I have absolutely no doubt that if I were still in NHS dental practice now, I would be fretting about hitting the 45% target before March 31st.
And the reason I’m so confident in my target-attaining inabilities, is that in all the years I worked under the bizarre UDA system, which I will be forever convinced was designed and forged in the bowels of Hell by Donald Trump’s policy advisors, I never hit my targets.
I say ‘never.’ I did hit target once, but that was more in error than design. I’ve no idea HOW I did it. I truly do suspect it was probably due to an internal corporate accounting error.
I quietly basked in that brief private glory, not daring to crow about it lest a corporate accountant suffered a twinge of guilt because he generally did no work to speak of, looked into the matter and found I’d been vastly overpaid for all the seven years I worked for them and they either wanted the cash all back immediately, or a child of mine as hostage.
But despite my general financial incompetence, I somehow managed to survive in a thirty-plus long career.
My only flash of genius was sticking with the NHS Pension option I took up when I first qualified and not changing it when given the option, years ago. Again, that was more luck than judgement. I didn’t understand the nuances or implications, of staying on the original NHS pension plan, but again basked in the glory when a financial advisor told me a couple or three years ago, that I had made a ‘wise’ decision. I think I displayed suitable modesty about my sagacity.
In fact, on reflection, my whole career was snatched relatively unscathed from the jaws of disaster, on many, many, occasions.
I think on the whole, I ‘did no harm’ during my career, but I did make a few mega boo-boos along the way.
To be honest, I did harbour a deep-seated feeling that I was perhaps not up to the task of dentistry, from very early on, and ‘disaster’ was a noun I often used to brand a procedure or treatment I was never completely happy with.
That early lack of confidence probably stemmed from my humble academic beginnings. I only gained a couple of ‘O’ levels and a handful of CSE’s from my secondary modern school and so I had to go to evening classes as a mature student in order to get the ‘A’ and ‘O’ levels I required to get into Hogwarts (as I like to think of my dental school).
So, when I first went to dental school, I felt more than a little out of my depth. Firstly, I was very much from a working-class background. Some of my peers were from public schools like Marlborough, Cheltenham and Worksop, whereas I was from a school that was berated simply because it was built from scratch on the local Grammar school’s second-best rugby pitch.
I remember feeling a complete dental disaster when we first went onto clinics and we all took OPG’s of each other. Nowadays, I don’t know how on Earth such random OPG’s would have been in any way shape or form ‘justified,’ but in the early 80’s…well, simpler times.
Whereas most of my young peers (I was on entry to dental school 29 years-old) had perfectly intact dental arches, my mouth WAS a disaster. Having grown up in the sixties, fed a steady diet of Spangles and Sherbet Dip, I’d endured a fair few amalgams by the time I got into dental school.
I wanted the Earth to swallow me up whole on holding my OPG up in the radiography seminar, when a girl in my group, who had been a pupil at Roedean exclaimed “Oh my God! Is that YOUR mouth? That looks a total disaster!”
She was right. It was, as she said, total . In my defence, I have only ever had bits of cusp replaced since 1982, with no new cavities. Nevertheless, I’m still sitting here, after all these years, crimson with shame.
A Child’s Mouth
I was obviously solely responsible for my own personal dental disaster, and for all the others I nearly inflicted on others.
I’ll quickly skate over fracturing a sizeable chunk of buccal bone when I was taking an upper E out on a child under GA in my first year on clinics.
After playing at it with a ‘figure-of-eight’ for what everyone around me thought was an eternity, the bad-tempered psychopath of a consultant who was supervising said “Give it a bit of welly!” When I did, that was the result.
It was the first tooth I ever took out under GA as well. I always looked back on that episode as a disaster. I never used the ‘Welly-Technique’ ever again.
A False Mouth
But I REALLY cringe when I think back to my experiences on the prosthetic clinics on dental school.
I think I’ve said before that there was one short Caledonian lecturer in the prosthetics department that appeared to hate me. Feeling were reciprocated.
There was nothing I could do right in her eyes and she really frightened me to death. We had only relatively recently learned how to take special tray impressions and modify the periphery of the trays with greenstick.
One day, near lunchtime, she instructed me to send a patient off with a temporary reline material in order to take a functional impression for a reline. She instructed me to make sure I got a good fit.
So, what did the dumb-cluck student do?
