Dental specialties – popularity versus real need
The world of dentistry represents a wide spectrum of oral healthcare and amongst the everyday work of dentists is the need for various specialists to provide care for patients with specific needs.
That care can be facilitated if clinicians have expanded their knowledge and skills in certain areas and completed the likes of MScs or other qualifications.
All dentists have to ensure they are developing and maintaining their knowledge with the General Dental Council’s (GDC) requirement that they complete 100 hours of continuing professional development (CPD) during a five-year cycle.
However, specialisms play their part in making up the full spectrum of dental disciplines and help to boost practitioners’ knowledge and skills.
The 13 dental specialties are dental and maxillofacial radiologogy; dental public health; endodontology; oral and maxillofacial pathology; oral medicine; oral microbiology; oral surgery; orthodontics; paediatric dentistry; periodontology; prosthodontics; restorative dentistry; and special care dentistry.
Information in the GDC’s Registration Statistical Report 20231 published earlier this year, showed that in 2024, the dental register had 4,357 registrants listed as being a specialist – the most common type being orthodontist (1,382), followed by oral surgery (747) and then prosthodontics (446).
Popular choices
Orthodontics is and has been for some time, the most popular choice of specialty, driven by what patients are seeking, according to experts in dental education.
Consultant in Restorative Dentistry and Associate Professor at the College of Medicine and Dentistry (CoMD) in Birmingham, Tim O’Brien, says: “Based upon what I’ve learnt working for CoMD where we currently only provide education for postgraduates, currently the highest number of enquiries are received for the orthodontics and oral surgery courses, but the majority of the courses have many more applicants than places.
“I wonder whether the potential for private work has influenced this. The public is more aware of what orthodontics can do and the service the NHS can provide has contracted over the years, so there seems to be an increased potential for private work.”
Professor Ewen McColl, Head of the Peninsula Dental School (Faculty of Health) at University of Plymouth, adds: “Orthodontics is very popular because although it's covered at undergraduate level, this often piques interest with a lot more to learn clinically beyond undergraduate.
“Maybe students get a taste for it as undergrads and then want to do a bit more so that’s why they decide to go on to do a master’s course. It does seem to be the most popular but most of the specialisms are pretty consistent in numbers as far as our postgraduate courses are concerned. We regularly hold postgraduate open evenings and there will be a good mix of interest across disciplines.”
However, Professor Stephen Porter, Director of UCL Eastman Dental Institute in London, says: “While orthodontics has the largest number of practitioners as specialists in the UK, it is important but it’s not our main programme and indeed we have seen a fall in numbers of UK applicants as there has been a shift in the GDC-approved curriculum such that there has been a lessening of the need, or wish, for Russell group university-driven education with a replacement by the NHS and/or other universities.
“The highest numbers of postgraduates we have are those wishing education allied to aspects of restorative dentistry – for example those undertaking full time programmes in periodontology, prosthodontics or endodontics or those doing our flexible restorative dental practice programme.
“This last programme has proven to be extremely popular as it is undertaken in a part-time manner and is flexible – the postgraduates being able to exit after one. Two or three years with a Certificate, Diploma or Masters. The part-time nature of the programme fits around the busy working lives of the dentists and over the past 20 or so years we have seen that such experience has greatly enhanced the careers of the dentists – by, for example, being able to provide more complex care than they might have ever thought possible.”
Boost to specialty training
There are concerns about difficulties of access for patients to specialist dental service across the country alongside falling numbers of dentists providing specialty services.
In the NHS Long Term Workforce Plan2 published in June 2023, NHS England said: “In 2022-23, NHS England made an investment in postgraduate dental specialty training, focused on areas currently underserved by existing provision, which will improve access to specialist dental services in future. The growth set out in this Plan builds on this investment.”
The possibility of making dentists have to commit to a certain time period of working in specialism that they had trained in and gained accreditation for has been floated.
In the Department of Health & Social Care’s dental recovery plan3 published earlier this year, the then (Conservative) government said it planned to consult on mandating NHS service for dentistry graduates and added: “Subject to consultation, we will consider the impact of these measures and explore whether we need to go further - for example, tie-in periods related to specialty training or a tie-in for other dental professional groups.”
NHS England acknowledged access problems in its evidence4 to the Review Body on Doctors’ and Dentists’ Remuneration submitted in February of this year.
It said: “We are aware that through postgraduate training, the numbers of dentists on speciality lists have fallen, particularly in oral surgery/special care dentistry and additional dental specialties (these include dental and maxillofacial radiology, oral and maxillofacial pathology, and oral medicine), and there are very few paediatric posts in some regions.”
Neglected specialisms?
Perhaps inevitably, some specialties are underserved and need more dentists to become interested in them.
