From generalist to specialist - how postgraduate education is transforming modern dentistry
Dentistry, like other areas of healthcare, evolves and specialisms in dentistry – although practised by a minority of the profession – are playing their part in helping to transform and improve patient care.
Such a theory is supported by many experts in dental education and training who, despite holding some concerns about the impact on general dentistry, believe specialisms are helping to boost dental services across the board.
Current levels
The regulator for UK dentistry the General Dental Council (GDC) recognises 13 dental specialties – dental and maxillofacial radiology; dental public health; endodontics; oral and maxillofacial pathology; oral medicine; oral microbiology; oral surgery; orthodontics; paediatric dentistry; periodontology; prosthodontics; restorative dentistry; and special care dentistry. In addition, oral and maxillofacial surgery is a medical specialty in the UK that requires the trainee to have a medical and dental degree before starting specialist training.
Since the regulator introduced official lists of specialisms in 1998, the numbers of dentists who are listed as having them have fluctuated.
According to the GDC’s January 2025 Registration Report1, out of 45,620 dentists in the UK, there were 4,389 dentists listed as having a specialism, which is around 9.6% of all dentists.
The most common specialties are orthodontist (1,381), followed by oral surgery (763) and prosthodontics (445).
However, the trend in recent years has been stable. Figures in the most up to date GDC’s annual Registration Statistical Report 20232, published in May of 2024, showed there were 4,373 dentists on the specialist lists in 2019, 4,404 in 2021 and 4,357 in 2024.
Some dentists can choose to train in an area of special interest which although not on the official GDC specialisms list, is still a qualification that proves they have completed training to provide that care.
In addition, all dentists have to ensure they are developing and maintaining their knowledge with the GDC requirement that they complete 100 hours of continuing professional development (CPD) during a five-year cycle.
Barriers to training
Gaining access to postgraduate dental training is not straightforward and can deter even the most enthusiastic of practitioners.
Entry is becoming increasingly competitive, according to Dominic Hassall, Director of the Dominic Hassall Training Institute.
“There are plenty of dentists who would like to do various forms of [postgraduate] training but it’s the cost and the length of it that it is quite prohibitive,” he explains. “What has disappointed a lot of us over the years is that there hasn't been more of an expansion into different, more flexible routes into specialist training.”
One option that has been considered is for dentists to do a lot of the specialist treatment within their own practices but be supervised remotely.
“That hasn’t been allowed to evolve in the way that a lot of us would have hoped,” he adds. “If people could do that, they would have to get to a certain level of training, such as a Masters level, and then they could do quite a lot of the training under supervision in their own practice.
“That has been bandied around in principle for quite a number of years, but it’s never come to fruition. That could be driven by the Royal Colleges.
“However, it’s important that there is a degree of competition. If you want the better dentist going into speciality training, there has to be an element of competitiveness there.”
Growing appetite
Despite the barriers, the appetite for gaining specialist knowledge and qualifications is growing, says BDJ Editor Philip Preshaw, who has a specialism in periodontology and restorative dentistry.
“The appetite is growing amongst dentists for a number of reasons,” he says. “Traditionally most people who go through dental school graduate with a BDS degree and go into NHS practice.
“The old model was that they might join a practice as an associate and eventually become a practice owner and practice principal, but that landscape has been changing because we have an increasing number of corporate practices.
“A lot of younger dentists these days do not necessarily want to have practice ownership responsibilities – employment, equipment, premises, and HR.
“There is also a shift in people wanting different kinds of careers and a different structure to their career. They might want to work part-time, for example. From a career lifestyle aspect, there is increased interest and demand for specialisation.
“There is also the interest factor. If you become more specialised in your area, it’s interesting to develop new skills and provide specialist interventions and procedures for those patients who need them.”
Market growth
Another indicator that postgraduate education and training for dentists is growing in popularity is the fact that more providers of such education are entering the market.
Alan Goldie, Managing Director and Partner at the VSSAcademy, a provider of continuing dental education, says: “My experience is quite specific to implant dentistry, but we do an MSc course in endodontology. I know there is still a healthy appetite for implant courses and there’s a lot more of them coming online.
