Reflections on dentistry in the army
The second of two articles on healthcare in the military
A soldier from 2nd Battalion The Royal Gurkha Rifles fire his personal SA80 weapon during a live fire range on Exercise Wessex Storm. Exercise Wessex Storm intends to validate 2nd Battalion, The Royal Gurkha Rifles to TL FOXTROT in order for them to assume very high readiness for their assumption of Air Manoeuvre Battle Group 1 (AMBG1). 1st Battalion, The Royal Irish are being validated for the Light Recce Strike (LRS) Concept of Employment (CONEMP) as part of the pathway to LRS FOC by 2025. The exercise will provide an opportunity for the British Army to demonstrate its ‘Future Soldier’ concept, agile adaptation and through air-land integration, 16 Air Assault BCT’s role as the land component of the UK’s Global Response Force.
Having been invited to give a reflective talk at Glasgow Dental School towards the end of last year, I was asked to set down some key thoughts on dentistry in the Army. It’s quite a challenge to distil 38 years into 600 words on healthcare in the Military, but here goes…
The first thing is that you are part of a – part of the – team. This is not a commercial enterprise. The soldiers you care for are your colleagues and comrades. They put themselves in harm’s way, so you owe it to them to practise to the highest reasonable standards.
You do this in two main ways: by making and keeping, them fit to deploy; and by being prepared to deploy alongside them. By ‘deploy’, this may mean to fairly inhospitable spots, anywhere on the globe. Ideally, your preventative care should allow them to operate for about six months without requiring routine maintenance. However, a proportion will require emergency care in the field, and that is why a uniformed dental service – whether Regular or Reservist – is essential.
The Sandhurst motto, ‘Serve to Lead’ reminds you that you must look after your staff before yourself
Major General Ewan Carmichael
Your soldier patients work around the clock, in any weather and in any terrain so, as an Army dentist or dental nurse, you may need to be prepared to do the same. On deployed operational service, every emergency visit may take many hours and tie up several personnel as escorts, so your treatment must be prompt and effective.
Your dentistry needs to be durable and lasting. While you will have much clinical freedom and access to good clinical equipment, you need to bear in mind that ‘heroic’ or fashionable trends may not always be in your patients’ best interests; sometimes, simplicity is best!
In peacetime, you practise in garrison dental centres or hospitals. On deployment, you may be part of a medical regiment or a field hospital. You and your staff are non-combatants, wearing the Red Cross, but armed to protect yourselves and your patients. While operating in challenging circumstances, and required and expected to share some of the hardships, your combatant comrades will do their darnedest to ensure that you are safe.
You will be encouraged and resourced to continue your professional development to a high standard.
Your staff (in my experience, well-trained, well-motivated, and entertaining companions) will look to you for genuine leadership. So, you owe it to them to be an authentic leader. The Sandhurst motto, ‘Serve to Lead’ reminds you that you must look after your staff before yourself. Inevitably, this means that you must take responsibility for an element of administration. However, the leadership training offered by the Services is probably second to none.
As you become more experienced and senior, you will be required to pull your weight in planning, procurement and training.
The Army draws from a wide demography so, while you are unlikely to practise much paedodontics or geriatric dentistry (unless on a humanitarian mission), your patient base will tend to be young-ish and generally fit. Many play contact sports. However, some of your patients may not have experienced much dentistry before the Army, and that can bring its own challenges. Add to this, that deployment in combat may render dental hygiene a secondary consideration; it means that you sometimes have to coax/cajole better dental standards from them.
Servicemen and women sign up that they are prepared to give their lives. Sadly, very occasionally, you may be required to carry out forensic identification of colleagues.
The rewards and satisfaction stemming from being encouraged to practise to high standards, both professionally and ethically, and from being part of a team, are immense. You live, work and play alongside your patients – which is almost unique in dentistry.