Tim O’Brien, who is also the Convenor of Examinations for the Faculty of Dental Surgery, the Royal College of Surgeons in Edinburgh, says: “From my own experience, recruiting to dental maxillo-facial radiology posts is very challenging and many go unfilled. Roles such as this, and oral medicine are immensely important to the workforce and to patient care, but many of my colleagues complain that they just can’t access clinicians trained in these specialties.
“There appear to be fewer people interested in paediatric dentistry, when compared to the other disciplines, which is a real shame as they are such useful members of the team. The number of people applying for special care dentistry is also relatively low.”
Professor Porter adds: “Paediatric dentistry is an area which will always require to be promoted across the UK and the globe as there is great variation in the oral health of children.
“Paralleling this, there is great variation in the availability of well-trained staff to prevent disease in children and to manage dental carries in children. Towards this end, we have created the flexible learning programme in paediatric dentistry.
“We have created a doctorate in dental surgery in paediatric dentistry, which means that the postgraduates go away with much greater understanding on how to safely and effectively provide preventive care and operative care to children which means that in adulthood, they will not have the levels of oral disease and possible distress that they might otherwise have.”
Private versus NHS dentistry
Concerns have been raised by some that the market offering postgraduate education has changed in recent years to the detriment of NHS dentistry.
In a BDJ article5 published last year, author Kevin Lewis, Special Adviser and Consultant for BDA Indemnity, argues: “The market has become crowded and highly competitive in other, 'hotter' areas, like implant dentistry, aligner/short-term orthodontics, dento-facial aesthetics and cosmetic restorative dentistry, and alongside all this, marketing, merchandising and selling techniques.
“The crisis that has befallen NHS dentistry has created a windfall for those who offer to show ways to escape it, creating markets for learning to do and sell private dentistry.”
Alan Goldie, Managing Director and Partner at the VSSAcademy, a provider of continuing dental education, says: “We’re in one particular part of the market and we're very much focused on implant dentistry. We do MScs and certificate and short courses. We also do endodontology.
“Implant dentistry remains popular. It is not a specialism as such but it’s for dentists with a special interest. It remains popular because is it still a relatively untapped market and it's becoming more popular, and more people know about it is, so it is becoming a bit of a career path for younger dentists.
“Implantology is where we are most established and last year partnered with UCLan (University of Central Lancashire) for the endodontology MSc as well, so we are moving into that. It’s a very busy market.”
Trends
Education leaders are noting some trends in what dentists are seeking from further education such as gaining specialism qualifications early in their career and a desire to develop their skills in place of securing a full Master’s degree.
Alan Goldie says: “What I see different is the age of the people coming along. Ten years ago, you would be looking at an average age of five to 10 years post BDS [Bachelor of Dental Surgery] qualification coming to us but now you are looking at two years as the minimum for people to go on most of the courses and they've got this career plan that includes implants. Dentists are clear about what they want to do sooner.
“The public are now more aware of implants because of TV shows and social media and it has become a solution they aspire to, so dentists can see they can make a good career from that and provide that service rather than referring them to someone else.”
Tim O’Brien says: “There seems to be an increased demand from UK dentists who wish to simply develop their skills in certain areas, rather than go on to obtain a Master’s degree. There is a noticeably increased demand from overseas early career dentists but the demand from UK dentists seems to be more evenly spread across a broader age-range.”
Professor McColl argues that students are the best judge of what they need to broaden their knowledge and how to apply it, as he says: “We encourage undergraduate students to make their own minds up and ask them what they enjoy and what suits them.
“With some of the specialties it's what suits the portfolio career they’re going to have. At University of Plymouth the dental school is based in primary care, so we like the idea of upskilling colleagues to become dentists with special interests.
“We’ve got a good number of former undergraduate who have completed their MSc and now practice as a dentist with a special interest in endodontics, for example. They are not on the specialist list, but they've got an area of their practice they enjoy and provide enhanced care in certain areas which benefits patients. Our area is often described as a dental desert so upskilling local clinicians allows patients access to such care, which may not be otherwise available.”
Future growth areas
Certain specialisms are on an upward trajectory in terms of popularity, suggest the experts, largely down to public demand and what makes business sense for dentists.
Professor Porter explains: “Growth should come from endodontics, prosthodontics, periodontology, special care dentistry and paediatric dentistry because that would reflect the needs of the changing population.
“But for us, growth can only happen provided there is a funding stream for postgraduates. That’s why we have tried to create programmes which are flexible, which not only deal with the working and family life of the postgraduate, but also the availability of finances.”
Tim O’Brien adds: “Within the recognised specialties, I predict that the demand for orthodontics, prosthodontics (particularly where aesthetics and implants are involved), periodontics and endodontics will remain high. This is partly based upon the way in which the UK dental disease burden is changing but also on trends in patients demands.”
Demand for speciality training at all of the institutions that these experts are based in is healthy, but it remains to be seen if all of subject areas will attract sufficient numbers of dentists to develop the necessary skills needed to meet patients’ needs.
