Restoring a back-to-basics approach
Despite still being in its infancy, the British Academy of Restorative Dentistry (BARD) has already managed to spread its wings across the UK and around the world.
With 11 study clubs already established around the country, including Edinburgh, the academy has also developed four worldwide affiliate branches in Greece, Cyprus, Poland and Sudan.
Inaugural BARD president Paul Tipton explained that the academy came into existence less than two years ago following concerns he and a few colleagues – including Linda Greenwall, Tony Kilcoyne and Adam Toft, among others – had about the quality of restorative teaching at both undergraduate and postgraduate level. He said: “We were despairing at the quality of restorative dentistry teaching that goes on these days in dental hospitals and the quality of the dentists who are qualifying. I think that is both north and south, although I think over a period of time, the teaching up in Scotland may have been better, thanks to the work of people such as Professor Richard Ibbetson in Edinburgh.”
Paul explained that they felt there was a real need to get back to basics, with concerns over taking amalgam out of dental schools being a big driver.
He said: “That would mean that the graduates won’t be using amalgam at all, so they will just be using composite. Posterior composite is probably the most difficult technical skill for a young graduate or an undergraduate to do. So they are going to be asked to do posterior composites everywhere that amalgams are at the moment. The alternative is that they are going to put glasionomer in teeth, so either way the nation’s teeth are going to start suffering.”
He also added that graduates don’t get any occlusal training and are not trained on things such as bridge design. “So, some of the fundamentals of good restorative dentistry, that you can’t leave out in practice, are just not being taught,” he said. “Everyone is going cosmetic crazy and minimal intervention crazy. Of course, that is fine for a patient who only needs a little bit of work doing, but we all know that there are an awful lot of people who have massive amalgams and already have crown and bridgework, and dentists are just not being trained in how to deal with these people.
“So the aim of the BARD is just to get back to teaching some good-quality restorative dentistry techniques that maybe the dental hospitals and especially the younger graduates just aren’t doing at the moment.”
Paul is one of the most well-known and respected names in restorative dentistry, not just in the UK, but also internationally. He is a specialist prosthodontist and has established a series of Tipton Training Academies in Manchester, Leeds, London and Dublin.
As a young man, he was a keen cricketer and between 1974 and 1978 he opened the batting for Lancashire County Cricket Club and enjoyed five years as a professional. He explained that his decision to follow a career in dentistry was down to the fact that his ability and ambition didn’t quite match up. He said: “I think I came to the realisation that, at best, I would only ever be a county cricketer. I didn’t really feel that I had the ability to go on beyond that.
“Also, the life of a county cricketer in those days was pretty mundane. You didn’t get paid a lot of money and in the winter time, most of the professionals went on the dole, so it was not really an inspiring career choice. As a kid it seemed a great idea, but as I got into it and I realised that I wasn’t going to play for England, I thought I’d better do something else.”
Halfway through his spell at the club, Paul enrolled at university in Sheffield to study dentistry and when the term was over, he came back to Lancashire to play the second half of the season. After graduating in 1978, Paul carried on playing on a semi-professional basis with Cheshire until a back operation on his 30th birthday put an end to his paid playing days.
He still turns out for the veterans on a regular basis and he believes there are definite parallels to be drawn from his cricketing career and his dental career. He said: “I think it is all down to hard work, really. As a cricketer, you have to put in the hard work, you are practising all the time – if you don’t, you don’t get anywhere. And it is the same with dentistry – you have to practise it, work hard at it and go on lots of courses. That’s the same as a cricketer having lots of sessions in the nets.
“The great parallel is that I worked really hard to get to the top of cricket by and I probably took that same work ethic into dentistry.”
Paul has used this formidable work ethic in order to bring about the establishment of the BARD and he has already spoken at study clubs in Stoke-on-Trent, mid-Cheshire, Liverpool and, most recently, in Edinburgh at the end of May. The chairman of the Edinburgh branch, Midlothian GDP Stuart Campbell, explained that it is Paul’s ability to distil complex techniques into easy-to-digest talks and courses that makes him stand out. Stuart said: “He makes the complex simple and he brings things back to first principles so that, while some of his slides and the treatment plans he is carrying out appear to be very complex, he is able to break them down into their component parts.
“A further advantage of his teaching is that he relates the scientific literature to clinical dentistry, which really reinforces evidence-based practice. And he puts just as much effort explaining the simpler techniques as he does the complex ones.”
