
including root resorption
• Atypical pain
• Suspicious pathology
• Surgical endodontics
The NHS/Private Interface
with Raj Rattan
Raj addressed that question
that many dentists in the UK
have difficulty answering: “What
treatment should be provided on the
NHS?”
The answer is that all treatments
that are proper and necessary to
secure and maintain oral health
should be provided under the NHS.
Most NHS dentists will hold General
Dental Service contracts, but
additional services can be provided
if the dentist has been contracted to
carry them out. These include dental
public health, sedation, domiciliary
and orthodontic services as well as
advanced mandatory services.
Simple extractions such as periodontally
involved teeth or orthodontic extractions
shouldn’t be a problem for general
practitioners; however, teeth which are
heavily broken down with deep caries,
bulbous or divergent roots which have been
endodontically treated may prove more
difficult.
So when should I refer?
What are Advanced Mandatory
services?
A service which provides a high
level of expertise and facilities,
where general practitioners can
refer their patients for specialist
periodontal or endodontic
treatments.
There are several guidelines
available that assess the
complexity of the treatment
required for a patient, which can
be used to determine whether
a referral to an advanced
mandatory service is indicated.
The most common treatments
that are ‘pushed privately’ by
dentists who violate the terms
of their NHS contract and do
not follow the GDC Standards
of Care include cobalt chrome
dentures, periodontal treatment
and referrals to hygienists,
bridgework and endodontics.
Where most likely, a surgical approach is
required and you do not feel confident doing
this.
Ultimately, you shouldn’t take on
treatments that you don’t feel confident
with! Always refer for a second opinion if
you are unsure as complications with oral
surgery can be serious.
How to survive as a young dentist
with Reena Wadia
What environment are young dentists
graduating into?
After five years of hard studying and
training, newly qualified dentists are spat
back out into the real world where there are
uncertain job prospects, increased litigation
and less NHS funding.
On top of this, we are now graduating with
much less experience than our more senior
counterparts - I could count the number
of root canals I did in dental school on one
hand. With so much competition how are
we supposed to get good jobs?
How to respond to a complaint effectively
1.Be confident
1. Acknowledge the complaint
2. Express meaningful regret
3.Tell the patient that you are sorry - this is
not an admission of fault
4. Discuss possible solutions
5. Do not abandon the patient
3.Invest in Loupes with illumination
4.Save up for a camera
1. Fractured teeth
2. Soft tissue damage
3.Root in the antrum/oroantral
communication
4.Haemorrhage
5. Fractured tuberosity
what you post online on social media - closed
groups and forums are not as safe as you may
think.
Reena’s Top Tips
2.Maintain your record
keeping skills and be a good
communicator
Common pitfalls in oral surgery in practice
So what sorts of things
are commonly referred?
Remember to always send a good
quality radiograph when referring a
case - either an original film, a copy
printed on photography paper, or a
CD ROM copy.
Reena shared her top tips with us to thrive
as young dentists.
7.Get published
The important message wasn’t to scare us
off practising dentistry, but to prepare us for
when things go wrong and how to explain
risks and adverse situations to patients.
8.Enjoy yourself!
Summary
5.Secure the job you want
6.Network and find a mentor
The thing that gets you out of bed in the
morning should be something you enjoy
doing. Yes, we have our ups and downs, but
if your career in dentistry is going to last
thirty or forty years, you must enjoy what
you’re doing.
Patients will notice it too. Dentistry
may seem a bit doomy and gloomy at
the moment but there are so many
opportunities out there for young dentists
with some exciting developments coming
up in the next few years.
Overall the day was a good combination of
the topical issues in dentistry for the younger
generation of professionals. Sometimes it
can be hard to find positivity in our profession
especially since the ARF hike earlier on this
year, but there’s still plenty of opportunities
out there – particularly for newly qualified
dentists. I can’t wait to see what next year’s
conference has to offer!
Do you see what I see? with
James Foster
There are lots of challenges for dentists
in today’s environment, not just dentolegal challenges of course. Some of these
challenges include:
•
•
•
•
•
Complaints
Negligence claims
Regulatory investigations (GDC, CQC)
Disciplinary procedures
Criminal investigations e.g. fraud
In a dentist’s career, there are around
250,000 interactions with patients (on
average). During your career, you will have
around 1-2 GDC cases, and 3-4 negligence
claims.
