Paul Tipton explains to Guy Hiscott how he’s trying to tackle the skill gap in restorative dentistry – and where the British Academy of Restorative Dentistry fits in
‘I’m not knocking the universities,’ explains Paul Tipton, just a few minutes into a discussion on the dental profession and the problems it’s facing.
‘They’ve got a very difficult job to do. But over the years I’ve seen a drop-off in the clinical standards of the young dentists coming out of dental school. It’s not the academic side of things – it’s the practical aspects. The clinical skills of newly-qualified dentists are in decline. Year-on-year, they are getting worse.’
It’s not an easy point to hear for dentistry’s younger generation, but if anybody is in a position to know, it’s Paul.
His name, and the training courses that bear it, is synonymous with restorative dentistry in the UK. He splits his time between thriving private practices in Manchester and London, and – perhaps more pertinently for this particular argument – teaching dentists the fundamentals of restorative dentistry with his training company, Tipton Training.
His success in this area – Tipton Training has helped more than 3,000 dentists improve their clinical skills – is well documented, but more recently has been leading him to bigger and better things.
At the beginning of this year, Paul was unveiled as the visiting professor and programme lead for the MClinDent in restorative and cosmetic dentistry at London’s new dental school – the City of London Dental School.
If you needed any indication of how serious he is about the importance of hands-on skills, the clue is in the very qualification he has played a role in designing.
‘There are an awful lot of academic courses out there,’ Paul says. ‘So the idea with this is to blend the academic with a lot more clinical work – hence the MClinDent, rather than an MSc, which signifies it’s much more of a clinical qualification.
‘It’s an important distinction – I know that before anybody discussed it with me I was always confused about the difference between an MSc and an MClinDent.
‘But the penny drops as soon as it’s explained to you: if you want to go into practice, you do an MClinDent, and if you want to go into hospital or research work, you do an MSc.’
Fittingly enough, the new qualification dovetails neatly with Paul’s courses and the other big project occupying his time.
The bard’s tale
Paul is also the founder and president of the fledgling British Academy of Restorative Dentistry (BARD), an association dedicated to bridging that gap, and one that marks its inaugural conference next month.
The organisation offers many things, not least of which are postgraduate certification and postgraduate diploma exams that provide stepping stones on a training pathway that takes dentists from short courses to formal, university-lead MClinDent programmes at the City of London Dental School.
Perhaps more pressingly for Paul, it’s a direct answer to the problem that he feels is facing a very particular group of UK dentists: a void in one area of dentistry.
The BARD’s focus is on the set of skills that fall through the gaps in university teaching and the first few years of clinical practice; years that are often defined by the limitations of NHS dentistry.
‘There are millions of patients out there for whom minimal intervention and adhesive dentistry can’t satisfy’
Those skills are practical ones, explains Paul. Occlusion, tooth preparation, bridge design, gold restorations: the list is extensive.
‘What we’re trying to do is teach basic restorative dentistry techniques to the younger people in our profession,’ he says.
‘It’s very much the bits that universities have missed out. We’re trying to bring them back, and hopefully at the end of the day we’ll get well-trained dentists with good hand-eye coordination and good knowledge – and society and the dental community will be all the better for it.’
It doesn’t take much for Paul to explain why he sees it as such a problem.
‘There has been a definite shift to minimal intervention, and to adhesive dentistry,’ he continues. ‘Both these are fine – these treatments are great for patients in their 20s and 30s.
‘But there is a huge percentage of our population that’s been treated by the NHS “drill and fill” approach for years and years. There are millions of patients out there for whom minimal intervention and adhesive dentistry can’t satisfy.
‘That older generation still needs those basic restorative skills of how to prepare teeth for porcelain fused to metal and gold restorations, and how to ensure the occlusion is correct.’
Without the skills to tackle treatments like partial crowns, three-quarter crowns, gold onlays, and so on, Paul argues that younger dentists have a worrying gap in their skill set.
He describes it as a ‘depressing downward spiral’ for restorative teachers like himself, and one with negative connotations for patients of a certain age.
‘There are so many dentists who don’t know how to do these treatments, so they don’t offer them,’ he explains. ‘And because they don’t offer them, patients aren’t getting the dentistry they need.
‘It’s a self-fulfilling prophecy; if you’re not taught something, you won’t do it, and you don’t ever really get in a position with the NHS to learn how to do things any more.’
Filling the gap
And so we come full circle, and to Paul’s reasoning for setting up the BARD in the first place.
‘There are other cosmetic and restorative dental organisations,’ he admits. But he’s adamant that they don’t fill the same gap that the BARD is trying to.
He continues: ‘The British Association of Cosmetic Dentistry has obviously gone big into cosmetic work.
‘You look at the guys there, and they produce some gorgeous work. But what doesn’t always come through is that they’ve gone through the basics of restorative dentistry: they’ve been doing it for years and years, they’ve gathered huge amounts of experience, and now they’re showing off their beautiful cosmetic work.
Those sections of dental society aren’t what the BARD is about, argues Paul.
‘We’re trying to encourage the 25- to 40-year-olds,’ he says. ‘We want them to come back and learn those very good techniques that we were taught – the basics, really.
‘I worry that some people are trying to run before they can walk. I go to these meetings and there is beautiful dentistry being done there. But it can sometimes come through that anyone can do this cosmetic dentistry by going to this conference or that course – and I don’t think that’s quite right, in the real world. All that high-end, wonderful stuff won’t work if you haven’t got the basics right.’
Back to basics
Those basics are underpinned by one fundamental thing for Paul: occlusion. And despite its reputation as an arcane area of dental practice, don’t call it a dirty word when he’s around.
‘You ask most dentists about occlusion and the reaction is often that it’s mumbo jumbo,’ he laughs.
‘It’s always been very badly taught at university, and because of the way it’s historically been written down it puts a lot of people off after that, too.
‘But it’s the heart of dentistry. Occlusion is how the jaw works – how it moves – and what teeth should be in contact when the jaw moves. If people don’t understand that (and 95% don’t) then it can cause all sorts of problems.’
Paul talks about the importance of full-mouth dentistry – in terms of making sure everything fits together, rather than extensive restorations. It’s a song sheet that everyone in the BARD sings from, and an approach coming together in harmony at the organisation’s first conference next month.
Running over 16 and 17 May, the conference boasts 20 leading speakers, selected largely from BARD committee members. Under the careful eye of scientific chairman Martyn Amsel, the lecture topics range from endodontics to implants and everything in between.
As Paul points out, ‘restorative dentistry is a very wide field’, but he is adamant that it’s one built on the bedrock of occlusion. It should come as no surprise to find that occlusion is at the centre of his newest venture in restorative dentistry. ‘The heart of BARD is occlusion: occlusion for everyday dentistry,’ he explains