Robert Leigh, a dental hygienist and therapist and a BDJ Team reader panellist, reflects on his career to date and describes how he has navigated dentistry's diverse pathways.

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After embarking on a career in dentistry, by the age of 22, I had my qualifications freshly in my hands and eagerly stepped into the profession, ready to carve out my path and push myself to excel, as we all do upon qualifying.

In the initial stages of my career, I attempted to juggle the demands of clinical practice with academic pursuits. Amidst the challenges of a full-time clinical job, I committed myself to further education, enrolling in a Postgraduate Diploma course while simultaneously pursuing a top-up degree aligned with my career aspirations.

The challenge of balancing work and education is certainly no small feat. Yet, fuelled by a relentless drive for achievement, I forged ahead, earning accolades from patients and colleagues alike. The affirmation of my accomplishments served as potent motivators, spurring me onward in my journey.

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The early days of clinical practice: a trial by fire or tough love?

My first role after qualifying was somewhat a baptism by fire, although I had the opportunity of full clinical freedom, coupled with a supportive clinical team on a personal level who were always more than happy to provide advice and knowledge while also recognising my own knowledge and ideas. I faced short appointments, always without a dental nurse supporting chairside and in decon, and worked weekends and late nights. These demanding patients and challenging working conditions require us all to stand on our own two feet very soon after qualifying, managing patient expectations, and honing our communication skills and time management. It was here that I realised the importance of teamwork and the vital role dental nurses play in providing comprehensive care after experiencing the difficulties of working without them. The differences I have experienced in my energy levels, mental and physical health and the patient care I feel I can provide are night and day now that I work alongside dental nurse colleagues.

Navigating the demanding world of dentistry, I've experienced the exhilarating highs of early career achievements, but also the profound lows of burnout.

Encountering and overcoming burnout

Navigating the demanding world of dentistry, I've experienced the exhilarating highs of early career achievements, but also the profound lows of burnout. I've previously written about my journey through burnout, and it was this pivotal experience that prompted my career change. Despite managing the loss of three grandparents in a year, I believed I had balanced grief and career pressures. However, physical symptoms like severe facial inflammation and impaired vision due to the inflammation and dermatitis being present on my eyelids, led to a dermatologist advising me that my physical condition was likely a result of extreme stress. This experience was a wake-up call, prompting me to step back, seek help, and ultimately redirect my focus. The lesson learned? Recognising and addressing burnout is crucial for both personal wellbeing and career longevity.

Oral health promotion: a new direction

Looking back on my earlier career, I reflected on my time as a dental nurse. I had worked in an area that I perceived to be reflective of the dental health of the rest of the country. However, upon studying as a dental hygienist/dental therapist, I soon realised how naive I had been. I discovered that not all people are fortunate to have the level of dental health I had experienced in general practice. Seeing children, especially, with high levels of dental decay, many requiring multiple tooth extractions before the age of five, was eye-opening. Searching for non-clinical roles with these memories in mind led me to discover a role in oral health promotion. This role involves making efforts to improve the health of all generations within the community.

My role as an Oral Health Promoter was a significant departure from my clinical practice but remains deeply rewarding. It provides me with a broader perspective on healthcare as well as education and social care and how these services are commissioned. It highlights to me the systemic issues and disparities in oral health across different populations. Engaging directly with the public and fellow health professionals has been incredibly fulfilling, as it allows me to educate and raise awareness outside the confines of the dental surgery. Being able to gain a deeper understanding of education systems, healthcare commissioning as well as spending time in an ‘office job' has shown me how easily we can apply all of our clinical knowledge and personal transferable skills in many different ways. Engaging with various different groups within the community outside of those who traditionally present to a private dental practice also gives me a fantastic variety in my working week and means that you really feel that you are making a difference to those who may not be able to access our services normally.

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A major component of our outreach involves visiting schools to deliver supervised toothbrushing and fluoride applications. We hope that this hands-on approach will be instrumental in tackling the high rates of dental decay in children. By providing children with the tools and knowledge to maintain good oral hygiene from a young age, we aim to reduce the prevalence of dental issues and improve overall oral health in the community.

