DDU journal: What drew you to dentistry?

Dr Susan Tanner: At school I loved the sciences, but I also wanted a career where I could be creative with my hands and my brain. Dentistry ticked all the boxes, especially as a profession where we are able to meet lots of new people, which is an aspect I love. I trained at University College Hospital, and then sought to lay strong and broad foundations with hospital positions in maxillofacial surgery, paediatric dentistry, orthodontics and prosthodontics.

A part time master's degree in prosthetic dentistry at the Eastman Hospital allowed me to use the new skills I was learning in part-time practice, where I started to work with some of the first dentists in the UK to work with Professor Branemark. I was lucky to do an implant course in Gothenburg as well as one in maxillofacial prosthetics on implants. At this early stage in my career I also set up a prosthodontic service in the Maxillofacial Department of St Bartholomew's Hospital (long before it became part of the Royal London). I then committed to full-time private practice.

DDUJ: …and then to implant dentistry specifically?

ST: Implant dentistry was so new and exciting in the very early '90s, and the research coming out of Sweden was so enticing. I was lucky to have the opportunity to train in Gothenburg at the Branemark Clinic and meet the incredible Professor Branemark himself. I carried out some research on implants during my master's degree at The Eastman Hospital, and together with Dr Andrew Dawood we began to incorporate implant dentistry into our everyday practice, The Dawood and Tanner Specialist Dental Practice - treating our first patient in 1993.

DDUJ: What aspects do you like about it?

ST: When implants have been placed correctly, with a careful, prosthetically-led plan to guide the surgery, restorations supported by dental implants are often an excellent alternative to a dental bridge or removable denture - a wonderful addition to our armoury.

The accurately machined prosthetic parts of an implant system are a pleasure to work with and it can be quite straightforward to give the patient a beautiful result. Providing a full arch bridge for a patient can be particularly fulfilling, sometimes offering a fantastic improvement to a patient's whole quality of life.

DDUJ: Were you inspired by anyone in particular?

ST: All through my career I have been inspired by any dentist who executes careful conservative dentistry, with the patient as their main focus, always trying to save the natural dentition wherever possible. I am also inspired by clinicians, like myself, who are always looking to improve, whatever stage they are at. I have always said, if I ever felt that what I have done is so perfect I did not need to learn more…it will be time to stop.

DDUJ: Did you face any particular challenges or barriers along the way?

ST: Early on, as a young dentist I used to get so upset at the lack of respect for female dentists. All consultants, lecturers, teachers and most colleagues were male, and originally the field of implant dentistry was predominantly surgical, dominated by men. There were so few female role models. In the early years of my career I experienced a great deal of male chauvinism; appalling comments and inexcusable language that, thank goodness, is now frowned upon - such behaviour is becoming rare.

DDUJ: Did your priorities and balance change as you went on?

ST: All the time. When my children were small, I was always in a rush to get home to them. Now the paperwork and running of a large practice takes its toll on personal life. Lecturing also changes life balance as I take so much time to prepare each lecture it eats up so many evenings and weekends. However, lecturing and teaching is not only challenging but also such a pleasure; it is a privilege to be able to pass on the skills and experience that I have honed over the years.

DDUJ: What led you to form the BWSID?

ST: When I was lecturing at implant conferences there would often be a very few women lecturers, compared to a multitude of male lecturers. Unfortunately this has not improved with time. The lack of women was also mirrored in the few female attendees. I decided to form a group to address this. Together with talented specialist periodontist and implant surgeon Dr Fiona Mackillop, we formed the first British Women's Society of Implant Dentistry, BWSID. We are now going into our sixth year.

DDUJ: What are its aims and ambitions?

ST: The BWSID is a not-for-profit association that sets out to inspire, empower and support women in the field of restorative implant dentistry. We aim to bring women at the start of their implant journey together to create tight-knit, inspiring support groups that allow women to flourish and to encourage them to use their new skills in everyday practise.

The groups meet four to six times per year and cover many topics on implant dentistry with mentors in both restorative and surgical implant dentistry. We have hands-on sessions at nearly every meeting, lectures, external speakers, discussion and treatment planning.

As groups advance, the mentoring becomes more interesting, encouraging the participants to take on more advanced cases and learn to present their work. The BWSID is there to compliment other more formal learning activities. We have not only had members who are new to implant dentistry, but also clinicians who have completed MSc courses, who want to develop their skills and share experiences.

DDUJ: Do you feel that female leadership has been held back by organisational cultures and stereotypes?

ST: There is a marvellous article by Lala & Thompson (BDJ in Practice, February 2020), 'Equality in the dental profession', which states that the consistent underrepresentation of women in UK professional dental organisations across different boards and committees is leading to male-centric decision-making structures, blind to female experiences. Among many issues it describes the lack of female keynote speakers, often due to 'manels', all-male panels choosing their male colleagues as leaders in the field.