“Interest in our courses is very healthy. There are a lot more competitors on the market, and we are having to fight harder to get people to choose this course over another.
“The dental implant market is far from saturated in terms of dentists with special interests so there’s still a massive scope. The penetration into the dental market by implants is still quite small compared to some other countries.
“What I have noticed is that dentists doing this are getting younger and younger. They seem to come out of dental school with a clear idea of what they want to do and to get into implants.
“They need to have a certain experience before they go into any specialism. The difference with dental implants is that it’s not taught at undergraduate, so they have to deliberately go and do it as a postgraduate course.”
Dentists are increasingly keen to gain advanced knowledge or qualifications, he adds, saying: “It’s to have a better business because if they don't know how to place or restore implants, they have to refer patients out and a lot of dentists are loath to let patients go because there's a possibility that they will lose them.
“They are doing that because it’s good for business and career progression. You can see them turning towards private practice.”
Shortages in general dentistry
The growth in dentists’ desire to specialise and boost their knowledge is happening at a time of workforce challenges. Simply put, the UK needs more dentists and better access to dentistry for the whole population.
Office for National Statistics data3 in December showed that 94% of new patients who attempted to secure NHS care were unsuccessful.
Data4 from NHS England published in November of last year showed that as of March 2024, more than a fifth of positions (21%) for NHS general dentists were unfilled, with these vacancies amounting to nearly half a million days (495,774) of lost NHS activity.
Preshaw, who is also Dean of Dentistry at the University of Dundee, says: “We have a shortage of dentists in the country. Under NHS England’s workforce plan, they are aiming to increase the number of dentist, dental hygienist and dental therapist training places which is good, but we don’t have the detail yet on how that will be done.”
Consequently, as dentists seek to gain advanced knowledge or qualifications, this may have an impact on general dentistry, he warns, saying: “If there are too many people specialising rather than doing general dentistry, then we can lose that generalist provision which is so important as well.”
Hassall adds: “There is always a danger that because everybody wants to do these specialties, that general dentistry can be neglected in the fact that there aren’t that many dentists doing just general private dentistry.
“But I haven’t really seen that to be the case because most people tend to do generalism, but then with a particular lean to implants or cosmetic or short-term ortho.”
Better care
As interest in providing advanced care appears to be rising overall, this has many advantages for patient care and is changing dentistry for the better.
So argues Goldie, saying: “I’d say that it is making dentists more able, more knowledgeable, and it’s keeping their CPD up to a higher level. It’s offering more treatment options for patients. It’s a good thing.
“The downside would be that some people might just be doing it for the wrong reasons, but the more dentists are able to do or learn safely, the better for us as patients. It also means opening up more treatment options for patients.”
Hassall adds: “It won’t do any harm because it’s all about raising standards and for me as a restorative specialist, that training definitely takes you to a higher level. Anything that is looking at improving standards has got to be a great idea and that is improving patient care.”
From his work as Senior Clinical Lecturer in implantology at University of Cardiff, Hassall has seen a desire for dentists to grow their knowledge in many ways.
“There is an appetite for people to branch into more specialist areas of dentistry but without doing a full formal specialist training,” he says. “There is this big demand for dentists to do things like short term ortho, implants and also more cosmetic work.”
Preshaw agrees that growing specialisation can lead to better overall care for patients, saying: “The increasing number of specialists have played a part in transforming dentistry in the UK.
“The level and quality of service is improving. Since the GDC introduced the formal list of specialties nearly 30 years ago, that has led to a massive transformation of dentistry.”
- General Dental Council. Monthly Registration Report (January 2025) www.gdc-uk.org/docs/default-source/registration/registration-reports/registration-report---january-2025.pdf?sfvrsn=32a2c0d_3
- General Dental Council. Registration Statistical Report 2023 (May 2024) www.gdc-uk.org/docs/default-source/registration/registration-reports/registration-statistical-report-2023---final-and-accessible-v2.pdf?sfvrsn=91957fe_3
- Office for National Statistics. Experiences of NHS healthcare services in England: December 2024 https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/bulletins/experiencesofnhshealthcareservicesinengland/december2024
- NHS England. Dental Workforce (November 2024) https://www.england.nhs.uk/statistics/statistical-work-areas/dental-workforce/
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