Presidential address

The Presidential and Valedictory addresses published here were given at the British Dental Association Wimpole Street Office in London on the 2 May 2019.

In her Presidential Address last year,1 Susie Sanderson talked about dentists being allowed to function within areas in which they are confident and comfortable, a theme central to this address. Ladies and gentlemen, may I, on your behalf, congratulate Susie on what has been a very busy and successful year? I can safely say Susie has worked tirelessly on your behalf and will be a hard act to follaow, but I promise you I will do my best to emulate her example in order to repay the huge honour bestowed on me by the British Dental Association (BDA).

Roslyn Elizabeth McMullan, BDA President 2019/20

Dentistry became a profession to protect the public from the snake-oil sellers and quacks plying their unregulated trade to the unsuspecting public, and with professional status a patient-centred, evidence-based and societally valued profession evolved. It allowed a mutual trust to develop between us, our patients, the government and regulatory bodies, which in turn empowered dentists to practise with confidence that we were respected and supported. I am proud to be a dentist. It has given me a hugely enjoyable and satisfying career. However, since I started my career forty years ago, a tectonic change has occurred in my beloved profession.

An opinion piece was recently published in BDJ In Practice by Dr Alun Rees,2 'Is Dentistry making us sick?' It starts with the statement, 'Dentistry is tough'. I don't think any of us would argue with that. These are certainly difficult times in the profession with a massive reduction in practice income and increase in expenses that most small businesses would struggle to cope with. Associate contracts have come under similar pressures over the last ten years. Young dentists are coming out of university with large debts. Our community, hospital and academic colleagues are also affected by funding pressures, trying to maintain high standards of care, teaching and research, with reducing budgets alongside demanding performance targets and often concerned they are not valued by the organisation they work for. This, in addition to the burden of regulation and fear of complaints, has produced a profession that is anxious and constantly looking over its shoulder. For some, the stress can be overwhelming.

While reflecting and learning from mistakes is important, it is equally, if not more vital, to learn to celebrate your success

If experienced in short bursts, stress is important for a healthy body, mind and spirit as part of our physiological flight and fight response mechanism. However, if stress becomes overwhelming it can lead to burnout. Mindtools definition3 is particularly useful. 'Burnout occurs when passionate committed people become deeply disillusioned with a job or career from which they had previously derived much of their identity and meaning. It comes as the things that inspire passion and enthusiasm are stripped away, and tedious or unpleasant things crowd in'.

Recent research by the BDA shows there are very worrying levels of stress and burnout in the profession, particularly among general dental practitioners (GDP) and community dentists, with those aged 35-44 worst affected. In GDPs, scores typically increase as the proportion of NHS work increases. Morale is also very low within the profession; more than two-thirds of practice owners, over a half of associates and a third of community dentists report low or very low morale. Nearly two-thirds of dentists are considering leaving the profession. That statement is worth repeating; nearly two-thirds of dentists are considering leaving the profession. That is nothing short of a travesty.

High levels of stress and burnout can manifest physically and mentally. I like the clarity of Professor David Peters, Clinical Director of Westminster Centre for Resilience and a trained general medical practitioner when he says, 'long term drowning in adrenaline and cortisol eventually makes you ill. Before that, it makes you stupid and unfriendly'. Being stupid and unfriendly are not good traits when working with people and treating patients. You will make mistakes and get complaints.

Prevention of stress-related illness involves doing all you can to maintain a healthy body. Keeping up to date gives confidence and having professional support where you can get advice in a safe, confidential and non-judgemental environment is essential. Allowing yourself not to become isolated, attending professional meetings for that soft peer support and having an appropriate work/life balance are all important in maintaining good mental health. BDA Branch and Section meetings, as well as the many excellent seminars and training courses, not only mean our members access high-quality and relevant CPD, but are also important opportunities to prevent isolation and get peer support from the 'dental family'.

While reflecting and learning from mistakes is important, it is equally, if not more vital, to learn to celebrate your success.

Recognising the signs and symptoms of stress is key and many good stress awareness courses are available in the UK. There is an online two-hour CPD verifiable course available on the BDA CPD hub (https://cpd.bda.org/course/info.php?id=112). If you haven't already done so, I encourage you to take this course. It is preferable to not do both one-hour modules at the same sitting and take time in-between to reflect.

Developing resilience and coping strategies is important in having a healthy approach to life's difficulties, but I am afraid it will not prevent someone feeling pain when they do come along. If you are feeling overwhelmed and unable to cope, then reach out and ask for help. You can recover and go on to have a successful and richly fulfilling career. The famous psychologist, M. Scott Peck starts his best seller4 The Road Less Travelled with the statement 'Life is difficult'. That it certainly is, but that very fact makes overcoming the difficulties all the more rewarding.

There are many organisations and individuals who voluntarily give up their time to raise awareness of stress and its impact and give practical help to dentists and their teams who are suffering burnout. They include the Dentists' Health Support Programme (BDHSP), BDA Benevolent Fund, LDC PASS schemes, Probing Stress in Dentistry in Northern Ireland (NI) and Stress in the Dental Workplace Working Group in Scotland. I want to take this opportunity to thank all of those involved in this important work, helping, dentists and their families and the wider dental team on a daily basis. If you feel this is an area you can volunteer, please make that decision now to get involved. Think about making a regular donation; your contribution will make a difference. On that theme, many dentists and their teams give their time, skills and money supporting many charities helping those in need, both within and without healthcare. That work often goes unnoticed, but it always makes a difference; thank you.

