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Tackling Primary Care From Day One

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Tackling Primary Care From Day One

Priya Mistry is a second year dental student on the four year graduate entry programme at UCLAN School of medicine & dentistry.

She has chosen to write this article to give other prospective dental students an insight of how their programme differs from traditional dental schools with an emphasis on primary care exposure from day one.

 

I knew that my experience at dental school was going to be quite different but nevertheless a unique one in comparison to fellow dental students entering traditional dental schools. I am in my second year (3BDS) on the graduate entry dentistry programme at UCLAN and I must say the experience on this course so far has been fantastic!

After eleven months of intense training in phantom head in year one, a countless number of exams and then onto passing the clinical progression exams meant it was time for me to move on from the dental school and to start practising dentistry in the real world. This might sound a little strange to other dental students but at UCLAN we are split at the end of year one and sent to one of four dental educational centres (which include Accrington, Blackpool, Morecambe and Carlisle) and I am based in Blackpool where I work in primary care dentistry.

I have been on clinics for seven months now and so far the experience has been overwhelming, challenging but extremely exciting at the same time. Blackpool is a very socially deprived area of the North West and with a high caries rate in this area. I am not short of patients. I see patients with complex medical histories from learning disabilities to lifelong medical problems and this collectively is an aspect of special care dentistry which I have been exposed to from day one. It has made me realise that dentistry is not as simple as the textbooks say, you do get patients from all walks of life coming through your doors and I feel I have improved in my confidence and skills in being able to manage these challenging patients from the cases that I have been involved with so far. I attend to patients of all ages from very young children to the frail and elderly patients who require a lot of assistance when coming to the dentist. This has really helped me to strengthen my communication skills when interacting with patients of different ages whilst being professional at all times.

There have been times where I look in the patient's mouth and it's like 'gosh where do I start?' The patients I see are not pre assessed by the tutors which means that I see them first. The reality here is that you do not know what is going to come through the door and I guess this keeps the excitement going! What more, there have been situations where sometimes I do feel like it is beyond my experience and that maybe a final year student would be more appropriate but this is not the case on this course. It is my patient and therefore I am expected to complete the treatment, you are basically thrown in at the deep end here! Unlike traditional dental schools, there are no restorative, endodontic and periodontics clinics of such where you can refer your patients instead I am responsible for undertaking all the necessary treatment and I will see the patient through till the end of the treatment. This is brilliant because I do feel like a real dentist and on the final appointment myself and the patient can compare the before and after photos and it is a great feeling knowing that you did that and a simple thank you from the patient makes all the months of hard work worthwhile.

Failure to attend appointments is a regular occurrence within primary care and in these situations I usually take on a triage patient. A triage patient is an emergency patient who usually is not registered with a dentist or is unable to find/get access to an NHS dentist. These patients usually present with pain, swelling or trauma. Taking on triage patients has defiantly put me on the spot, the key is to keep calm and reassure the patient whilst ensuring that you manage the situation with a patient centred approach not a professional centred approach (i.e. not to extract the tooth in question because it will be the easiest option!).

Moreover, working in primary care has been a real eye opener to see first-hand the pressures faced by NHS dentists. Time is an issue among many dentists with lots of patients to see, it is difficult for a dentist to spend time with their patients and especially when it comes to addressing preventative measures. One of the luxuries of being a student is that my appointments for each patient are an hour and a half, thus I have the time to get to know my patient and focus on preventative approaches. A lot of patients I see have not attended a dentist for a long time, some of them in excess of 30 years due to a previous bad experience and these patients are extremely nervous about coming to a dentist and especially the idea of being seen by a student dentist. It is my job to help them overcome their fears, make them regular attenders and motivate them to prioritise their oral health. It is challenging to get the patients on board but it is not impossible.

Another great aspect of working in primary care is that I have undertaken a wide variety of dental procedures on both adult and child patients in the last 7 months. So far this includes 4 complete denture cases (including immediate & copy technique), currently working on 2 partials denture cases, 25 extractions and a wide range of restorative work and lots of root surface debridement and much more. I would say my favourite clinical experience so far has been a lower clearance of 8 teeth under IV sedation on one of my patients who required an upper complete and a lower complete immediate denture. This particular patient was extremely nervous about needles and after discussion with the patient and the tutors IV sedation was the best option and the patient was really happy with the overall outcome, a new smile. It was a fantastic experience something which I would like to go and do some further qualifications in and it taught me how to manage extremely nervous patients. The opportunity to work in primary care from day one is what makes UCLAN a unique dental school and I know I will be well prepared for DF1.

Seven months in and it has been great so far, clinic experience has been challenging, overwhelming but brilliant at the same time and I look forward to the cases thrown at me in the next two and half years, there is still a lot to learn and I look forward to that as well as starting my secondary care placements. My advice to any young dentist starting clinics is to keep calm, be confident and be in control. Let the patient see that you know what you are doing, this helps them to build their trust in you and most importantly no matter how complicated the procedure gets take your time especially in the early days and don't be afraid to ask for help.

Priya Mistry


 

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