In September 2016 I was lucky enough to hear about a course at the University of Essex. The course was one year long and I knew of one person that had done it previously and given it rave reviews, but perhaps I need to set the scene for anyone reading this article.

I qualified as a dental hygienist in 1993 whilst serving in the Royal Army Dental Corps. I have worked in every situation you can probably imagine from the armed forces to private practice and the NHS. I have been lucky enough to be involved with various companies and organisations that have maintained my interest in dentistry throughout my career. I moved to the Shetland Islands in 2013 for one reason or another and have worked in the Public Dental Service since arriving. It is a great place to work as I am very privileged to receive continuous support at work.

That aside, I was becoming a little disillusioned with dentistry and the prospect of another 20 years or more being a dental hygienist started to fill me with fear. I was casually looking for an outlet and was considering walking away from a profession that had certainly treated me well but at the same time was becoming tedious. My encounter in September 2016 with Sarah Murry MBE was somewhat fortuitous and has saved me from leaving the profession.

I was attending the British Association of Dental Therapists (BADT) annual conference when I bumped into the aforementioned Ms Murray. Sarah and I have met on many occasions and this time she was busy representing the University of Essex and was promoting two courses run by the university for dental hygienists and dental therapists. One was for the MSc in Periodontology that may appeal to some. However, the course that Sarah knew would interest me was the BSc (Hons) in Oral Health Sciences that, if successfully completed, would not only give me an honours degree but also add the skillset of dental therapy to my current scope of practice.

As I have already said, I live in the Shetland Islands and the course is run from the Southend Campus of the University of Essex. That's about 800 miles as the crow flies and would require some serious thinking about to see if I would be able to commute to the course and this was before I even asked my Clinical Director. I will briefly explain the course structure so that readers can understand how the course works.

Unlike other previous incarnations of this course by various educational institutions, the course is split between university work and ‘work based learning’ which can be either your current employer or a placement arranged by you the student or with the help of the university. You are learning the vast majority of your skillset whilst seeing live patients in practice. The course starts with an initial one month block and then is mostly two day or five day blocks of lectures and learning to help develop knowledge. Your clinical skills are initially taught in a skills laboratory and are then developed in the workplace working under the supervision of a clinical educator that can be a dentist or an experienced dental therapist.

It is a novel approach to learning but works well as I will discuss further in this piece. The student is required to maintain logs of treatment delivered, write reflective logs on various issues and have case based discussions with their clinical educator throughout the year. There are numerous Direct Observed Procedures to be completed under the supervision of the clinical educator also. As you can probably imagine, this is time consuming for the student and the clinical educator but this is to ensure all learning outcomes are achieved.

There is also more mundane testing carried out at the university which takes the form of completing certain clinical gateways achieved on phantom heads and more old-fashioned testing in the form of exams, both written and practical. The course is modular so once tested on an area you move onwards. It sounds complex and difficult but it has to be as this is high level learning.

So, I approached my Clinical Director with a proposal about the course; he was initially guarded in his response as he would have to make a submission to the health board. It would mean me being absent for a considerable amount of time throughout the following year and there would be a financial impact that had to be considered. Despite this, I was given the go ahead to apply for the course and did so. I was successful in my application and due to the distance and time frame was able to complete my interview by telephone. I was successful and now the fun was about to begin.

I had to fund not only the cost of the course but also travel and accommodation. I was going to have to attend university 25 or so times with an initial one month block. Frantic bookings of flights, trains and accommodation took place alongside trying to find funding for student fees. Needless to say, everything was put into place successfully and I have now completed the course, earned a first class degree with honours. I managed to commute successfully through the year although some days seemed very long indeed. All the students on this course made huge sacrifices to attend and complete this learning journey whether it was many hours of travelling in my case, not earning an income for one reason or another, and also time away from home and family.

So, how has this rekindled my passion for dentistry? This new skillset takes the treatment I can offer to patients to a whole new sphere. I can now get patients out of pain and help my dentist colleagues in a way I only dreamt of previously. The scope of a dental therapist only differs in four respects from that of a dental hygienist but these are somewhat significant. To remove hard tissue and (deciduous) teeth is something that cannot be undone and this means that decisions to carry out care must be fully thought through with a clarity that never existed in my previous treatment planning.

The class of 2017, BSc (Hons) Oral Health Sciences, University of Essex, with Shaun back row centre
The first ‘multi surface’ filling that Shaun carried out on a real tooth set in a plaster mould, a disto-occlusal amalgam

When treatment becomes mundane then it is time to rethink. It certainly was not the patients that made my working life seem humdrum but now I carry out the treatments I previously did interspersed with restorations and extractions along with the odd lost filling or even a patient in pain that needs assessing and then either treating or referring onwards. I am, as I said previously, very lucky to be so well supported in the workplace but that aside, it has been great to learn new knowledge and skills.

I am now back into learning and I am considering my next move. I joined the army young and never went to college or university. Taking on a degree level course at 46-years-old may seem odd or even foreboding but I would recommend embracing new skills and knowledge to every single GDC registrant that feels they are in a treadmill. It is a shame to let many years of experience fall by the wayside. I am now looking at another degree, and I think 2019 is the year but I achieved a lifetime of learning in 2017.

Other BDJ Team articles by Shaun Howe

‘I’ve had a brilliant first year’ - Shaun's relocation to the Shetland Islands. August 2014. https://www.nature.com/articles/bdjteam201486

‘Oh what a night’ - Shaun on what dentistry can expect post-election. June 2015. https://www.nature.com/articles/bdjteam201581

Where will DCPs be in 10 years’ time? January 2016. https://www.nature.com/articles/bdjteam20169.