Specialist practice: a deeper dive into periodontology

My subsequent and ongoing experience in a specialist practice has provided me with invaluable exposure to the intricacies of periodontal care. Working alongside specialist periodontists, I also independently assess and plan care via direct access. Many of our patients range from routine family care patients and periodontal maintenance to more complex non-surgical periodontal treatment and pre and post-surgical care supporting patents after they have undergone periodontal surgery with the specialists. Additionally, I am actively involved in events for our referral and media network. Like many of us, I also help with training and supervising new dental nurses to the clinic, further emphasising the importance of teamwork in delivering patient care.

Academic pursuits and future aspirations

Although from a clinical aspect I have never felt limited by my qualifications being at the diploma level rather than a bachelor's degree, I have always had a desire to further my education. For many of us who wish to study at master's level and beyond out of our own self-interest and passion for learning, the option of a top-up degree is sometimes chosen. Those who have undertaken top-up degree courses will be aware that there are excellent offerings from universities for dental-focused BSc top-up degrees. I chose to explore the non-traditional and honestly, not widely advertised options within our community and found the Management and Leadership in Health and Social Care top-up degree at Anglia Ruskin University.

After reading the course outline, I soon realised it was closely aligned with my undergraduate diploma studies and shares many similar module themes, despite the theoretical content itself not being dentally related. Having completed, and thoroughly enjoyed research projects and presentations in these areas during my diploma training, I felt that pursuing a BSc was the natural next step from my previous studies. This BSc programme has provided an excellent platform for me to delve deeper into healthcare management and leadership, topics I am passionate about. It is helping to equip me with the skills and knowledge needed to drive positive change within the healthcare system.

Dental nurses are the unsung heroes of the dental world. They're crucial for patient care, especially when things get tough.

Even if we may not fit the traditional criteria for this kind of course, most universities will consider applications from professionals with varying qualifications and experiences. I would always recommend exploring the different options available that interest you. Even if something doesn't clearly seem to be a traditional option, enquiring and utilising your transferrable skills is always worthwhile. Although at present it can be challenging if not impossible for some dental professional groups to expand their clinical scope of practice, there is nothing to limit our own personal career and education aspirations if we explore outside of the traditional realms.

My anecdotal advice for dental professionals

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    Keep Learning: Dentistry is always changing and developing with new techniques, technology, health initiatives and guidance popping up all the time. We all have a hard enough time keeping up to date with these using our mandated CPD. However, if further education is your passion, then pursue it! Juggling a BSc alongside my full-time work has been a challenge, but it's been worth it. Keeping up with the latest in the field not only keeps you sharp but also boosts your confidence and improves patient care. So, keep an eye out for courses, workshops, and new methods to stay on top of your game and keep yourself feeling fulfilled.

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    Teamwork Makes the Dream Work: Dental nurses are the unsung heroes of the dental world. They're crucial for patient care, especially when things get tough. Building a good relationship with your dental team can make a world of difference in patient care. So, keep the lines of communication open, show respect, and work together to create a positive environment. This applies to all of us and goes both ways, if a practice or person does not offer you basic respect and politeness that we all deserve as human beings, then seek support in standing up for this, whether this support be internal within the practice or external through representative associates like the BADT or BSDHT and many others.

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    Broaden Your Horizons: Clinical work is just one part of dentistry. There are plenty of other paths to explore, like public health, research, education, and even policy making. My NHS colleagues have backgrounds as dental nurses who carried out further training to become oral health educators, using their skills to educate people about oral health. My service managers come from this dental nursing background and another manager still practises as a dental therapist alongside their role in senior management. Oral health promotion is a great option for dental nurses and other dental professionals who want to use their skills in a different way. Exploring these different areas can help you grow professionally and make a bigger impact on oral health in the community, outside of the surgery.

    I am excited to see where this next phase of my journey takes me and am confident in the path I have chosen.

In conclusion, with the interest and drive from my undergraduate diploma studies fresh in my mind and feeling ready to begin my next academic challenge alongside my work in general practice and oral health promotion, I am poised to become the best-rounded clinician. This gives me the chance to expand the impact I can make to people's health beyond being purely focused on the patients I care for clinically but also to the wider population. I am excited to see where this next phase of my journey takes me and am confident in the path I have chosen, combining clinical expertise with a broader understanding of healthcare and a commitment to leadership and education in the field. But who knows what the future holds? Certainly not me, so I always remain open to change whatever form this may come in, even if it may be somewhat outside of the traditional path of a clinician.

Read Rebecca Silver's article, ‘Don't let burnout burn you out' in BDJ Team: https://www.nature.com/articles/s41407-023-1923-1.