Advancing dental research
In a career spanning more than 40 years, Professor David Wray has faced more than his fair share of medical and scientific challenges.
Indeed, so successful has he been at finding clinical solutions to the problems faced by his profession, the British Dental Association (BDA) has recently awarded him the John Tomes Medal in recognition of his remarkable contribution to medical science.
However, when Scottish Dental magazine met the Professor of Oral Medicine at Glasgow Dental School to discuss his award, he was mulling over what he sees as one of the great moral dilemmas facing the profession today and in the years ahead.
“To my mind, there is a moral dilemma in dentistry today: it’s about making a choice between serving the public or making a good living.
“When I was working in dentistry, it was pretty simple: you got paid per item of service for every patient. However, now the profession has become more specialised and I think new graduates have more of an entrepreneurial approach to make dentistry more of a business than a public service.
“The guys doing implants now are not always doing this work as a medical treatment for patients, but as a cosmetic procedure – but they have been trained using public funds – just as in the case of ‘plastic surgery’ in the medical profession.
“We are given public funds to produce dentists for the NHS, but we are losing them to private practice and 15-20 per cent of them leave Scotland altogether, either for the south-east of England or further afield to places like Australia.
“Luckily, in Scotland, we are very good at supplying qualified dentists for our needs. In fact, we produce twice as many dentists per head compared with the rest of the UK, but I can see this situation being affected by government cuts.
“Nicola Sturgeon has already announced a 10 per cent cut in the number of medical students being taught in Scotland, so I can see a similar cut coming for dental students – we’ll have to wait and see,” he said.
From pulling teeth in Govan as a newly qualified dentist in the 1960s to becoming dean of the University of Glasgow Dental School in the 1990s, Prof Wray’s years of dental research have advanced medical knowledge around the world.
And this contribution to research has been recognised by the award of the BDA’s prestigious John Tomes Medal.
Dr John Drummond of the BDA’s honours and awards committee, said: “Professor Wray is a central figure in oral medicine, research, teaching and patient care. He is acknowledged as one of UK’s leading experts and richly deserves to be recognised for the immense contribution he has made.”
Such an accolade has given Prof Wray great pleasure. He said: “It’s the second highest honour that the BDA can bestow on a member, apart from making them president, so it’s wonderful to receive the medal. It’s always good to find out that your contribution is appreciated by your peers.”
Prof Wray said he was destined for a career in dentistry after breaking his tooth as a youngster. “Seeing the surgery and the staff gave me the illogical desire to become a dentist. Unlike other children, a visit to the dentist held no phobia for me – which was just as well as, being a pre-fluoride baby, your teeth got filled as quickly as they came through!” he laughed.
In fact, dental health in the 1960s was quite shocking as he found out after he entered Glasgow Dental School at the tender age of 16 in 1967.
“After graduation I got a job as a dentist in Govan where I basically spent all my time gassing people and pulling their teeth out… and doing the odd filling!
“Dentistry at this time was largely dealing with the end result of years of decay, so I could not honestly see myself doing this for the next 40 years.”
However, his interest was piqued in the medical side of the profession and he was fascinated by his medical studies. He explained: “While we touched on all the main aspects of medicine during the first three years of the course, I was interested to find out the full story on dental medicine.
“I was intellectually driven, rather than career-driven, and I was lucky to fall under the influence of Professor David Mason, who was dean of the dental school and later knighted for his contribution to dentistry.
“His work on oral medicine was an inspiration to me and his mentoring put me on the path of research. It’s from him that I developed my whole ethos to research and continual learning.”
Prof Wray said he was lucky to get into dental research at that particular time and described it as a “golden era”. He said: “We were driven by ‘blue sky’ ideas and had the freedom and autonomy to explore a wide range of interesting ideas.”
Prof Wray specialised in oral ulceration and one his earlier research successes was in finding the relationship between mouth ulcers and deficiencies in the blood, which made patients more susceptible to ulcers.
On the back of this research, in 1979 he was awarded a Fogarty Fellowship to study at the National Institute of Health (NIH), one of the world’s foremost medical research centres based at Bethesda, Maryland, USA.
He said: “This was a fantastic opportunity for me. This was one of the world’s most renowned centres exclusively focused on research and I was working with and surrounded by some of the world’s leading scientists in their fields.
“To give some idea of the size of the place: there were 26,000 people working on the campus – 26 of them Nobel Prize winners – and at the time I was working in the largest brick-built building in the world!
“And when you went to lectures in the evening, you weren’t being taught by teachers – you were being told first-hand by the very people that had made the medical breakthroughs.
“It was such a hothouse of research excellence – you couldn’t help but be successful!”
After his two years at NIH, Prof Wray returned to the UK to work at the Royal Dental Hospital in London and then moved to Scotland to take up the post of senior lecturer in oral medicine at the University of Edinburgh – and just in time to witness the explosion in HIV which hit the city in the early 1980s.
He said: “Patients were starting to present with oral manifestations of HIV, first from the gay population and then from IV drug users. Edinburgh was the first significantly affected city in the UK so our research on this subject was cutting edge. The knowledge we were able to build up on understanding the disease process proved to be world- leading.”
His research on the disease was also able to allay the fears of dentists and other healthworkers about contracting HIV from treating patients with AIDS.
He said: “It was a steep learning curve, but our research was able to calm the panic and to show that treating patients while wearing rubber gloves was enough to stop any transference of the disease.”
In 1993, his old mentor Prof Mason retired from Glasgow Dental School so Prof Wray returned to his alma mater to take up the chair of oral medicine. He was later promoted to associate dean for research, then dean of dental education and clinical director of Glasgow Dental Hospital.
“I had no real intention of coming back to Glasgow, but the opportunity was to good to miss. I’ve benefited from a career spanning 40 years in research, which has enriched my intellect and given me a very broad and in-depth knowledge of dentistry and medicine. This is a good way to use my experience and pass it on to students wanting to develop a career in the profession.”
Although Prof Wray’s role is largely administrative, he ensures that he spends at least half of his time taking four patient surgeries a week with students and
giving several hours of lectures.
“It’s the part of my job I really enjoy: the students are young and enthusiastic, thirsty for knowledge… and great fun to be with!”
Professor David Wray, MD (Honours), BDS, MB ChB, FDS RCPS, FDS RCS (Edinburgh), F Med Sci, Professor of Oral Medicine, University of Glasgow Dental School.