Students by Beth Bradley, DentalTownUK student editor

DentalTownUK student editor Beth Bradley

Earlier in this issue, Dr Kishan Sheth presented interesting evidence and links between the dreaded ‘C word’—cancer—and common dental conditions or treatment.

This has me thinking of the recent Netflix documentary Root Cause, which follows an individual’s experience with chronic, systemic issues that he claims are directly linked to a previous root canal treatment.

My initial thoughts:

• What is the evidence base?
• What about our patients?
• What now?

So, firstly, let’s talk about evidence-based practice (EBP)
EPB requires integration of the best available current, valid and relevant research, along with individual clinical expertise and informed patient choice.¹

Many of the facts presented within the documentary do not uphold these standards. A few examples from the film include:

• “The No. 1 cause of heart attack is a root canal-treated tooth.”
• “97% of patients with breast cancer had a root canal on the same side as the cancer”.

Both seem to be merely ‘scare-mongering’ tactics, because from my own research I cannot find any scientific, strong, supportive evidence.

What about our patients?
Any patient watching this readily available documentary, perhaps sitting with one or more root treated teeth, would no doubt be panicked or frightened by the information presented.

It is important that dental students reassure patients and provide sufficient evidence to support the success of RCTs. Provided a correct diagnosis has been made, a 90–95% prognosis is reported for an initial RCT on a tooth with no periradicular lesion; an 80–85% prognosis is reported for a tooth with an established infection and periradicular lesion; re-treatment of a root treated tooth prognosis falls to 65%.²

What now?
From my undergraduate experience, many patients wish to retain teeth ‘at all costs’. Explaining that RCT may possibly be the best option for this is important, but always case-dependent.

Patients who suggest removing root canal-treated teeth to prevent ‘cancer’ or ‘heart attacks’ should be listened to and their worries discussed accordingly.

At dental school, we are fortunate to be surrounded by clinical tutors and colleagues, which allows the perfect opportunity to ask for their expertise to help manage a difficult communication situation.

So next time you are faced with any difficult or confusing clinical questions from a patient, use it as a learning opportunity, find the best evidence and use that knowledge to inform your future practice.

References

1. The Chartered Society of Physiotherapy. (2019). What is evidence based practice?. [online] Available at: https://www.csp.org.uk/professional-clinical/clinical-evidence/evidence-based-practice/what-it [Accessed 17 Feb. 2019].
2. Carrotte, P. (2004). Endodontics: Part 2 Diagnosis and treatment planning. British Dental Journal, [online] 197(5), pp.231-238. Available at: https://www.nature.com/articles/4811612.pdf [Accessed 17 Feb. 2019].

Experience Gained as a Maxillofacial Dental Core Trainee

by Dr Nicola Parten

‘Do a year in Maxfacs’, they said. ‘It will be good experience’, they said.

And they were right. I am a DCT 2 in maxillofacial surgery at the Royal Victoria Infirmary in Newcastle upon Tyne, and my time in this post has taught me some invaluable skills and experiences.

First up, organisation and time management. These skills are gained without realising it, and are important in all careers and daily life.

Being part of an ever-alternating busy rota, changing shift patterns and managing the many jobs of an on call means that you quickly learn to prioritise. At the start, the experience is overwhelming, but soon the list of initially daunting tasks—assessing the weird and wonderful presentations at A&E, taking bloods, assisting in theatre, clerking patients—is managed efficiently and in half the time once one has learnt to prioritise and organise time appropriately.

In many Maxfacs posts, you are a member of a team of junior colleagues, and effective teamwork and delegation creates a proficient working environment. This is true of any area of dentistry, and demonstration that you are able to work this way will be advantageous for many future career choices.

Within a secondary care setting, a DCT will most likely be working alongside a range of specialties, both dental and medical. This is a great opportunity to learn from others and to create good links and interworking relationships with colleagues and teams you may not otherwise have had exposure to.

The maxillofacial team is involved with most of the dental specialties in one way or another, whether it be assisting and facilitating appropriate treatment for special care patients, consulting with the paediatric team when paediatric dental trauma presents in A&E, or involvement in joint orthodontic cases for the assessment and completion of orthognathic surgery. This team also involved in joint restorative and oncology cases, and there are close links and time spent in oral surgery departments, depending on the post.

Furthermore, one may develop a greater working knowledge of general medicine, with each medical speciality often happy to explain and teach to help broaden your knowledge. This is important to provide the best multidisciplinary care.

You will develop basic skills in interpreting CT scans, radiographs of facial bones, along with the weird and wonderful.

Ward jobs such as taking bloods, cannulating and placing nasogastric tubes, initially thought to be complex, are soon accomplished with ease. In addition, management of unwell patients, although something rarely faced within general dental practice, is often a daily event. The ability to appropriately manage an acutely unwell patient is essential and can be life-saving. A maxillofacial post equips you with the knowledge, experience and ability to care for unwell patients whom you may be faced with at any time in your future career.

By working in secondary care, one is familiarised with the hospital environment and gains a better understanding of more complex procedures and referrals. Having a good working knowledge of this will be an advantage in future careers caring for patients.

It may enable you to refer more appropriately and to have the ability to explain expected pathways or procedures to your patients in general practice. This can provide patients with more information that can be helpful and reassuring, and also increase their trust in you as a practitioner.

There are often a wide range of different opportunities and possible academic ventures to explore whilst working as a maxillofacial dental core trainee. You may wish to be involved in audits, research or service evaluations alongside other colleagues and consultants.

With the right amount of input, this may lead to national or international posters or presentations and even publications.

Academic ventures may take you to different parts of the world, to conferences and courses that open many doors for your future in academic or clinical careers.

You may also wish to also be involved in teaching, and may be supported through medical education courses or assessments that you may decide to pursue further.Irrespective of future career plans, the ability to teach is a useful quality to have because it also helps when assessing your own practice, ability and learning style.

Finally, you are employed to provide a varied service like no other, and therefore you will learn and develop an almost unique range of skills.

You will have interactions with a diverse mix of patients daily and develop skills in history-taking, treatment-planning and managing the more difficult patients both medically and socially.

Depending on your unit, one skill that will improve from Day 1 is your suturing capability, and the ability to suture well in a range of difficult situations.

Examples could include a patient in resus who’s just been involved in an RTA, a 5-year-old child who needs a lot of persuading, an intoxicated patient in the early hours of the morning, or assisting in theatre closing large surgical cases.

Other new skills you’re likely to learn include undertaking biopsies and surgical extractions, whether this be under local, sedation or general anaesthesia. You will also be incising and draining dental abscesses and assisting in complex surgical procedures including fixation of facial fractures, removal of benign and malignant lesions, and orthognathic surgery.

In conclusion, the role of a maxillofacial junior is varied and if open to it, one can learn a lot in a small space of time. These are skills that you will use and develop in any future career you chose.

Not all maxillofacial posts will be the same but each is likely to provide valuable experience and new skills.

After reading this article, it is not surprising that spending time in a maxillofacial surgery post is a requirement for most speciality training pathways, because of the experience it provides and the close links it has with all specialties. I fully recommend it to any young dentist.