Stuart got to know Paul after attending three of his year-long restorative courses in Manchester over the past few years and joined the academy in autumn last year as the chairman of the Edinburgh section. He said: “I think the aim is to widen and deepen knowledge of restorative dentistry among the profession and therefore improve our clinical practice. We would like to encourage like-minded dentists to get together at meetings on a regular basis to discuss and chat about our needs and wants.
“As well as that, we plan on having high-quality speakers, such as Paul and other affiliates of the BARD, come to talk to us. So we aim to get them up to Scotland and learn from them.”
Paul explained that, although there is already a British Society for Restorative Dentistry (BSRD) that has been around for more than 40 years, its membership is predominantly hospital dentists and academics.
He said: “We wanted to make this a bit more wet-fingered and practical as opposed to hospital based. We wanted to get away from hospital consultants being there lecturing to GDPs. We wanted wet-fingered dentists themselves to be lecturing to each other and in the organisation of the academy.
“The BSRD has been around for some years, so we are the new kids on the block. We aim to put on proper courses and CPD, do certificates and diplomas eventually as well. We want to give people a pathway that is not via the hospitals or the Royal College of Surgeons, but another pathway where they can get decent accreditation.”
And Stuart explained that meeting up with peers and colleagues at events such as study clubs is a vital learning tool. He said: “I think it is important simply because you can learn so much from your fellow practitioners. Most clinicians will have faced similar challenges in general dental practice. The way we manage and deal with them can be helped immensely by chatting with others.
“But we shouldn’t lose sight of what the scientific data is telling us and meetings such as these are important in encouraging practitioners to use the dental literature for solutions to clinical questions. Having clinicians like Paul critically reviewing the dental literature is extremely helpful.”
One of the main benefits of the Edinbur
gh study club – if it proves successful – is the fact that Scottish dentists will have access to top-quality courses and qualifications without travelling down south. As Stuart said: “The main aim of the study club is to share knowledge and promote understanding of restorative dentistry. If we can encourage people through the BARD to gain further qualifications, then I think that would be great.
“However, at the moment, that would involve attending courses down south. But, if we do get enough interest, I know Paul would be keen to look into the possibility of doing something in Scotland.”
By training dentists in the “science of restorative dentistry and occlusion”, Paul explained that the wider BARD “mission’ is to help the nation’s teeth. He said: “The nation’s teeth are in a shocking mess. We see it day in and day out. Many dentists out there are trying their best, but they don’t really have the skillset to know or do what is required. So we are aiming to give dentists some of these abilities using good-quality materials that last.
“Cosmetic dentistry can be fantastic, but there is no way cosmetic dentistry lasts as long as restorative dentistry. Talking to graduates, very few of them have the ability to do three-quarter crowns or gold onlays. These are the sort of restorations that last the longest and it is something of a dying art.”
And despite the rise in cosmetic procedures, Paul and his colleagues in the BARD believe that there is a real need for good-quality alternatives. He said: “What we are trying to say is that not everyone in the world wants cosmetic dentistry. There is a certain age group – late 40s into the 50s and 60s – who want something that will last. They want longevity rather than a white filling that will need replacing in seven or eight years. But those people don’t really seem to be catered for.”
The BARD is open to anyone in the UK who is interested in restorative dentistry and who want to learn more about the discipline. But, as well as UK dentists, BARD has attracted interest from Europe and Africa.
Through his lecturing and teaching overseas, Paul has come into contact with many dentists who wanted to know more about the new academy. So far they have four worldwide affiliates in Greece, Poland, Cyprus and Sudan.
Paul explained: “It came about from me flying off here, there and everywhere and finding out that dentists in other countries have exactly the same problems: their undergraduate curriculum is maybe not as good as it should be, or as good as it was.
“It is just a worldwide movement to try to get quality dentistry done for patients and not necessarily cosmetic dentistry. Cosmetic dentistry is very good in the right situation, but you can’t overplay cosmetic dentistry. Sometimes you need to go back to quality long-term materials.”
The academy actively espouses a back-to-basics approach, but Paul said the system down in England means that restorative dentistry is becoming increasingly rare.
He said: “With the NHS system of UDAs, there is less and less restorative dentistry being done on the NHS. You get the same UDA for a root filling as you do for taking a tooth out, so you take the tooth out.
“I did crown and bridge work on the NHS and I like to think that, in the nine years I spent in the NHS, I helped many patients using some quality restorative work on the NHS. But nowadays it just doesn’t get done.”
Paul is speaking at the next Edinburgh Study Club in November, details at http://www.bard.uk.com