Dr Howard Lloyd talks us along the path that led to his career in endodontics.
How did you first get into dentistry?
I was always very driven as a child and had a feeling I wanted to be a dentist from a young age. There were no dentists in my family, but I always liked going when I was very young and was interested in the technological and care aspects of the profession.
I was the first person in my family to go to university and my father wanted me to follow a vocational course. I considered medicine and pharmacy as other options but felt that I’d prefer to do something directly with my hands.
At the time of choosing what O Level subjects to study, I decided that I wanted to go to UCL, and would undertake an MSc at the Eastman Dental Hospital. I didn’t know what subject I would take, but as I say, I was very driven! Not going to UCL didn’t really figure in my plan, and although my O and A level grades were average, they were enough to get me a place.
What inspired you to pursue your specialty?
My first job after qualification was House Officer at UCH Dental Hospital. My main consultant was Dr Andrew Hyatt. He was responsible for endodontic teaching for the undergraduate course and I spent one or two mornings each week in his clinics. I enjoyed this but didn't think much more about it.
After UCH I worked in oral surgery departments for a couple of years and then became a registrar in restorative dentistry at Cardiff Dental Hospital. I worked under a number of consultants there but I specifically remember Dr David Edmunds and Professor Paul Dummer, both of whom had a great interest in endodontics and encouraged me.
I then moved to the Eastman Dental Hospital as a registrar and after two years had to make a decision about which way to go - leave and go into practice or to try to obtain a place to study further on one of the MSc programmes. After some discussion with friends and people already on the course, I made an application and was lucky enough to be accepted. I never thought I would be working full-time in endodontics, more that it would be an interest along with other things.
What do you like most about working in endodontics?
The things I find most appealing about endodontics are the technical challenges, treating pain, managing nervous patients and trying (but not always succeeding) to disabuse them of the myth that root fillings are painful, unpleasant procedures. I enjoy re-treatment and surgery, and whilst it may seem to some that there is little variety in the work, in reality there is quite marked variation through the day.
Dr Howard Lloyd
Many dentists seem not to like or enjoy endodontics and I can fully understand this. It's certainly not for everybody. It requires a lot of patience, a good eye for detail and remaining calm when things are not going as well as one would like. Having done nothing but endo for just over 20 years, I think I’d be pushed now to try to do any other form of dentistry.
I think it's easier to aim to do one thing very well than to try to do a number of things to a good standard, and I feel that general dental practitioners have, in many ways, a much harder job than I do. For me, the teeth are difficult but I only I have to do the one procedure, and for the most part the patients and referring colleagues are appreciative.
I like much less the increasing level of scrutiny and the threat of litigation. The defence organisations are finding that a large proportion of claims made against dentists are for problems in endodontics. I am frequently requested to provide records of my treatment as part of an ongoing claim against other dentists, and the claims often seem unduly harsh. I do think that some could be avoided by dentists taking great care in assessing a case and their own abilities before starting treatment.
Referral endodontics is often quite costly and patients may be unwilling to pay. But if a procedure goes wrong and it can be shown that the procedure is way outside what would be expected of a general dentist with a certain level of experience or expertise, it may be that a claim will be successful.
What additional skills have you learned as a result?
Other skills that I think have come as a result of my choice of career include problem-solving, communication skills, public speaking, personal resilience when things aren't going as planned and empathy with patients when they are undergoing sometimes tough procedures. I was lucky enough to be President of the British Endodontic Society a few years ago, which was a great honour.
What advice would you give to anyone considering this specialty?
For a young dentist considering their future, I could certainly recommend specialising in endodontics although it is not the easiest route to choose. Training pathways are now three years long, and can usually only be undertaken after obtaining a few years' experience in dentistry. Postgraduate programmes are costly, but against this, incomes are generally good and job satisfaction is high. Things are always moving forwards but I think it is unlikely that we'll not be needed in the future, no matter how easy the newer instrumentation is to use.