Who wants to be a dentist?

September in the northern hemisphere conjures the start of early morning pre-autumnal mists, reaching into the bottom drawer for long-buried favourite jumpers, and back to school. The start of academic terms throughout the world provides emotionally charged memories of encountering new places, people and challenges which ultimately help shape our lives. Such as starting dental school. Hundreds, thousands of young people are poised to take these first steps but what has motivated them to do so, and what if the appeal is diminishing?

One stated objective of the recently published NHS Long Term Workforce Plan is an expansion of 'dentistry training places by 40% so that there are over 1,100 places by 2031/32. To support this ambition, we will expand places by 24% by 2028/29, taking the overall number that year to 1,000 places'.¹ This is potentially the stuff of rousing positivity, of cheers from the halls of dental education and candidates scrambling for the extra opportunities. Yet there are caveats to consider before we toss our putative mortarboards skywards. To begin with, we must not lose sight that this is entitled the 'NHS Plan', the primary aim of which is to provide more pairs of hands for NHS dentistry. Then there are the recent moves to improve patient access by tinkering on the peripheries of the scope of practice for dental care professionals. Many of us are not opposed to expanding the roles of our team members but if this is to be the case then the nature of the job of dentistry will necessarily change too. As we are projecting ahead, we need to consider this or more pertinently future dentists need to be appraised of this so that they can make informed decisions. We are constantly pressed on the need for valid consent, are we not?

We also need to think about the wider landscape. The move to train dentists is to throw a rope ladder to today's politicians to help them stumble out of the NHS dental contract funding hole. Who will they be by 2034 when the first of these new recruits qualify? By my reckoning at the minimum that is at least three general elections away. Fascinating.

Turning back to our own considerations, bluntly, will there be sufficient numbers not just to populate the increased appetite for places but to fill them with the appropriate calibre, mix and diversity of candidates? The assumption is that there will be, but reference to a paper in the previous issue of the journal by Niven et al. gives me pause for thought.² The authors researched the journey of teenagers through the decision-making process of applying to dental school. Some of their findings reflected changes in society while others were soberingly reminiscent of exactly the same motivations that drove me and my peers to trudge the same roadmap over half a century ago. What struck me about the thoughtful Niven et al. paper was that very little has changed in the process of considering a career in dentistry. What will it take to change this? If indeed change is deemed necessary or whether, like coal miners, milkmen and supermarket checkout staff, it will ultimately be market forces which overtake our moral discussions, professional hand-wringing and internalised soul-gazing to make the decisions without us.

It is incumbent on us to decide not only what sort of dentists we want to be in the future, but also to determine who, exactly, will want to be us.

The discussion must encompass not only what sort of dentists we deem appropriate, as a profession, but also what type of person will be suited to being a dentist in the late 2030s and beyond, and what type of work will suit them. Given our current focus on stress, burnout and mental health, these are more than abstract constructs. In throwing back to the 1970s A-level requirements, may I ask if, for example, our future needs are for further cohorts of the contemporary, academically starred youngsters when the majority of tasks look increasingly likely to be AI-mediated tooth whitening, cosmetics and retainers? Do we need more behavioural management, greater patient empathy and less enthusiasm for micro-engineering?

One of the discussion points in the Niven et al. paper was that as dentists, our influence on the career choice of young people could be huge, but in reality is very passive and slight. We are almost ghostly figures, having far more impact as family members than as otherwise impartial and informative professional role models. If this is indeed the case, then are we also to be half-hearted in the concomitant bearing we have on shaping our prospective colleagues? It is incumbent on us to decide not only what sort of dentists we want to be in the future, but also to determine who, exactly, will want to be us.