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Restorative dentistry Expertise

by Mr Christopher J Allan
BDS FDSRCPSG FDSRCS Eng MRD
Consultant in Restorative Dentistry
(More about Mr Allan)

Restorative dentistry is concerned with the diagnosis and treatment of diseases and disorders of the teeth and their supporting structures, including their repair and replacement. It involves adults primarily, including those with special needs such as may be associated with medical, mental and physical disability. It includes the disciplines of endodontics, periodontics and prosthodontics.

  • Endodontics: the diagnosis and management of diseases of the dental pulp resulting from dental disease and trauma.
  • Periodontics: the diagnosis and management of diseases of the supporting structures of the teeth, gum and bone.
  • Prosthodontics: the provision of complete and partial dentures, and more complex restorations such as crowns, bridges and veneers. Dental implants may be used to support crowns and bridges or to retain removable dentures.

Restorative dentistry, therefore, encompasses much of the dental treatment provided in primary dental care – general dental practice and the community dental service.

The most common dental diseases and disorders encountered are dental caries (decay) and periodontal (gum) disease and their complications and consequences for function and appearance. A number of other congenital and acquired disorders are or may be within the scope of restorative dentistry, such as congenitally missing teeth, tooth wear, dental trauma, pain management and dysfunction of the jaw joints.

Much of cosmetic dentistry falls within the scope restorative dentistry too. Patients frequently require complex restorative dental treatment after surgery for dental and facial trauma, repair of cleft lip and palate and removal of tumours from the mouth and jaws.

Restorative dentistry is also recognised as both a hospital and ‘high street’ specialty by the General Dental Council (GDC). It includes the GDC-recognised specialties of endodontics (root canal work), periodontics (treatment of gum disease) and fixed and removable prosthodontics (repair and replacement of teeth). The last of these also includes implant dentistry.

While some patients may require relatively simple treatment from only one specialist, many patients require multi-disciplinary diagnosis, treatment planning and treatment along with colleagues in orthodontics and oral and maxillofacial surgery.

Legal context

All of this may have great significance in the legal context. Many patients are living longer and wishing to retain their teeth for longer, which may result in the need for more complex treatment and concomitant medical management. Their expectations of treatment are tending to increase, often without a concomitant understanding of the underlying problems. These are societal trends exacerbated to some extent by the media and by the profession itself.

Patients are entitled to complain when things appear to have gone wrong, and particularly when they may have sustained actual harm. Patients may complain about unsatisfactory treatment of many kinds, missed diagnoses, inadequate pain control, etc., and these complaints may raise concerns about treatment planning, risk assessment, consent, quality of x-rays, infection control, technical laboratory work, maintenance care, etc

First, find your expert

The specialist lists in restorative dentistry, endodontics, periodontics and prosthodontics maintained by the General Dental Council should be reliable sources of expertise. But they give no indication of interest in dento-legal work. The following dental postgraduate qualifications may be indicative of the necessary clinical expertise. NB This list is not exhaustive

FDSRCS Ed, FDSRCPS Glas or FDSRCS Eng, each followed by (Rest Dent). This is the qualification currently recognised as being required for appointment to a consultant post. The letters stand for Fellow in Dental Surgery of one of the Royal Colleges (Edinburgh, Glasgow or England), and the specialty (Rest Dent) in which the expert is trained and has passed an exit examination.

Since 1994, MRD (Membership in Restorative Dentistry) (Endo) or (Perio) or (Pros) is awarded on completion of training and passing an exit examination in one of the mono-specialties of restorative dentistry. It is awarded either by the Royal College of Surgeons of Edinburgh or jointly by the Royal Colleges in Glasgow and London

MClinDent or Masters in Clinical Dentistry is awarded on completion of a taught clinical programme, usually in one of the mono-specialties, but not to the level of a specialist. Note that some may have been granted entry to a specialist list through mediated entry. A number of other diplomas are appearing in various aspects of restorative dentistry, including implant dentistry, but their level is usually pitched at the general dental practitioner with a special interest.

Other letters may appear such as MSc, PhD, MDSc, DDSc, etc., awarded by various universities. Many of these are indicative of completion of a period of research, with or without clinical training. While these qualifications are usually of a high standard and worthy in their own right, they should perhaps be treated with caution when seeking an expert unless the qualification FDS or MRD accompanies

MFDS, or Membership of the Faculty of Dental Surgery of RCS Edinburgh or RCPS Glasgow or RCS England, and MJDF, or Membership of the Joint Dental Faculties (RCS England and Faculty of General Dental Practice UK) are qualifications taken about 2 years after graduation or on completion of general professional training. These qualifications used to be required for entry to specialist training but are no longer a requirement. They are certainly not specialist qualifications!

by Mr Christopher J Allan
BDS FDSRCPSG FDSRCS Eng MRD
Consultant in Restorative Dentistry
(More about Mr Allan)

 

 
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