I have used so many channels to try and find experienced female clinicians to lead BWSID groups around the UK. Although there are many women in dentistry, there seems to be a dire lack of women active in implant dentistry. I hope that in our small way with the BWSID we can help to change this.

DDUJ: Did you identify a need for female dentists wanting to enter this area of dentistry as not being met? And is there any data on this if so?

ST: Dental implants are an integral part of modern dentistry and should be offered when appropriate. There is very little data, but research shows that female dentists are currently much less likely to place or restore dental implants than their male colleagues, surprising considering the General Dental Council reports 49% of dentists registered are female.

A paper published in Germany, 'Gender aspects of implant dentistry: Opportunities and Career paths' concluded that early integration of implant dentistry in the dental curriculum is an absolute requirement, and mentoring programs by successful female implant dentists and supervisors who can provide counselling and coaching in terms of the mentee's career planning, decision making, conflicts and challenges in time management appear to be of the utmost importance.

DDUJ: How does the BWSID help address this need?

ST: The BWSID aims to increase the number of women placing and restoring implants, and would also like to see more female key opinion leaders paving the way for others. However, we would like to be able to identify more female leaders around the UK, those clinicians who are at the 'coal face' and are really experienced, to lead more groups local to them. Please do contact us if you feel you would like to get involved in your area. We also have great pleasure in organising a structured approach to 'mentor the mentor', if there is a need.

DDUJ: How important is your mentoring role to your work?

ST: I so enjoy the communication and camaraderie with my colleagues, and the success of colleagues who have started out in implant dentistry and have a new-found excitement and experience such success with their patient treatments.

I didn't have this opportunity myself at an earlier stage in my career, and I would have loved to have someone to guide and mentor me. Having a mentor helps build confidence and allows your skills to develop in a positive way; carrying out new and more challenging treatments in a safe environment under the guidance of your mentor.

DDUJ: Particularly as regards implant dentistry, how important is it to have access to good training and mentoring when you're starting out?

ST: It's essential to have excellent and comprehensive training in implant dentistry, and this should not only cover the techniques involved in the placement of an implant. The importance of prosthodontic guidance and correct restoration should not be underestimated, preserving natural teeth whenever possible, understanding the patient's medical and dental health, patient education in hygiene maintenance, and long-term maintenance.

Good training and mentoring are key to understanding all the parameters involved from a technical, functional, biological and mechanical point of view, ensuring longevity of our treatments and health of patients' teeth and restorations.

DDUJ: As it's not recognised as a specialty by the GDC, do you feel there's less information or support for those wishing to pursue this career route?

ST: I think so. Because there is not a specialised pathway, it can be daunting, and it can be difficult to choose the training programme that may suit you. It's also expensive and time demanding. Most courses do not have enough hands-on patient sessions to instil confidence in delegates to place implants or restore them independently.

A mentor role in this situation is often very useful to help establish confidence and develop fully one's skills, and this is where organisations like the BWSID comes in.

DDUJ: Is there a disparity of female/male implant dentists, and do you see this mirrored in other areas?

ST: There is barely any research or any data to show numbers comparing men and women in implant dentistry. However, it's obvious by looking at attendees at conferences that there is a higher male attendance at any implant event or lecture. This is slowly changing, perhaps as more female dentists are qualifying; interestingly 63% of newly qualified dentists are female. Traditionally more women specialise in paediatric dentistry, orthodontics or periodontics, but there should be NO barriers to women in any area of dentistry!

DDUJ: If there is a disparity, what do you feel accounts for it? Attitudes, work arrangements, lack of role models?

ST: The lack of female role models in implant dentistry has definitely had an impact. As implants are not on the undergraduate syllabus, to master the subject there needs to be time devoted to study, implement new skills, and as a young clinician, it can be challenging both financially and to combine it with a family.

DDUJ: How can dentists address these barriers, both as individuals and as a community of practitioners?

ST: As a community, the implant associations should include and encourage more female participants, include women on their boards, committees and make sure they are visible as lecturers at their conferences.

DDUJ: What would be your advice to those wanting to pursue a career in implant dentistry?

ST: A patient requiring an implant retained restoration wants to look good and function well. On the restorative side an understanding and experience in prosthodontics is paramount to succeeding. Do not underestimate the importance of tooth and arch form, occlusion, materials, impression taking, and so on.

For implant placement, experience in oral surgery and periodontics as well as a good understanding of the principles of implant restoration will set you on the right path. A structured two to -three year post-graduate training would be best to establish a good base. My master's degree in removable prosthetics was seemingly far removed from implant dentistry, but actually it is not possible to construct a large bridge and full arch reconstructions without a good knowledge of these principles. Whenever possible, spend time shadowing experienced implant dentists who can guide and inspire.

Best of all, find a mentor or a group, such as the BWSID with whom you can discuss your cases, treatment plan, treat initial cases together, and have an ongoing relationship to discuss concerns to help build up confidence as you progress.

DDUJ: …and to those already established in the field?

ST: Encourage those coming after you!