Toothache on the frontline is a potentially lethal distraction for service personnel. Ensuring that members of the British armed forces are dentally fit is the responsibility of the Dental Defence Service (DDS), who provide oral health advice, check-ups and treatment at UK and overseas military bases, as well as out in the field.
Treating dental patients in Basra or on board HMS Bristol is probably as far from high street dental practice as you can get. But these challenging environments are a major part of the appeal for those in the Defence Dental Service.
The DDS is a tri-service organisation which comprises dental professionals from across the armed services and provides dental care to over 196,000 entitled patients, essentially servicemen and women but also family dependants in overseas postings and some allied personnel. 'It's not a job where you come in and work nine to five,' says Colonel Sarah Ramage, 'but I was attracted by the prospect of different challenges and opportunities which would develop me as an individual. Although it was a leap of faith initially, I'd do it all over again tomorrow.'
In the 18 years since she joined the army, Sarah has enjoyed plenty of variety. As well as a posting in Afghanistan, she has been a vocational trainer, managed a dental clinic and worked in a number of non-clinical staff roles. 'I was going to complete my six year cadetship and then do something different, but every time I thought I was going to leave, another new opportunity came up!'
Dental officers must have a dental degree and be registered with the GDC before they enrol and receive basic military training as an officer recruit. If necessary, they complete a year's foundation training before gaining a commission and being assigned to a dental centre, where they will usually work alongside a mix of military and civilian dental professionals.
As this implies, it is not necessary to sign up for a life in uniform if you want a career as a military dentist. Sarah Locke qualified from Kings Dental School and joined after her vocational training year in 2012. 'I wanted something with a bit more financial stability and something that was a little bit different to just doing day-to-day dentistry,' she recalls.
As a civilian practitioner, Sarah has completed postings in Colchester barracks where she treated soldiers and detainees at the Military Corrective Training Centre, at Nelson Naval Base in Portsmouth, a large dental centre with 14 dental chairs, and the smaller clinic at Whittington Barracks. 'It's very different to high street practice,' she reveals, 'because although you have a lot of clinical freedom, you have to get used to the idea that the patient might be going away somewhere for months without access to dental care and that means you might have a restricted timeframe for your treatment plan.'
An occupational service
While DDS dentists provide the same range of treatments as any high street dentist, the emphasis is very much on providing an occupational service, as Surgeon Commander Tim Elmer explains. 'Armed services dentistry is about ensuring our patients have a certain level of oral health to minimise, as much as possible, the chances of a dental problem when they are doing HM Government business and that requires a different approach to the demand-led focus of high street dentistry.'
In the armed services, dentistry is free at the point of delivery and the dental officers receive a salary so their focus is entirely clinical. 'Most working days the only real limitation is how good you are with your hands and what the patient will consent to,' reflects Tim. 'If you enjoy your dentistry, to my mind there is no better environment than the armed forces in which to do it.'
Day-to-day practice at a forces dental centre involves a large slice of preventative care. Each member of the armed forces is given an initial examination and risk assessment when they join and then recalled in line with NICE guidance for check-ups and necessary procedures. DDS dental teams also provide emergency treatments for those on sick parade - dental diseases feature in the top five non-battle injuries - and are expected to take on block bookings ahead of a major deployment to ensure each person is 'dentally fit'. During these intensive periods, they can examine hundreds of patients over the course of a few days.
Surgeon Commander Tim Elmer
Out in the field
Although most treatment is delivered in a clinic, the DDS also provides frontline dentistry during operations, whether at an army base or an aircraft carrier. In 2008, Wing Commander Claire Myhill was posted to Iraq, where she treated British troops and local civilians. She is proud that her work made a difference to operational effectiveness, helping to keep people on the ground and fit for service. 'One patient presented with a failed implant,' she remembers. 'Not having any specific experience, we made a phone call back to a specialist in the UK who talked me through the process and helped me diagnose what the issue was. We ended up taking the implant out under local anaesthetic, putting it in a bag and sending it back with the patient a few months later!'
When Tim Elmer was dental officer on an aircraft carrier, there were occasions when the sea was too rough to treat patients safely, but until that point he would wedge himself under the dental chair and tie a bungee cord to the bracket table so he and the patient would 'move in glorious harmony'. At the same time, Tim stresses, he was working in a fully-equipped dental surgery and could even call a consultant anaesthetist down from the sick bay if he needed to sedate a patient.
Back on dry land, there are plenty of opportunities for career and professional development within the DDS. Sarah and Claire have both been able to study for an MSc, while Tim was selected for a consultant training pathway in dental public health. 'It was an amazing opportunity to take a mid-life change in career direction while still being fully supported by my employer, which doesn't happen everywhere,' he says.
Such professional qualifications are funded by the armed services on the expectation that the dentist will commit to a specific length of service, and Sarah does sound a note of caution. 'There are training opportunities but what the service really needs is a strong cohort of capable, high quality dental practitioners.'
'The people make it'
Anyone thinking of a career as a forces dentist should be 'prepared for a bit of turbulence,' says Sarah. 'You have to be ready to adapt and overcome but at the same time you get developed and trained and there is a lot of mentoring. No one is thrown in at the deep end.'
'Everyone needs to decide if the lifestyle is for them', adds Claire Myhill. 'We generally move around every two to three years so it's definitely a lifestyle and not just a job. It's important to do your research online and if possible, speak to someone in the services.' Like Sarah, Claire is happy with her career choice and particularly the camaraderie of service life. 'The best part is the people - they really make it,' she reflects. 'I've met a great bunch of people throughout my career which has made it so enjoyable. Challenging at times, yes, but always enjoyable!'
Interview by Susan Field
Forces dentistry - find out more
Detailed information about dental officer careers within each branch of the armed services can be found here:
Many roles are being demilitarised and civilian opportunities are increasing. Applicants for civilian roles can register to be updated about vacant DDS positions within the MoD on the Civil Service jobs website.