Yes, before I put the reline material in (it may have been an early-eighties version of Viscogel), I put greenstick around the periphery of the upper and lower dentures.
The lecturer came over impatiently, just as I was about to send the patient off, saw what I’d done and very nearly wet herself in the middle of the prosthetics clinic.
When I saw her in the medical school staff restaurant half an hour later, she was sitting in a gaggle of senior house officers and junior lecturers, pointing and laughing.
Yup. A true disaster, albeit on a purely aesthetic level.
A Sleepy Mouth
Instead of doing the sensible thing on qualifying – either going into a VT placement (which wasn’t compulsory in those days) or working with an experienced principal, I did the opposite. I went to work part-time in two branch practices where I was the only dentist in the practice on the days I worked.
In one practice, I worked for a lovely bloke, who built up his main practice and his new branch practice, on intravenous sedation. He taught me intravenous sedation one afternoon in 1988, and I was good to go.
In those pre-Poswillo days, we had no reversing antagonists if you overdosed the patient, and no monitoring equipment, other than a nurse with a beady eye.
It was my second sedation patient, where I ran into trouble. I had treatment planned a lower seven removal and a heavy scale. The female patient came in with her husband and she went into heavy sedation very quickly.
Me and my nurse spent the next 45 minutes alternately pinching her earlobes to wake her up enough to either get a prop in, or her wide enough to give her an ID block.
What would have been useful to know was that she was so worked up about the appointment, she hadn’t slept for three nights previously. So as soon as muggins gave her an armful of midazolam, all she wanted to do was kip.
Eventually, we got her roused enough to open her mouth and I managed to get the broken-down tooth out before she got agitated.
A Stubborn Mouth
A couple of years later, I’d moved to another practice as the newest associate, and I had to do ALL the emergencies on a Monday. No help. Everything.
One day, a mature nurse came in just after lunch, with acute pulpitis in a broken down lower six. Endodontics wasn’t an option, and she didn’t want to save the tooth anyway. On that day I had half an hour spare and I offered to take the tooth out.
I secured great anaesthesia and she was a good patient. I couldn’t budge the tooth and eventually, the crown of the tooth snapped off at gum level.
I decided to raise a flap and took a bit of bone, wiggled, another bit of bone, wiggled. I did that all afternoon until ten past five, reception having had to cancel my whole afternoon. It was like trying to take glass out of granite.
My principal COULD have helped or given me guidance, but he apparently told reception “He got himself into it, he can get himself out of it.” He stopped my more experienced associate colleague from lending a hand.
My afternoon was destroyed, as was the buccal bone around my patient’s six. The thing that was most decimated though, was my confidence.
The following day, I rang a local oral surgeon I’d only spoken to once before and begged him to teach me oral surgery. He invited me to work with him in theatre on my afternoons off. I did that for about a year and I did everything, from routine surgicals to horizontal eights, to exposing unerupted palatal canines and bonding power-chains. From that point on, I only ever referred if a patient needed GA or it really was a specialist job.
A Refreshed Mouth
By far my most embarrassing disaster was at one of my first practices. I had joined a partnership in a small county city. After about a year, the younger of the partners decided to set up a new practice the other side of the city.
The arrangement was amicable, and I was asked whether I would like to work in the new practice. I decided on the new practice and I was to work part-time in it initially in the main newly decked out surgery, while my surgery was being finished.
My boss was in the old practice on my first afternoon, working in his brand-new surgery. I was actually working with a nurse who was my boss’s daughter.
I’d given the patient a local and pressed the auto return button to bring the patient down so she could have a rinse. In those days I used to give locals with the patient sitting up.
Suddenly there was a bang and a torrent of water started spraying from under the spittoon unit. We had to turn the water off at the mains to make it stop.
When I pressed the return button, I hadn’t noticed that the back of my operator’s chair had caught under the spittoon and as the unit descended, the whole thing had flipped up, ripping the unit off the water pipes below.
Although I remained friends with my boss (we had a convivial lunch only a few months before lockdowns started) he refused to forgive me (as did his daughter). He even sent a message via his wife recently, which implied that I would see my maker, unforgiven.
Those are just a FEW of my dental disasters. Fortunately, apart from a spittoon that was eventually fixed, there was no lasting damage.
Overall, the only thing that was damaged, was my pride and dignity.
But as you can imagine, with all that lot going on, I wouldn’t have the time to hit a 45% target anyway.