Therefore, to reduce your risk of a complaint
you must learn how to communicate
effectively with patients. Also be aware of
Keep an eye out for the
Young Dentist conference
2016 dates. You can find more of our
events on www.youngdentist.com
9
Kevin Lewis ran his
Why effective listening is the clinician’s most precious asset
C
ommunication skills don’t just involve choosing
the right words to say, and saying them in
the right order, and in the right way. Equally
important are:
•
•
•
•
The ability to listen effectively, without interrupting
The ability to control our ‘body language’
Being able to interpret the ‘body language’ of others.
Making sure that both parties properly understand
what is being said
• Trying to form an understanding of the underlying
feelings of the other person.
We all enjoy talking to people we like and get on well
with; but in the surgery this can create problems, as it is
easy to allow these conversations to take us away from
other patients and other important work that needs to
be done.
those of the other person. Eye levels
are affected by whether the people
are sitting or standing or by relative
heights, if both are standing. The
person whose eye level is highest is
placed in a more dominant/controlling
position, and this disparity can
adversely affect the ability of one
party to listen effectively to the other.
Body language tips for
effective listening
Face
1Maintain as much direct eye
contact as possible. Don’t look
around the room, at the floor or at
other people.
2Make a conscious effort to avoid
blank expressions and distant
stares.
3Look interested. Use appropriate
facial expressions and be aware
of what your face is saying – is
it smiling? revealing anger or
irritation? conveying concern?
expressing regret? suggesting
empathy and/or support? looking
bored and disinterested?
4Nod your head to indicate interest
and understanding, without the
need to interrupt.
5Sit/stand upright, but lean slightly
towards the speaker where this
is possible without invading the
personal space of the speaker.
6Avoid distracting hand/foot
mannerisms (eg. tapping your foot,
fidgeting with documents, pens
and similar items).
7Use ‘open’ gestures and avoid overt
‘closed’ gestures like crossing your
arms high on your body – which
most people would interpret as a
‘defensive’ or ‘resistant’ gesture.
8Avoid extreme movements/
posture – like leaning back and
crossing your legs, or clasping your
hands behind your head.
Because the face is the most obvious and visible part of
the body, your smile and facial expressions are critical.
They must all be sending out the same message. Eye
levels are particularly important as it is much easier to
communicate when your eyes are at the same level as
When meeting someone for the first
time, it is important to ‘read’ their
body language in order to ensure that
what you are saying and doing, and
your own body language, is creating
A similar situation arises with people who, it appears,
could talk for ever. Their most important message
can easily get lost within masses of unnecessary
detail, or simply because it is difficult to maintain
your concentration within such a torrent of words.
Some people just never stop talking and rather than
interrupting them, ignoring them or stopping them in a
rude or abrupt way, the challenge is to steer them very
gently so that they are talking about what you want
them to talk about.
When listening to someone, our own body language
can be very revealing. Similarly we can also learn a lot
by observing the body language of the people that
we are speaking to. Examples of non-verbal signals of
particular relevance in this context are;
Appearance
The way we feel like is influenced by our physical size,
the clothes we wear (uniform), our hair, makeup etc.
In a professional healthcare environment, appearance
is important whether one is working in a surgery, or
in a reception role, although different considerations
apply. Here again, it can have a major influence on the
attitudes and behaviour of both patients and team
members, and the interactions between them.
10
own general practice
before being appointed
Dental Director of
Dental Protection
in 1998. He lectures
internationally and
writes regularly in the
UK Dental Press
the right impression for them. They
will be forming impressions about you
from the second you meet.
Be a good listener
Effective listening is a skill which
can be learned. Many people have
a tendency to ‘half listen’, their
attention drifting in and out of a
conversation. A person’s willingness
and ability to listen will be a reflection
partly of their underlying personality,
partly of the subject matter and
the other demands on the person
at that time, and partly of their
communication skills.
Good listening styles
1Suspend judgment – at least
initially.
2React to the words, not to the
person. Don’t dismiss a message
too readily, simply because of your
perception of the person who is
conveying it.
3Remind yourself why you need to
listen.
4Forgive and ignore delivery faults
and irritating mannerisms.
5Be flexible and look for strengths
and key points/themes in what is
being said.
6Stay cool - don’t be too quick to
interrupt.
Overcoming listening barriers
1Understand your own
communication style and habits.
