Why should dental students get experience in oral surgery?
I think it’s important to do something you enjoy and I found oral surgery enjoyable from the start, but developing those skills will also be valuable when working in general practice.
Dental school gives you some experience with surgical procedures, such as extracting wisdom teeth or retained root removal, but you would be unlikely to achieve the level of competence necessary to feel comfortable doing the trickier procedures, such as dental implant placement.
Taking a hospital training post after your first year of foundation or vocational training means you’ll have the chance to practice and improve your basic surgical skills and get experience in inpatient management, from suturing facial lacerations in A&E to caring for patients as they recover from surgery. Even if you only do this for a year before working in general practice, getting that broader experience is a great foundation for your career.
In what way?
You’ll be in a much better position to carry out the kind of treatments that are in growing demand in today’s dental practices. For example, dental implant surgery would typically involve lifting the gum off the bone, stripping the bone and drilling into it.
When I qualified as a dentist in 1981, around a third of the UK population were edentulous and many of them had replaced their natural teeth with dentures to celebrate their 21st birthday! Now patients expect dentists to save their teeth, which creates its own challenges. If you eventually need to extract a tooth that has been root-filled and heavily restored, then it’s more likely to need surgery as it’s more brittle and prone to break at the gum line.
Again, it all comes back to acquiring those basic surgical skills that should help you gain the confidence to handle most clinical situations.
What made you choose a dental career?
I didn't choose dentistry as a career until the sixth form. I distinctly remember reading a prospectus for the old Newcastle Dental School in the school careers office and something clicked. I thought: this was the career for me.
How did you come to specialise in oral and maxillofacial surgery?
Back then, it was possible to do a couple of house officer posts in the dental hospital after graduating, so I did a lot of oral surgery at Newcastle and really enjoyed it.
I then took a senior house officer (SHO) post in oral surgery in Taunton. That department consisted of two consultants and two SHOs doing a one-in-two on-call rota, covering the whole of West Somerset. I was very busy, but it was an amazing year, and I got the bug.
I was on the verge of going back to do a five-year medical degree to pursue this career when a paid lecturer post at the Sheffield University came up. It offered a rare opportunity to combine teaching with higher specialist training in oral and maxillofacial surgery, alongside studying for a PhD.
Seven years later, I had completed my thesis on lingual nerve repair and received my certificate of accreditation in oral and maxillofacial surgery from the Royal College of Surgeons.
What did you do next?
In 1995, I was appointed senior lecturer/honorary consultant in oral and maxillofacial surgery in Sheffield where I stayed for 22 years.
As a clinical academic I effectively had three overlapping lines of work with very different demands:
- teaching
- clinical research into areas such as the sequelae of nerve injuries, which also involved presenting my work at international meetings
- maintaining my surgical practice where I developed a special interest in orthognathic surgery to reposition the jaw.
Life was hectic but I loved the variety and job satisfaction.
I thoroughly enjoyed my NHS career and had no real desire to stop, but in 2017, at the age of 60, it felt like the right time to ease back from the kind of surgery I had been doing, which involved intensive operations that could last five hours or more.
Although I’m retired from teaching and NHS practice, I’ve continued to work. I now have one private clinic per week and an operating list of less complex day cases such as impacted wisdom teeth and nerve repair. In addition to my clinical practice, I do a lot of dento-legal expert work for the DDU, among others.
What does your dento-legal work involve?
My interest in dento-legal work arose from my own surgical practice. When we began repairing lingual nerves there was invariably evidence that the nerve injury had occurred during the removal of the patient’s wisdom tooth, but we felt quite strongly that this was an unfortunate complication of the extraction rather than negligence by the surgeon.
That led me to work with the DDU, which defends surgeons in these kinds of clinical negligence claims. I’m currently on the DDU dental advisory committee, and I’ve been a member of the MDU Council since 2014.
I can often tell from an early stage whether a claim is defendable, but a few cases do get to court – I have three court appearances scheduled this year and I gave evidence at two last year. In both of these claims, the DDU was defending the dentist and were successful.
Do you see many oral surgery claims against high street dentists?
In the present climate, general dental professionals are expected to take on more cases that might once have been referred to the local hospital, such as impacted wisdom teeth, difficult extractions due to a long or curled root or complex root canal treatments. All these procedures carry the risk of nerve injury.
Unfortunately, things can always go wrong during oral surgery but there’s a feeling that if a procedure hasn’t gone to plan then someone must be at fault. I’ve been asked to give an expert opinion on cases where there was a known complication, and the records show that the patient had been warned about it.
However, when I give lectures on how not to get sued, I tell my audience that one of the most important factors is how you manage the situation when something does go wrong.
In my experience, the thing that upsets patients the most is when the practitioner won’t accept that they have caused nerve damage. I even remember a case from my surgical career where the patient actually told me they were going to sue the original surgeon to teach them a lesson for being arrogant.
As the DDU advises, open and honest communication with patients is always the best approach following an adverse incident.
Careers information
If you want to specialise in oral surgery, you’ll need to apply for a dental core training (DCT) post in oral surgery.
After completing at least two years DCT to gain the necessary skills and experience, you’ll be eligible to apply to enter a specialty training programme through the national recruitment process.
Specialty training for oral surgery takes three to four years and follows a curriculum approved by the GDC. If successful, you’ll receive a Certificate of Completion of Specialty Training (CCST) in Oral Surgery, meaning you can join the GDC’s specialist register.
Note that oral surgery overlaps with and complements oral and maxillofacial surgery and many hospitals appoint consultants in both specialties. However, it is recognised as a medical specialty by the GMC, so most consultants are dually qualified in dentistry and medicine.
Not a DDU member?
The DDU is here for you as a student and throughout your dental career. Visit the join DDU pages to explore the benefits of membership now and beyond graduation.
This page was correct at publication on 14/05/2025. Any guidance is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.
by Dr Keith Smith
A respected oral surgeon with more than 30 years’ experience.