DentalSASH welcomes Dental Core Trainees, Dental Paediatric Trainees and Special Care Dentistry Trainees. This section covers Training information for both trainees and established Consultants. Training Programmes Home
The Dental service at SASH has a strong multidisciplinary focus, with both Level 2 (enhanced primary care) and Level 3a/b (specialist and consultant led care) services hosted within the department.
Trainees will gain experience/exposure to specialities including oral surgery, orthodontics, paediatric dentistry, restorative and special care dentistry. Trainees will gain experience of treating patients under local anaesthesia, conscious sedation and general anaesthesia.
Education and Clinical Teams
Alison is a Consultant Orthodontist at SASH where she has worked since 2001 and served as Clinical Lead of the Dental & Maxillofacial Department from 2010 to 2018. She was responsible for the inception of formal dental postgraduate training in the department in 2004 and founded the Dental LFG in 2012.
Alison has a long-standing interest in dental postgraduate education. She was responsible for moving the local British Dental Association Section meetings into SASH in 2004 and was subsequently elected President of the Southern Counties Branch of the Association in 2016. She was also a pioneer of local orthodontic postgraduate education and served as Honorary Patron of the British Orthodontic Society in 2017.
As Chair of the Dental Local Faculty Group her focus has been in consolidating postgraduate dental core and specialty training across the department, allied to the development of innovative clinical services to enhance both professional development and high quality service provision for the benefit of patients.
Mili Doshi is a Consultant in Special Care Dentistry and has worked at SaSH since 2014.
Mili has always been very committed to improving oral health services for adults with special care needs and integrating oral health into general health. Mili has a special interest in behavioral management and has established a dental conscious sedation service for special care patients. Together with her team she has developed several pathways for hospitalised patients to improve access to dental care.
Mili is leading on a Health Education England initiative, working to improve oral health for vulnerable adults, called ‘Mouth Care Matters’. After a successful pilot at East Surrey Hospital this initiative has been rolled out across 13 trusts in Kent, Surrey and Sussex and is currently being rolled out nationally.
The Dental Core Trainees are expected to see ward patients with urgent dental care needs and support the Mouth Care Matters initiative. For more information, please click on the following link: https://sasheducationcampus.net/wp-content/uploads/2018/04/DCT-Timetable.doc
The Trainee Experience
Dr Rachael Otukoya
Most Monday mornings consist of seeing ward referrals from over the weekend, including those from doctors and allied health care professionals, and referrals made via Mouth Care Matters. I would also see patients alongside the Special Care Dentistry consultant, who assesses patients referred into the hospital for dental treatment under local anaesthetic, sedation and general anaesthetic.
I work with the Oral Surgery Specialist doing a list which involves carrying out biopsies, routine and surgical extractions on patients that have been referred in from general practice. These are performed under local anaesthetic and the complexity of cases and treatments increases as confidence and experience increase.
Tuesday AM / PM
I do a community dental clinic alternating with a colleague, seeing patients who have difficulty accessing a dentist, or are being maintained within the salaried dental service following treatment/management within the special care dental service. Treatments include fillings, extractions, making removable prosthesis and referrals where necessary to the appropriate specialties. When I am not doing the clinic, I work on quality improvement projects, such as audits, patient information leaflets and also delivering teaching to allied health care professionals, including oral suction training and oral health training for doctors.
I work on Godstone Day Unit which is a special needs theatre list. This includes treatment under local anaesthetic, intravenous (IV) sedation and general anaesthesia in an anaesthetist-led environment. Following assessment on the clinic, patients that require treatment are clerked in, may have pre-medication to help them settle, and have their treatment in theatre, led by the Consultant in Special Care Dentistry, and full treatment is provided to restore oral health, which includes xrays, fillings, extractions and full mouth cleaning. The trainee would usually perform one half of the treatment. Following treatment, the patients are taken to the recovery room with a recovery nurse until they are well enough to return home. The trainee is responsible for discharging the patients home also.
The Consultant in Special Care Dentistry and I would often go to Remeo (Lane Fox) Unit. This is a specialist commissioned respiratory service to support both the acute and long-term management of patients with sleep disordered breathing, chronic respiratory failure and pulmonary hypertension. We provide check-ups to the patients, do treatment such as fillings or extractions and if patients have problems or require more comprehensive assessment and treatment they can easily be transferred to the hospital to be carried out. This is an important part of the Special Care service we provide for these patients who would otherwise be transferred to Guys for their treatment. Other sessions may involve performing dental treatment under dentist-led sedation in Godstone Day Unit, or treating medically complex patients under general anaesthesia in Main Theatres with the Consultant.