2Select an environment in which
it is easy to listen and use it to
maximum advantage.
3Establish a suitable physical
separation and appropriate eye
levels.
4Remove or resist distractions
(background noise and the
proximity of other people can
seriously impede the ability to
listen).
5Avoid jargon (people often stop
listening when they become
© Ninell_Art/iStock/thinkstockphotos.co.uk
Stop, look
and listen
confused or can’t understand what is
being said to them).
6 Seek common ground.
7Actively reduce stress - this will improve
communication. Patients do not listen
well when they are anxious or frightened,
or when they are annoyed or angry.
How to listen well
1Be warm, approachable and friendly
wherever possible.
2Use overt physical signals that you are
listening (nodding, eye contact etc).
3Concentrate – however busy you are.
Elicit the meaning of what is being said.
4Look for, and read the nonverbal signals
of others.
5Note mixed messages and wait until the
message becomes clearer.
6Fill in blanks mentally, but don’t feel the
need to do so verbally.
7Take notes and recall key words. These
notes would be written in the case of a
phone conversation but mental in any
other instance.
Effective listening takes less time than
ineffective listening; don’t make the
mistake of thinking that you haven’t got
time to listen; if you ‘disengage’ from a
conversation it will often take longer than if
you had remained actively involved in it.
Studies have demonstrated differences
in the communication styles of men and
women. Women tend to use more ‘hint’
language whereas men tend to be more
direct/blunt and less subtle. There are
variations in language (meta-language)
that occur in male-male conversations, and
female-female conversations. Men tend
to interrupt earlier in a conversation, and
also to interrupt more frequently once a
conversation is under way.
There are also some potentially confusing
differences when words and phrases are
used by people for whom English is not
their first language. A skilled communicator
needs to understand all of these individual
variations, and take them into account.
Active listening
This is a specific, structured way of listening
and responding to others, where the
listener’s attention is focused heavily on
the speaker. The benefits of this approach
are not simply that more of the message is
reaching the listener; equally important is
the fact that the speaker can see that the
other person is really listening, and is actively
engaged in the conversation. It therefore
has a particular importance in consultations
between patients and clinicians.
If a clinician can convey to a
patient that they are not only
hearing and understanding
the words that the patient
is speaking, but also
understanding the patient’s
feelings, the quality of the
interaction is significantly
enhanced. Reflective listening
has been described by Carl
Rogers and others as a
particular technique of active
listening, widely used in
psychotherapy. The starting
premise is that at the start
of any consultation, only the
patient really knows what/how
they are feeling.
If the clinician jumps to
conclusions and reaches a
diagnosis on the basis of the
first piece of information
they hear, the patient may
well be denied the chance to
provide other, highly valuable
information and perspectives.
As a result there is a danger
that only part of the patient’s
problem will be treated, or
worse still, the real problem(s)
may be missed entirely.
Using the reflective listening
technique, the clinician asks
questions which reflect what
the patient has said, and
seeks confirmation from the
patient that s/he has correctly
understood the patient’s
underlying feelings.
Summary
The ability to listen effectively
is one of the most powerful
ways to build and strengthen
the rapport we have with
our patients. Many studies
have shown that this ranks
very high on the list of what
patients want most from
healthcare professionals. It
can help to maximise patient
satisfaction and strengthen the
patient:clinician relationships,
improve treatment outcomes,
reduce the frequency of claims
and complaints, and assist
dental team members in
resolving dissatisfaction and
complaints quickly and easily
when they do.
Here are some specific techniques used in active listening;
1. Silence
A powerful tool - it can show interest by
encouraging the patient to speak, and letting
them know that you are ready to listen. Used
incorrectly or excessively, it can show disinterest
or withdrawal, but it is possible to use ‘active
listening’ techniques (such as nodding, raising
eyebrows to demonstrate attentiveness etc) to
actively participate in a conversation without
actually saying anything at all.
2. Summation
By pausing to review the information given by the
patient you can let the patient see that:
a) you have been listening
b) you are keen to interpret
their information correctly. Summation allows
the patient to reject this emphasis if it has been
incorrectly assumed.
‘Am I right in understanding that you would prefer
not to go ahead with having the tooth crowned right
now?’
‘What I think I am hearing from you is that you are
more concerned about the shape of the tooth than
the actual colour of it. Is that correct?’
