As lockdown continues, and we face another few months of life without access to our traditional gym settings, I have been inundated with questions regarding training strategies that can be implemented at home.
Hi my name is Frances Robinson and I am a dental hygienist working in London; primarily in the Harley Street Medical District. I am particularly passionate about patient care and reducing oral health inequalities.
Recently I was successful in securing a prestigious fellowship with Health Education England, becoming the first dental hygienist to ever hold such a post. My ambition for my career is to continue to develop my clinical skills by working with distinguished specialists at my dental practices. Meanwhile continuing to foster my public health career working to strengthen our health systems and reduce oral health inequalities.
I qualified from Cardiff university in Dental Hygiene and moved to London where I was lucky enough to start my career in St Johns Wood, in a wonderful practice that nurtured and encouraged me. It took a long time to build my working week as most hygienists are self-employed and work at a few different places at a time. I worked across both NHS and private settings gradually moving around getting a feel for different practices. I also did a lot of locum work which was invaluable at the start of my career; it allowed to me work in numerous practices, meet lots of people and decide what kind of practices I wanted to base myself in.
After what, in hindsight was a bit of a life changing trip to Nepal with a dental charity; I realised the need for a drive in dental public health both in the UK and globally and from there went onto study a masters at University College London in the subject. I really want dental public health to become a bigger part of my career in the years to come; hence my fellowship now. Other healthcare professionals like Dental Hygienists, Dental Nurses, Nurses, Occupational Therapists and Physiotherapists, not just Doctors and Dentists, have a huge part to play in improving the health of the population.
I have always wanted to work in dentistry even though my parents weren’t in the profession. However, my parents were hugely supportive and encouraged me to secure work experience from aged 12!! I really encourage anyone looking to go into dentistry, dental hygiene or any medical field to really do as much work experience as possible. Phone all your local practices and ask them to meet you. Try to visit different clinical settings like an NHS practice, a private and or specialist dental practices and community clinics. I also visited a dental technicians lab (where they make the crowns and bridges etc) to diversify my CV.
I also think building your CV outside of education is really important for university and future job prospects. For example, I volunteered with my chosen sports and hobbies, achieved various awards and dedicated myself to leadership roles. To work in healthcare, you have to be a good communicator, be passionate about what you do and have good time management. So, I would recommend building a CV that reflects those qualities. In dentistry you have to be pretty manually dexterous so having skills that demonstrate that will help your application stand out. Also finding yourself a mentor who will champion and encourage you throughout your career is really helpful.
Dental hygiene is a very preventative focussed profession and therefore our teaching aligns very well with education of others; it's part and parcel of the job. But I think to be a good dental hygienist having a passion in oral health promotion is key. I am often called 'gentle' and 'thorough' in my clinical work which is a compliment I take particular pride in.
I think competing in sports allowed me to develop skills that I have taken forward in to the work place like good communication and fostering an inclusive environment. Team work is essential in the healthcare environment - I am always discussing cases with the specialists I work with so we support each other better and serve our patients.
My position of volunteer fundraising officer at Dental Mavericks was spurred on by my interest in public health and the desire to do more globally to improve dental access and education. I use the skills gained in my masters degree to write grant proposals to funding bodies and strengthen our research base. It is very rewarding work and I work with such a fantastic determined team.
I don’t think I was always super organised but it’s a skill I had to develop. I kept very busy outside of school and now outside of work. Balancing extra circular hobbies prepared me well for a clinical role where I am self-employed and work at various practices.
Working with people 1 on 1 is the main reason I love the job. I think you would find this line of work difficult if you weren’t a people person - I find the interaction stimulating and rewarding. You must think on your feet the whole time - there’s no having a biscuit break when you have a patient in the chair!
Revolutionising the way people think about a dental hygiene appointment is key, because I truly believe positive experiences get better clinical results. Trying to bridge the gap between the scientific community and the general public is important in this job; making sure I am treating patients to the highest evidence-based standard is very important. Building trust and a longer-term relationship is something I thrive on and that’s what keeps me passionate about the job.
I love treating complex cases which require many visits and treatment planning, often with multiple clinicians- but thankfully I don’t see too many of these! It’s great to see someone develop get great results though. Oral cancer patients and those with complex medical histories are also really interesting, these cases are particularly fulfilling.
