Where's the Guidance?

The week when we could have done with a bit of guidance

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Paul Isaacs

Leadership now and then

I had a "Simon" too in my first year under the rudimentary VT of the early 80's. Ahead of his time, popular, competent, enthusiast... Read More
Friday, 03 April 2020 12:47
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Unreasonable behaviour - dental students in the 80s

How did we survive without GDC guidance

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Consistent changes - Michael Sultan

Consistent changes - Michael Sultan

I have to admit, I have never enjoyed our annual infection control lecture. Past experience has left concerned about the quality of the CPD on offer, worried that I will be subjected to another afternoon of scare-mongering and opportunistic commercialism. Far worse, though, is the yo-yo-like introduction and withdrawal of guidelines that happens year on year – usually without any scientific evidence to support the decisions.

Like any conscientious practitioner, I take these responsibilities very seriously and, ultimately, I think the changes that have been made have been positive.

But all I want is a little consistency. I’m sure we can all remember when we were required to keep our sterilised equipment in bags, to be re-sterilised after 30 days of non-use. That quickly changed to 60 days and now it’s gone up to one year. Why?

Who knows?

The science that dictates these guidelines is not made widely available to professionals – we are simply required to dogmatically follow them. What’s more worrying, however, is the fact that private practitioners are not consistently informed of these regularly changing guidelines. NHS practices and hospitals receive regular updates from the Department of Health – but we are too often left in the dark. Gone are the days when the BNF was sent to all practices: we now have to purchase it or subscribe online.

In fact, and I say this with a certain amount of trepidation, I regularly find out about new guidelines by reading through some of the GDC fitness to practise hearings. I often see cases where practitioners are being penalised for something of which I’m not even aware. In this, I think, there has been a fundamental failing in the profession – which is having serious ramifications for practitioners right across the country. 


I also couldn’t help tallying up just how much compliance could end up costing. With all the changes, with all the considerations, I was left wondering what strategies I would have to employ to make it feasible – and it all came back down to the question of consistency again. Should practices spend significant sums of money to replace their old sinks with ones that are compliant this year but potentially not the next? Should they have to budget for the government’s indecisiveness?


It’s a difficult situation and, ultimately, the patient will suffer. If practitioners are always having to buy new equipment, new cabinetry or new PPE the cost of treatment will inevitably go up to accommodate the additional costs. It’s not a case of ignoring these topics – the protection of our patients is, and always will be, our foremost consideration – but in order to best do that, we need a consistent direction and a better system for sharing the knowledge we need.


For further information please call EndoCare on 020 7224 0999

Or visit www.endocare.co.uk


Dr Michael Sultan BDS MSc DFO FICD is a Specialist in Endodontics and the Clinical Director of EndoCare. Michael qualified at Bristol University in 1986. He worked as a general dental practitioner for 5 years before commencing specialist studies at Guy’s hospital, London. He completed his MSc in Endodontics in 1993 and worked as an in-house Endodontist in various practices before setting up in Harley St, London in 2000. He was admitted onto the specialist register in Endodontics in 1999 and has lectured extensively to postgraduate dental groups as well as lecturing on Endodontic courses at Eastman CPD, University of London. He has been involved with numerous dental groups and has been chairman of the Alpha Omega dental fraternity. In 2008 he became clinical director of EndoCare, a group of specialist practices.




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You don’t have to do this - letter to a wavering dentist.

You don’t have to do this - letter to a wavering dentist.

You don’t have to do this - a letter to a wavering dentist.

Is this really what you want to do? You don’t have to.

Many students have made their decisions to study dentistry at university in their mid-teens, an age when they are neither mature nor in possession of great insight.

Parents, family and teachers see dentistry as a well-remunerated, successful profession with a secure future. Well positioned on any socially acceptable list that makes it traditionally attractive to the children of immigrants. My mother, a migrant from Ireland was determined that both her children would have professions, her background, in nursing, favoured the medical. I became a dentist, my brother a doctor.

How many of us have the nerve to say that it’s not what they want? Many dentists are ill suited to a profession that makes extensive physical, mental and emotional demands on its members. I am not convinced that the undergraduate course prepares students for the rigours of general practice.

After 5 undergraduate years and now carrying a large student debt it takes a brave new graduate to dare admit to parents and family that they have studied the wrong subject. If you have a degree in humanities or pure sciences you are fortunate to be able to continue with your subject. Only with a “vocational” degree is the graduate able, and expected, to follow a career pathway.

Socially, turning away is akin to failing to show up at your own wedding. An individual might be secretly admired for admitting that they don’t feel the commitment needed for a happy marriage but it’s a brave dentist who says that they have done the wrong thing.

Turn things on their head, if you know in your heart of hearts that you are going to be unfulfilled and unhappy being a dentist isn’t it better to say so sooner rather than later? How many more miserable years can you tolerate? How much stress and heartache can you endure once you have admitted to yourself that you’re in the wrong place?

Far too many dentists have plodded on through degree, foundation training, associateship, partnership, marriage and children all carrying with them increasing financial pressures.

They thinking that this is the way that it has to be, that it will get better, easier, less of trial to get out of bed in the morning - next year. They live from holiday to holiday and get absolutely no fulfilment or satisfaction from the clinical work that they do or the people for whom they are supposed to care.

Often they succumb to the stressors. One of my contemporaries only accepted that he had a problem when he needed a quarter bottle of vodka to start work in the morning and was facing his third drink driving conviction.

I have attended funerals of successful and apparently happy dentists who have taken their own lives because they could only see one way out.

These problems are not unique to dentists and many people “live lives of quiet desperation” so I would encourage them to change also, if they can.

What else is possible?

The answer is anything that you want to be. There are ex-dentists who are successful architects, writers, lawyers, musicians and businessmen. I know of one former specialist orthodontist who now builds dry-stone walls (and will also teach you how to build them). The discipline of your training means that you are suited to re-train in many disciplines.

Let’s not forget those people who are stuck in a rut. NHS dentistry has never embraced excellence, though lots of good work is done in spite of the system. You will never perform at the highest level on the conveyor belt of UDAs or whatever imposed system of production is in vogue this year.

If you are having second thoughts then I suggest that you examine your reasons. If you feel that you aren’t right for a job that demands a high standard of manual dexterity in order to practice at its best then you should explore your options.

Darwin says that empathy is instinctive not learned, so if you are not a person-person will you be happy going against the grain and attempting to gain the trust of your patients day in day out for the next 30 years?

If you are doing it just for the money, you will probably be disappointed at the amount of further training, dedication to a career pathway and sheer hard work that it will take. You might get a better return on the invested time in some other field.

On the other hand if you stay and you choose to dedicate yourself to a unique discipline, then every day will give a new challenge. You have the opportunity to grow as the leader of a team in a niche where you help your patients not only to achieve and maintain an important element of their general health but also to have an enhanced sense of confidence, comfort and function.

If you want to be happier then say so, and do something. This isn’t a rehearsal, there is no second chance, no re-run, no “it’ll be all right on the night”. If you want to be better nobody can do it for you. If you need help ask those who have already done it, study excellence and embrace it.

Polonius said to his son:

“This above all: to thine own self be true,
And it must follow, as the night the day,
Thou canst not then be false to any man.”

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Gaurav Vij

Great post....

Great post and sums it up succinctly. My experience is very few are cut out to be dentists. You are basically a surgeon in the cla... Read More
Saturday, 16 January 2016 07:20
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