Pursuing an opportunity
Tayside orthodontic consultant Grant McIntyre was recently honoured by the Royal College of Surgeons of Edinburgh with a Fellowship Without Examination.
It was recognition of the contribution he has made to the MFDS exam, the MOrth exam and the work he will do for the College in the future.
However, Grant revealed that the inspiration that set him on a path to becoming one of the leading hospital orthodontists in the country, was visiting his uncle’s practice in Johnstone, Renfrewshire, as a child. A west-coaster by birth, Grant grew up in Paisley and decided midway through his school years that a career in dentistry was for him.
He said: “My uncle was a bit of a role model for me, an independent professional who was able to make a contribution to the local community and that really sparked my interest.
“Unfortunately, he passed away when I was still in dental school, so he didn’t see me graduate, which was a real shame.”
At dental school in Glasgow, Grant found the area that really grabbed his attention was orthodontics. He explained: “I really enjoyed orthodontics and, on graduation (in 1993), I thought, the opportunity is there for me to pursue it. So I decided that it was the career that I wanted within dentistry and I started to plan my career jobs to fit my aim.”
His VT year in Biggar in the Borders provided the final confirmation for Grant that a life in general practice wasn’t for him. He said: “It wasn’t a negative experience at all, in fact it was wholly positive. Dentistry in practice has two elements to it, obviously there is the dental care itself but there is also the running of the business and all the pressures that come with that.
“That actually confirmed for me that orthodontics was the route for me. It was a positive decision in that I wanted to spend time with patients rather than running a business.”
After VT, Grant moved away from Scotland and embarked on an SHO job in oral surgery and orthodontics in Wigan and Manchester. After a year in the north-west, he embarked on the primary fellowship with the Royal College of Physicians and Surgeons of Glasgow and then returned to Glasgow Dental Hospital to complete the Fellowship in Dental Surgery.
It was at this point Grant applied for specialty training in orthodontics, which brought him to Dundee and opened up the Tayside chapter in his life. Apart from a couple of years completing his orthodontic training in Glasgow, he has been based in the City of Discovery ever since. He completed his PhD in Dundee, examining the cranio-facial shape of parents of children with a cleft lip and palate, a subject that he has continued to focus on through his career.
He said: “In actual fact, when it came to looking for a consultant post, I was keen that the job would allow me to provide orthodontic care for children with a cleft lip and palate. Luckily I am still doing this today and I am still enjoying the interaction with the patients and their families.”
Grant explains that the other main driver behind his clinical work is being part of the orthognathic surgery team. He said: “As well as the cleft lip and palate patients I am also on the orthognathic surgery team, working with people with fairly significant skeletal deformities. For both the patients with clefts and the orthognathic patients, quite often the satisfaction that they express at the end of the treatment really gives me a huge buzz. That’s a big driver for me.”
Grant mentioned that he also enjoys orthognathic surgery planning and, as well as doing cephalometric planning, he is often to be found in the laboratory discussing individual cases and planning the occlusion on an articulator with the technical staff.
Away from clinic, Grant is also the training programme director for the orthodontic specialty registrars based in Dundee and he explains that he enjoys seeing the trainees through from the start of their training to their future careers in either specialist practice or to a consultant post. He said: “In the time I have been the programme director, it has been hugely satisfying to see our trainees start off as very inexperienced in orthodontics, but finishing specialty training as highly skilled and highly qualified orthodontists.”
As well as this, Grant explained that he is also currently the chair of the specialty training committee for orthodontics at NES and is also involved to a lesser degree in undergraduate teaching and in foundation years training. He attributes his interest in learning and teaching to his parents, both of who were involved with education – his mother being a primary school teacher and his father a college lecturer in mechanical engineering – and they both discouraged him from a career in education. He said: “It is funny that my parents both said to me, the only career you shouldn’t contemplate is education, and here I am with it occupying quite a bit of my role these days.”
Grant’s other interest is research, and it’s something he admits to spending more time on than he should. “Being involved in studies investigating fixed appliances, tooth-size discrepancies, 3D imaging of smile aesthetics, CAD-CAM for cleft lip and palate patients, the Scottish cleft lip and palate electronic patient record, electronic orthodontic referrals and two Cochrane reviews requires several hours at the laptop each week when I shouldn’t really be working,” he admits. But the discovery aspect of research and publishing the research findings is something he enjoys.
Moving away from research, when asked about his thoughts on the introduction of the Index of Orthodontic Treatment Need (IOTN) in Scottish orthodontics, Grant believes that it hasn’t made as big a difference as was possibly expected. He said: “A couple of years ago I was part of the Scottish Government Orthodontic pathways group, and at that stage we did discuss within the group the introduction of IOTN 3.6 and what would that mean for Scottish orthodontics.
“To be honest I don’t think it has made a huge change to the patients I see on a day-to-day basis. I think
the ebb and flow of referrals would be there anyway. It is a fairly arbitrary threshold but it is probably what most orthodontists are working to and I don’t think it will make an enormous difference across the board.”
And the anticipated wave of patients being turned down for orthodontic treatment just hasn’t materialised. He said: “I haven’t seen that and I certainly haven’t heard that from my colleagues in specialist practice.”
Grant has been involved with the Tayside appeals process and he believes it is working well. He said: “I think it is fair and right that there is an appeals process but ultimately if the appeal is not successful then the patient will have to either accept that they are going to have some sort of minor malocclusion or they have to seek private treatment.
“Unfortunately, at the end of the day there is not an endless amount of money available, especially in the midst of this recession we find ourselves back in again.”
The economic situation of working within a consultant post also means that there are a number of technologies available to private clinicians that Grant and his colleagues in the NHS hospital sector are unable to take advantage of. He said: “It would be brilliant if we could provide lingual orthodontics within the hospital service. I think that would really extend me as a professional and that is something that I am really conscious that I do miss out on. Some days I wonder whether I should do some private practice, but then I think ’where would I fit it in?’”
Grant explained that they don’t have the opportunity to use aligner-type appliances either, but for many of the cases that they treat, he concedes that it wouldn’t be entirely appropriate.
Looking to the future, Grant acknowledges that the main challenges facing orthodontics in the hospital system are the age old problems of missed appointments and simply getting compliance among patients to actually wear the retainers they have been given.