3. Facilitations
A facilitation (eg. ‘In what way?’) is a verbal or nonverbal response that encourages the patient to say
more, without specifying the area or topic to be
discussed. A variation on this is to ask the speaker
something like ‘could you give me an example of
that?’. This lets the speaker know that you are
interested, and that you are actively involved in and
thinking about what they are saying.
4. Reflection
Responding in a way that repeats, recaps, or
mirrors the general drift of the patient’s previous
remarks. Reflections are best kept short – for
example,
‘I follow you’ or ‘I understand’ or ‘I see what you are
saying’.
Reflection is used to demonstrate empathy
with what the patient is saying without actually
interrupting.
5. Interpretation
Linking statements and drawing conclusions or
ascribing feelings or motives to what has been said,
‘...and this made you wonder whether it wasn’t the
back tooth after all, did it...?’
11
DENTAL PROTECTION MORE THAN DEFENCE
REDUCE
YOUR RISK OF
COMPLAINTS
AND LITIGATION
FREE
WORKSHOPS
TO MEMBERS
Our workshops are expertly
facilitated, using a blend of
presentations, small group
discussions and activities,
case studies, reflective
exercises and opportunities
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THE MASTERING
WORKSHOP SERIES
With the aim of minimising risk and
delivering improved patient care, our
risk management workshops are
focused on advice and practical
tools and tips.
Mastering Your Risk
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All our facilitators are dentists who
have undergone formal training with
Dental Protection. Where possible
and applicable, our workshops
are independently accredited for
continuing professional development.
Mastering Consent and Shared
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• Designed and facilitated by dental
professionals
Where and when?
With workshops being run in
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and Ireland, you can choose a
time and place to suit you
Who's it for?
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CPD points
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Cost
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• Provides three hours of verifiable CPD
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• Locations across the UK and Ireland,
throughout the year
of our attendees would
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Free to Dental Protection members
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FIND OUT MORE
www.dentalprotection.org/workshops
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Dental Protection serves and supports the dental members of MPS with access to the full range of benefits of membership, which are all discretionary, and set out in MPS’s
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13
the University of Birmingham in 2011 and is
currently working part-time at the Leeds Dental
Institute as a specialty dentist in the restorative
department and an associate in a practice
The early
years of
dentistry
James shares his advice
on career decisions
after graduation
The early years
What next?
From the golden gates of dental
school to becoming an independent
clinician can be a daunting transition
for many young dentists. As a recent
graduate I know it can be difficult
to match the expectations of
undergraduate training and what it
means in reality to become a dentist.
Foundation training is positioned
to provide enough support within a
community of other young dentists,
a personal trainer and extended
deanery support.
I stayed another year as a restorative
SHO at the Leeds Dental Institute.
This provided me with experience
within more complex restorative
treatments, IV sedation and
treatment planning on consultation
clinics. In addition, further experience
came from teaching undergraduates
and providing emergency care on
the acute dental care department.
The skills learnt from a hospital
dental post are invaluable whatever
career path you choose. Colleagues
that completed this year went
onto general dental practice roles,
community dentistry or to pursue
orthodontic, restorative and
paediatric specialist training.
My path after dental school began
as a foundation dentist (FD) at a
corporate dental practice within
the Nottingham area. With the
support of two very experienced
trainers I was able to develop the
knowledge and practical skills
learnt from undergraduate training.
To my surprise this was without
any significant influence from the
corporate business, allowing me to
have sufficient appointment times
and equipment, which is how all FD
roles should be. As a group of 12
foundation dentists, we would meet
up around once a week for a deaneryled study day. Whilst this provided
further educational support, more
importantly it provided a chance to
interact with other trainees with a
wide array of experiences from their
practices.
Maxillofacial
Following on from foundation
training I undertook an oral and
maxillofacial surgery SHO post
at the Leeds General Infirmary.
This was mainly driven from my
lack of confidence and experience
with surgical dentistry. Most
young dentists find a maxillofacial
role a challenging but rewarding
change from dentistry. You could
be working in a fairly quiet district
general hospital or a busy city centre
teaching hospital. The latter may
provide a wider range of experiences
including sub-specialist areas
such as cleft lip/palate, complex
trauma, orthognathic, oncology
and paediatric maxillofacial. On the
other hand, these positions may not
provide a great deal of exposure to
hands-on dento-alveolar surgery. If
you consider a maxillofacial year, my
advice would be to choose hospitals
carefully, whilst considering what you
want to achieve during the year.