Trust and respect are the building blocks of any good working relationship. Trust is a hard-won quality that is achieved by reputation and experience. To trust you must have confidence in the reliability, honesty and ability of yourself, others or organisations and it can be so easily destroyed by a single, poorly-considered word or action.

There is a direct inverse relationship between stress and trust. Therefore, it makes sense that to reduce the profession's stress, we should work to increase its trust. Everyone involved in the policy, commissioning, practice, regulation and representation of dentistry has a role to play by ensuring building and maintaining trust is central to every decision made and everything that is said and done.

We all know that toddlers fall down before they learn to walk. In fact, it is in learning how not to fall down that they eventually succeed. It is not long before they become so confident, they can run and jump. We must allow young dentists to develop in an environment with non-judgemental feedback and support, allowing them to reflect and freeing them up to tackle more difficult cases with confidence. Keeping up to date is an integral part of professional responsibility and even experienced dentists will be on learning curves as new evidence-based techniques and materials are introduced during their practising life. The indemnity providers must build trust that they can effectively protect the profession against opportunistic claims for outcomes that are part and parcel of normal healthcare, while having sufficient funds to fairly recompense the occasional patient harmed by clinical negligence.

The General Dental Council must regain trust by championing the profession of dentistry and acting wisely and proportionately when dealing with complaints. They must demonstrate to the profession that they accumulate and use our money frugally. All those who commission and regulate dentistry must not ignore the systemic failures, rather than taking the easy route of focusing blame on the individual practitioner.

We must be confident that the BDA will put dentists at the heart of everything they do

We must be confident that our government understands and values dentistry and recognises that prevention of dental disease is key, ensuring oral health remains integral to the population's overall well-being. We must be able to trust the dental leaders in all four nations to deliver a system of NHS dental care that is respected, valued, properly-funded and supports dentists, no matter in what area they work, to help our patients aim for good dental health from cradle to grave, rather than count widgets and fret about clawback.

We must be confident that the BDA will put dentists at the heart of everything they do, no matter what stage they are in their career or where they work. We must be able to trust the Association to deliver practical and timely support and effectively represent you in all your diversity.

Above all, we must have confidence in ourselves, celebrate our successes and learn from our mistakes.

Over the last few years, as the dental profession has lost trust and become increasingly stressed, it has also been very hurt by, and is still angry with the absence of respect accorded to it and the distinct lack of willingness to listen to its voice. There is some evidence that these attitudes are changing, and the tide is turning. While I have to give up hope for a better past, I reflect on these subtle changes with ambition for the future. 'Together we are stronger', to coin a BDA strapline.

The moment I arrived in the Dental School in Queen's University, Belfast, I had no doubt I had made the right decision. After gaining FDSRCSE in 1984 and qualifying as an orthodontist in 1987, I was appointed Consultant Orthodontist in the Western Health and Social Care Trust in 1991 and remained in that post until my retirement in 2016. During that time, I took on roles within the governance structure of the Trust, mentorship and appraisal schemes as well as Clinical Lead in Specialist Surgery. I always enjoyed, and gained much personal benefit from, training the next generation and I chaired the Northern Ireland (NI) Deanery Hospital Training Committee for eight years. Throughout my career I have helped support and encourage dentists and doctors who have found themselves in difficulty, often caused by stress.

While a student at Queen's, I became involved with the British Dental Students Association, gaining my early committee experience as Social and Hon. Secretary. After qualification I was encouraged to play an active part in the BDA NI Branch, earning my wings by helping to organise the annual presidential installation dinner, an event which remains a highlight in the NI Branch calendar. I was NI Branch President in 1999 and I have been an elected member and Chair of NI Council since 2015.

I have had a long, happy and mostly healthy career. That is not to say that every day in the last forty years has been stress free. In fact, I can recall life-impacting tensity, occasionally for long periods of time, brought on by challenges both within and without my working environment. My resilience came from ensuring my non-clinical work always came second to doing what I loved: treating patients and feeling valued in the clinical setting. I had the support of a great team, a very proud family, a secure friendship circle and many great teachers and colleagues, some of whom went on to become my mentors. Not that they thought of themselves as that, they were just generous in their time and advice when I went for help. Some of them are here today and I thank them for making the journey to be part of this special occasion. I always enjoyed attending BDA Branch events, which helped prevent isolation from my peers, a distinct risk in my career. I also have a life outside dentistry when I can stop thinking about it, at least for a little while.

I look with love at the next generation of my two nephews, Edward and David, as they carve their way in this world with all its pleasures and heartaches. While I understand why neither decided to go into our noble profession, I am trying ever so hard to forgive them. Neither of my parents have survived to see this day, but I know that they are here in spirit and in the legacy of life values they have left to our family.

I was deeply honoured and humbled when I was asked by the NI Branch if I would allow my name to go forward for consideration as President of the BDA and I thank you for your confidence in me. Ladies and Gentlemen, you can trust me to uphold the standards of our Association and celebrate all those within the branches and sections who give their time and talents to support dentists and organise events around the UK. You can trust me to laud you and the brilliant work you do every day that is so valued by your patients.

If you are feeling overwhelmed, please contact Dentists' Health Support Programme. Tel. no. 0207 224 4671. Samaritans Tel. no. 116 123 (UK) 116 123 (ROI).