Julie Wilkinson is a senior dental nurse who has worked in special care dentistry for 32 years, specialising in supporting patients through sedation and GA.

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Community Dental Services CIC (CDS) is an employee-owned social enterprise and a referral only dental service, providing community dental care and oral health improvement across much of the East of England and the East Midlands. CDS brings dental care to people who cannot easily be treated in general dental practice; patients typically have learning disabilities, mental health issues or severe anxiety.

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CDS provides care under conscious sedation (oral sedation, intranasal sedation, inhalation sedation and intravenous sedation), as this supports many patients to tolerate treatment in clinic that would otherwise have resulted in them being referred for a more invasive general anaesthetic (GA) in hospital. Where GA is the best option for the patient, CDS dental nurses work alongside hospital teams in theatre.

Here we are given an insight through the eyes of Julie Wilkinson, a CDS Senior Dental Nurse, who has worked in special care dentistry for 32 years and who specialises in supporting patients through both sedation and general anaesthesia.

Julie's background and career

After Julie left school, she went on to college and then on to a YTS scheme, working in offices. She later started as a receptionist at her local community clinic. Julie had considered a career move from administration, so when a dental nurse role in community dentistry, who were based within the same building, became vacant in 1991, she decided to apply. ‘I believed in the holistic approach to providing dental treatment by the community dental service to help the vulnerable groups we treat. I wanted to be part of that service,' says Julie.

Julie had been working in community dentistry for a while when a GA service for paediatric dental patients was introduced at her local hospital in Boston.

‘I had gained knowledge and skills in working with very anxious patients and felt that I would be able to transfer this to support the new service. We provided a service in Boston and Lincoln County Hospital, with the support of an anaesthetist, an operating department practitioner, and a recovery nurse for paediatric patients and adults with additional needs.

‘As time progressed, we developed our own inhalation sedation service, offered in some of our Lincolnshire clinics, as well as intravenous sedation which we offer at our Boston and North Hykeham sites, and I was keen to be involved. GA is still offered for more complex cases for both adult special care and paediatric patients, but it's been rewarding to see how our sedation services have reduced the demand for GAs.

‘I decided to apply to study for the NEBDN certificate in General Anaesthetic Dental nursing to increase my knowledge and skills and to better understand the pharmacology and physiology of GA. I also studied for the NEBDN Certificate in Conscious Sedation because I really wanted to be a part of the new service we were introducing. This is important because we needed appropriately trained team members to support the expanding initiative. GDC guidelines state that a second appropriately trained member is required to treat a sedated patient. Completing these post registration qualifications has enabled me to be that second team member. I travel around the county to support the sedation sessions and regularly attend training to complete CPD for my dental nurse registration competency framework.

I absolutely love working with our special needs patients. It's more than just dentistry, it involves getting to know people and gaining their trust and providing them with the confidence to have their treatment completed.

‘As a sedation and GA trained dental nurse, some of the tasks I am involved in include supporting the patient whilst a canula is inserted, and equipped with the additional knowledge and skills, I can monitor patients whilst they are sedated as well as monitoring them post treatment during recovery. Sedation nurses also have the knowledge and skills to prepare the patient for surgery and to safely attend the hospital, by giving them specific pre and post operative instructions. We make sure they have the right support at home for when they return after treatment and discuss the modes of transport to use to and from the hospital. We also ensure that their medical and social history is completed fully, highlighting any concerns when arranging their pre-assessment appointments at the hospital. We liaise with the hospitals on a regular basis to ensure we are aware of any medical complications that have arisen during the pre-assessment and then follow these up with the local GPs or consultants. It is also part of our role to communicate with the learning disabilities team to support the special care patients to attend for their GA or sedation appointment.'

Julie works for CDS Lincolnshire across two bases: ‘I absolutely love working with our special needs patients. It's more than just dentistry, it involves getting to know people and gaining their trust and providing them with the confidence to have their treatment completed. As I am senior nurse, I also like to encourage new members of the team to progress their knowledge and skills. I like to support my team in their daily activities and hope they feel supported in their role. The amount of time it takes to get the patient to where they need to be is often a challenge, but, when it has a positive outcome, it is worth it.'

The CDS Lincolnshire team consists of an Associate Operations Director; Operations Manager; two admin team members; five dentists - of which, two are specialists in special care; one therapist; one senior dental nurse (Julie) and 11 dental nurses. There is also an Oral Health Promotion team of three who work with people and communities to raise awareness of good oral health and its impact on wider health and wellbeing.

Julie continues: ‘I support the dentists with all the vulnerable groups that CDS are contracted to see. This includes special care patients, pain and anxiety management, and children. Outside of the clinic, I have supported the oral health team when they have had stands at events. Community dental nursing demands patience, empathy and lots of laughter to alleviate the anxiety and difficulties patients have experienced, and to show them dental treatment can be a positive experience, and I am proud to play a role in their dental journey.'

Outside of the clinic, to keep her busy Julie enjoys walking, exploring the Lincolnshire Wolds, yoga and family time with her two grandchildren.

Check out the latest vacancies at CDS-CIC: https://www.communitydentalservices.co.uk/work-for-us/.

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