Thursday AM / PM
I see patient referrals from the wards, accompany the Mouth Care Matters Team in seeing patients which have been referred and attend doctors Grand Rounds, a weekly teaching session predominantly aimed at junior doctors on interesting cases, scenarios or teaching points across multiple specialities. I may also attend study days as part of my continued professional development or deliver teaching to other members of staff.
Friday AM / PM
Fortnightly, I would work on the sedation assessment clinic, assessing new patients requiring investigations, management and treatment under local anaesthetic, sedation or general anaesthetic. This is run alongside members of the anaesthetic team that may need special investigations prior to arranging treatment. On the other sessions, there are sedation clinics, whereby patients are seen on clinic for dental treatment under inhalation sedation or intravenous sedation.
Portfolio – our e-Portfolio is a way of educational supervisors measuring our progress.
£890 study budget – I spent mine on courses, including Teaching and Mentoring and Special Care Dentistry specific courses.
Chichester Cup – an opportunity to present audit work done during the dental core training year at East Surrey Hospital.
Journal Club – run by the Paediatric Clinical Fellow and Paediatric Dental Consultant, is an opportunity to appraise journals and is open to all. Additionally if there is an interesting case, this can be discussed also.
Clinical Governance – DCT’s get the opportunity to present core CPD presentations such as medical emergencies, radiology update and infection control.
Dr Toby Mitchell Innes
I work with two oral surgery consultants, six months with one and six months with the other. At the beginning they identify your ability and depending on your experience you may be starting surgicals pretty quickly. After a few months you are seeing every other patient but if you want to see more then you can. The treatment includes surgical extractions and all types of biopsies, all under local anaesthetic.
I work with a Maxfax consultant on an oral medicine consult clinic. The consultant is very keen on teaching so each week he gives you a small amount of reading/home-work that means you gain lots of knowledge very quickly, so is very worthwhile. After a few months you are seeing every other patient and reporting back to him.
Tuesday A.M (odd weeks)
Working with a Paediatric consultant: Examining patients with multiple caries/hypomineralisation/ectopic teeth etc., sent in from GDP. The aim is to treatment plan for local anaesthetic, inhalation sedation or general anaesthetic. Any treatment that you wish to undertake you can book on your personal treatment clinics.
Audit – An afternoon to catch up with admin and do your audits. Usually two audits minimum required in the year. Also a poster presentation, a presentation at East Surrey Grand Rounds, Chichester Cup, or other clinical governance teaching opportunities held monthly.
Tuesday (even weeks)
All day – Restorative clinic. This is similar to a normal day in practice, although your patients need more time due their complex medical history/wheel chair bound/special needs. A typical day consists of fillings/dentures/xlas/exams/perio/RCTs/Crowns – everything really. You can book IHS patients in here.
Oral Surgery consult clinic – assessing patients and treatment planning them for LA/IV/GA. Again you can book them on your treatment clinics.
Occasionally you can cover the special needs GA clinic – this involves providing patients with a full MOT – each patient has an hour slot. The last patient I saw needed nine fillings and seven extractions and cleaning. You work alongside a consultant and usually do one side of the mouth each.
First 6 months: Treatment clinic – Restorative clinic.
Second half of year: IV sedation clinic runs every three weeks – this is where you will get your main IV patient experience – usually three patients in an afternoon. The other weeks are GA with special needs. You get training in cannulation and titration.
Two week rule oncology Clinic – working with two Maxfax consultants; treatment planning patients who come in with suspected cancer or who have already had surgery and are on review. The consultants are very keen for you to spend time with them watching their operations if you are keen to do so.
Thursday lunch – There is grand rounds where you get free lunch by reps promoting their products – mainly medical – you sit through 1-2 lectures mainly medical. Our Dental unit is expected to lecture once a quarter so usually you are asked to present at one.
Ortho clinic. Working with an ortho Consultant – initially for me it was mainly learning/observing. Now I am taking full records, placing bands on 6’s, placing and removing brackets 6-6 and wires. You are expected to do full ortho assessment and try and come up with treatment plans – pretty difficult but it gets easier.