14
For me, the completion of the
variety of tasks from undergraduate
training developed my enthusiasm
for dentistry. It provided me with the
confidence in a greater skillset, such
as providing independent conscious
sedation. When looking for positions,
a variety of hospital and community
posts catches the attention of
prospective employers from primary
and secondary care. It has given me
the opportunity to progress onto two
part time roles: one within the same
restorative department as a specialty
dentist and another as an associate
general dental practitioner.
Whilst salaried training duties
are a great source of experience, I
encourage young dentists to take GDP
roles before committing to secondary
care. There are important lessons
to learn, including having realistic
approaches to treatment. For example,
a common question may be “Am I
confident to charge ‘x’ amount for that
treatment in my hands?” You can learn
a lot very quickly about your strengths
and weaknesses that may not have
been apparent in previous roles.
I hope this article will encourage
recent graduates to consider gaining
a wide range of experiences early
on in their careers to develop both
as an individual and as a competent
clinician.
We are here to
support you in each
stage of your career
© kapulya/iStock/thinkstockphotos.co.uk
James Chesterman graduated from
How to be a
stress-free
foundation
trainee
Making the switch from dental school to
practice as easy as possible
Graduation is the climax of your university education;
everything leads up to it. You work incredibly hard for
five years, you experience some of the best days (and
nights!) of your life, with friends that you will hopefully
hang on to for a long time. But how on earth do you
keep it together when it’s all over?
My first piece of advice: Don’t be afraid
to be afraid!
Your graduation is just the beginning of your career;
then you have to go out into the world of work and
make a living. It’s a big jump to make so don’t worry
about nerves – totally normal.
Second piece of advice: Don’t be afraid!
Although nerves and fear are perfectly normal, they
are also unnecessary. The foundation training year is
designed to help you get to grips with the big bad world,
and everyone you work with knows how daunting it can
be to be the newbie. They are there to help.
There is no need to be stressed about it. But if you are,
here are some helpful hints to make the transition
easier:
1. Trust yourself
You have studied for five years and passed your final
exams – you know your stuff. Don’t be afraid to make
the call if it’s the right one for your patient.
2. Let your nurse help
The foundation training nurses are angels on earth,
I couldn’t have settled in to my practice without
my fabulous nurse. Most of them have worked with
previous foundation trainees. They know that only
three months ago we took three hours to do a root
canal, they know that last year we had someone
looking over our shoulder, checking everything we did
or what we were about to do, and they know it’s not
easy to not have someone giving you the go ahead
Jennifer McMullan
studied at Dundee University
and graduated in June 2014
Jennifer shares her top
tips on how to overcome
pre-foundation training
position nerves
now. Let them make suggestions, listen to
them and be grateful for their wealth of
knowledge – yes, you are the dentist but
they’ve been in practice a lot longer than
you have.
3. Don’t be afraid to ask for help
You know your stuff, you have a great nurse
but you’re still brand new. If you’re not sure
or you want a second opinion, or you need
someone else to find the elusive second
mesiobuccal canal – just ask. Your trainer is
there for you, your own personal fountain of
knowledge so make sure you use it.
4. Make the most of it
You have worked hard to get here and
the hard work isn’t going to stop, so enjoy
yourself. There will still be stressful days,
anxious patients and over-protective
mums, but there will also be brilliant days
– where you give someone a new smile or
you help someone overcome their disabling
dental phobia. Savour the good days and
don’t dwell on the things that don’t go
exactly according to plan.
For the majority of confident dental
students, this will all be common
knowledge but if someone had warned me
just how scared and nervous I was going to
be, it would have made my summer after
graduation a whole lot less stressful. It is a
huge change going from dental school to
general practice, but you have all the help
you need at your fingertips so don’t let
nerves get the better of you.
We provide a range of
articles to aid you in the
early stages of your career
15
A website
for young
dentists by
young dentists
theyoungdentist.com is one of the many resources
provided by Dental Protection to support you in the
early stages of your career
Dental Protection members receive tailored risk management resources, events and
publications specific to the early stages of their career including the Young Dentist Conference.
Careers | Events | Competitions | Top Tips | Work Abroad | Volunteer
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For more information about the benefits of membership visit www.dentalprotection.org