Put a smile back on your face

Dentistry has come a long way since the days when the village blacksmith doubled as the local tooth drawer. Even relatively recently, the only skill expected of a dentist was to be able to pull out a bad tooth as quickly and as cheaply as possible with the minimum amount of pain. The concepts of restorative dentistry, orthodontics, flossing, painless fillings and teeth whitening were as alien to the early practitioners as the idea of women dentists.

Dentistry has come a long way since the days when the village blacksmith doubled as the local tooth drawer. Even relatively recently, the only skill expected of a dentist was to be able to pull out a bad tooth as quickly and as cheaply as possible with the minimum amount of pain. The concepts of restorative dentistry, orthodontics, flossing, painless fillings and teeth whitening were as alien to the early practitioners as the idea of women dentists.

Now, dentists spend a relatively small amount of their time pulling teeth out. With the emphasis on prevention, conservation and enhancement, dentists are offering a huge range of user-friendly services with more than 400 different treatments on offer, from humble fillings to sophisticated face-changing technology.

And as the range of services has increased, so too has demand, especially for NHS dentists. Demand outstrips supply by a country mile, and the Government has announced changes that will mean more dentists and an additional 170 training places each year. But the word on Wimpole Street where the General Dental Council has its home is that this is just scraping the surface and is unlikely to be enough to meet demand. The additional training places are also unlikely to cater for the continually growing number of people who want to become dentists. In fact, the biggest career challenge on the way to becoming a dentist is actually getting a place at university.

Remarkably, there are more art schools than dental schools, with just 13 centres sending out a modest 800 young men and women a year to maintain the nation's dental health. And competition for those places is fierce. King's College London, the biggest dental school in Europe, has more than 1,000 applications for its 145 places. That number is up 9 per cent on the previous year - further evidence that dentistry is at least as popular as medicine.

According to the British Dental Association (BDA), the attractions of dentistry include working with people and helping them. Having an interest in science, leadership, communication and business skills is also important. "Imagine having the power to make someone feel better about themselves - to put a smile back on their face. If you are a dentist, you can do just that," says Jo Tanner, of the BDA. "In fact, with surveys telling us that your smile is the first thing that people notice about you, dentists have never been so popular.

"It's rewarding, but it's demanding, too. You'll probably spend most of the day on your feet, or at least sitting at fairly awkward angles. You'll also have to concentrate on very small areas with high precision. Good eyesight and manual dexterity are vital for anyone considering dentistry."

All dentists in the UK initially follow the same education and training to qualify to work, and most get a Bachelor of Dental Science (BDS) or a Bachelor in Dental Surgery (BChD) from one of the dental schools. Entry requirements for the schools are high. Successful applicants will usually need three science A-levels at grades AAA to ABB, including chemistry, or two science A-levels including chemistry and maths, as well as supporting GCSEs. Many dental schools ask for physics, mathematics and biology at GCSE level.

The standard dental courses last five years, and include a wide range of health, biological and behavioural sciences, as well as clinical skills in all dental disciplines. After completing the course, would-be dentists have to do a year's vocational training (VT) in a dental practice. A vocational dental practitioner works in an approved training practice under supervision and also receives additional training. Vocational dental practitioners are paid a salary of around £26,000 during the 12 months. After this year, the dentist is issued with a VT number that enables him or her to go on to the NHS dental list. After vocational training, dentists usually enter an established general practice as an associate or as an assistant. Newly qualified dentists also need to decide what kind of dental career they want - and the choice is wide, ranging from jobs in family practice, hospitals, community dentistry, the armed forces and industry.

Most dentists work in general practice in the community. Dental practices can take either private or NHS patients, and most have a mix of both. In general practice, dentists offer their patients a range of treatments, including fillings, extractions, fitting bridges and dentures, and check-ups - and they keep dental records. Like GPs, they have the opportunity to form long-term relationships with their patients and provide them with continuing care. "As well as an ability to get on well with people and to practice clinical dentistry, it is essential to have an aptitude for business, since the dentist is a manager and team leader running a small business," says a BDA spokesman.

In the Community Dental Service, dentists care for children in school and people in the community with special needs. After vocational training, many work as a community clinical dental officer, with further opportunities to gain postgraduate qualifications. Ambitious CCDOs can become senior dental officers with the special responsibility of promoting health and treating patients with special needs. In hospitals, dentists carry out specialised dental work, and patients are referred from general practice dentists or the hospital. Unlike self-employed general dental practitioners, hospital dentists are salaried, and they generally work as part of a team with consultants in other specialties.

"Most dentists go into general practice, treating patients in high street practices, both on the NHS and privately," says Tanner. "These dentists are mainly self-employed, so you'll need to get to grips with running a business - and your own finances - as well as treating patients.

"Other dentists stay on at university to train as hospital dentists - known as oral maxillofacial surgeons, or max-fax. These surgeons treat people with facial disfigurement and put people back together after car crashes, so if you're looking for more than general practice, this could be the route for you. Alternatively, you could go from student to teacher and decide to follow a career in research and academia.

"Dentistry offers lots of opportunities," Tanner adds, "especially if you're ambitious and prepared to work hard. It's also really rewarding work since you are able to see the difference you can make to someone's confidence and appearance."

There are other rewards, too. Those who do get trained and become dentists can expect to be well paid. Typical earnings for a full-time, self-employed general dental practitioner are estimated at £77,000 to £83,000 a year. Where more private work is carried out, salaries are higher. The average net income for a dentist doing purely NHS work is estimated at £47,800.

Those who opt for hospital work and who become consultants can expected to earn up to £90,000, while a clinical director in community dentistry will get up to £70,000. It's a far cry from the penny-a-tooth charged by village blacksmiths who found more profit in shoeing a horse than in dentistry.

And other things have changed as well. In 1895, Lillian Lindsay was the only woman dentist in Britain. Women now make up more than 30 per cent of the workforce, compared with 23 per cent a decade ago. For dentists aged under 30, women now make up about half.

General Dental Council: 020-7887 3800; www.gdc-uk.org

British Dental Association: 020-7563 4563; www.bda-dentistry.org.uk

NHS Careers: 0845 606 0655

NHS Student Grants Unit: 01253 655655

Guy's, King's and St Thomas's Dental Institute, London: www.kcl.ac.uk/depsta/dentistry

'I'M A PEOPLE PERSON AND ENJOY WORKING WITH MY HANDS'

Sheena Kotecha, who graduated from King's College Dental School this year, is about to start her vocational year with patients in a dental practice in Leicester.

"I was always interested in science and health, and I decided when I was about 16 years old that I wanted to become a dentist. It's such a good career because there are so many branches and so many opportunities. I knew the degree was going to be demanding, but at the same time I also knew that I had the ability.

"There were other attractions, too. I am a people person and anything you do in dentistry involves rapport with people - you can build up lifelong relationships with patients. I also enjoy working with my hands. Next week I am starting my one-year vocational training. Everybody has to do it now. I will spend four days a week with patients and one day studying. My practice is 30 per cent NHS and 70 per cent private. I will be working mainly with NHS patients.

"I am quite academic and l like learning, and at the moment I am looking at specialising in restorative dentistry and orthodontics, but I might find other areas that attract me before I make the career decision. Most orthodontic work is in paediatrics, like teeth straightening, while restorative dentistry is crowns, bridges and things like that." RD

education@independent.co.uk