I wish I could spend more time with chatty patients! I love building the knowledge of someone outside them being my patient. It’s friendly and I think it makes the professional relationship stronger too. For example, I might note down where someone is going on holiday, how many grandchildren they have, what their hobbies are etc.
I would also like to encourage “putting the mouth back in the body” approach to dental and medical care whereby we work more closely together as part of multidisciplinary teams. So many general diseases and conditions are linked to oral health; a more integrated oral health and general health workforce would serve the population to lead much healthier and happier lives.
It is hard to think you are not reaching those most in need. I fulfil this notion by doing volunteer work with various dental charities both in the UK and abroad. As I now work for Health Education England, I feel like I can reach more people with my work there on a day-to-day basis. We work on projects and programmes to strengthen the oral health workforce, make health more equitable and accessible and address the major issues in oral health facing the population now.
I tend to cycle into work - it allows me to combine fitness with the commute; my cycle is around 45 minutes one way! I generally get into my surgery about 40 minutes before my first patient to set up, go through patient notes, have a coffee, and prepare myself for the day. If I have a big case on, I will have looked everything out ready for whenever I see them in the day.
I generally see my patients for 45 minutes for standard appointments, but it can be up to 1.5 hours for a bigger treatment. Therefore, I generally see 8-10 patients a day. All my patients are on individually tailored oral health plans which consist of their home oral hygiene routines and their treatment plans.
All recall times are fluid, I may suggest different time scales depending on someone’s progress, they are never fixed. Someone that has brilliant oral hygiene and has had minimal dental treatment carried out will be on a 6-month recall. Those with orthodontic retainers or a tendency to slip with their oral hygiene will be on a 4-month recall. Those who have gum disease or have dental implants placed will be seen every 3 months. And if someone has very unstable gum disease then they will be seen every two months.
At the moment, due to the pandemic, I am seeing lots of patients that have slipped with their oral health where they were usually well maintained. In this case I would suggest they come back in a 2-4weeks for a further appointment and then hopefully we can get them back in their normal recalls after that.
I see a mix of patients, most are for a routine preventative hygiene treatment and oral health advice however, some are more tailored for those struggling with gum inflammation or staining. I use hand instruments, an ultrasonic scaler (with the water jet), a polisher or air polisher and various oral hygiene aid like floss and interdental brushes.
I regularly give local anaesthetic as either a numbing gel or as an injection into the gum. This is usually for deeper cleaning under the gums for gum disease, but some patients prefer it for routine hygiene appointments too. I also treat patients who have been sedated as one of the specialists I work for has many dentally anxious patients. This is either via oral sedation so taking a tablet prior to the appointment or intravenously, where I will have an anaesthetist working alongside me. The intravenous sedation is a lot deeper, almost like sleeping and patients don’t remember anything from the appointment!
Most of my appointments are aerosol generating procedures due to the instruments I use which means due to Covid-19 I have to wear enhanced PPE. This includes full surgical gown, ffp 3/respirator mask, eye wear and a face shield. There must also now be gaps between each of these appointments to let the air settle whilst an air filtration system works to reduce contamination.
You should see a health care professional that you trust. A referral from a friend or family member is usually how we have new patients attend our clinics. This is essentially word of mouth and is a lovely way to be introduced. Ensure you dental professional is registered with the General Dental Council (GDC) – this should be on their website or displayed in the practice.
If you can, look at their profile on their practice website to get a feel for what kind of clinician they are; for example;
Also, social media is great way to align yourself with a clinician now as people show case themselves on platforms like Instagram. You can then use their professional page to ask them about the services they provide before you book an appointment.
Everyone should really see a dental hygienist so I encourage everyone to book in – you will have an opportunity to ask questions and learn more of how to help keep your oral health on track.
Definitely ask what you can do you can do to improve your oral health, what other oral hygiene aids you can use, if the things you are using at the moment are suitable – this will ensure you know what to do in between your appointments.
Other good ideas for questions include;
No question is ever too small or silly – ask it anyway and you might get the answer you were always looking for!
Some people should see their hygienist more often; you will be informed of a suitable recall period when you attend your appointments, it is best to stick to what has been suggested as its been tailored to you personally.
To prepare for your appointment get there a little bit early to fill in any forms or medical histories before your seen by the hygienist. And - always make sure you brush your teeth beforehand! (top tip: most dental practice will keep some toothbrushes behind reception for you to use!)
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