Friday (even weeks)
Paediatric GA list: Paediatric patients booked in for GA. Multiple extractions/fillings/surgical expose and bonds etc. Usually take it in turns with the consultant to treat the patient.
Friday (odd weeks)
Oral Surgery GA list: All ages but mainly adults booked in for complex surgical extractions or anxious patients. Usually take it in turns with the consultant or occasionally you are put in ‘charge’ of running the list (obviously they are always there supervising). It includes surgical expose and bonds/biopsies/debriding cysts/removal of impacted teeth – lots of suturing!
Other bits: As you work with many consultants there is plenty of opportunities there for you to get involved as much as you like. If you like research/audits then speak to the consultant in that area and they will be more than happy to help you.
Portfolio is regularly checked by your Supervisor so ensure this is kept up to date. If you are planning on specialising, then keeping evidence of what you have done is very important.
You get 30 study days, 27 days holiday.
You get £890 towards courses – I spent most of mine on MFDS.
Hopefully by the end you will be trained in both Inhalation and IV sedation performing a minimum of 20 patients in each. The hospital provides accredited sedation training.
CPD lectures are run at the hospital once every few months.
Mouth Care Matters
Mouth Care Matters goes National!
– Mili Doshi (Consultant in Adult Special Care Dentistry & Oral Health Project Lead)
Three years ago I was asked by Health Education England Kent, Surrey and Sussex to develop a training programme to improve the oral health of hospitalised patients. Until that point I has not really given much thought to whether nursing assistants had any training in how to support patients with mouth care, what happened if a patient did not have a tooth brush on the wards and how many dentures were lost in hospital each year. We started to look at mouth care practice on the wards. We spoke to staff and patients, audited mouth care recording, observed practice and found that this was an area of care that needed to improve because mouth care really does matter! A lack of mouth care and poor oral health can cause pain and discomfort, lead to difficulties eating and drinking, infections including aspiration pneumonia and increased length of hospital stay. Polypharmacy and many conditions can cause mouth ulcers, oral thrush and dry mouth, which can be debilitating for people who are already in poor health.
A Mouth Care Lead was recruited to provide hands on ward based training and class room training to upskill all staff and also support staff and patients with specific mouth care related problems.
Mouth Care Matters focusses on four core principles:
- Knowledge – provide staff/carers with knowledge of why mouth care is so important
- Skills – ensure staff/carers are skilled to provide good mouth care
- Access – patients/people have access to effective mouth care products
- Support – staff/carers/patients have support from staff with enhanced oral health skills
Following a successful pilot at East Surrey Hospital, we rolled out the initiative to 12 trusts in Surrey, Sussex and Kent in 2016/2017. Each trust was funded to recruit a mouth care lead for 12 months responsible for implementing and leading the initiative. Mouth Care Leads were responsible for establishing a mouth care network within their trusts, proving hands on training to all health care professions, ensuring that the wards had a stock of appropriate mouth care products and that there was a pathway for advice if patients developed or had problems with their oral health. A health economics report conducted by the Kent, Surrey and Sussex Academic Health Science Network found the return on investment of the Mouth Care Matters programme was £2.66 of benefit within the health care system for every £1 invested in the project. A further £17 is identified in social benefits for every £1 invested.
There has been lots of interest from trusts nationally in the Mouth Care Matters programmes. Most of this interest is from staff on the wards who recognise the importance of improving mouth care. We are delighted to currently be working with 29 trusts all over the country to provide a two-day train the trainers programme.
We are also working with Great Ormond Street Hospital to develop ‘Mini Mouth Care Matters for paediatric patients.
The Mouth Care Matters intervention is simple to deliver and includes training, provision of educational resources and signposting to existing resources collated within an existing website http://www.mouthcarematters.hee.nhs.uk.
Three years on we are delighted with what the Mouth Care Matters has achieved to date. We are very grateful for the support and encouragement from Surrey and Sussex Healthcare NHS Trust that has helped champion this project and has truly made a difference in the care we provide to our patients.
For more information, please visit the following:
Education Campus Reception
SASH Education Campus
Surrey and Sussex Healthcare NHS Trust Trust Headquarters
East Surrey Hospital
Please use the form below to contact the medical education reception team.