In October 2023, I penned my first blog from the Dental Dean’s office at the Royal College of Surgeons of Edinburgh. Titled 'Room with a View', this piece was in anticipation of the forthcoming three years. Thirty-seven blogs, twelve Surgeons’ News columns, thirty-six diploma ceremonies, numerous examination diets, multiple engagement events, courses, webinars, around 200 Faculty, collegiate and intercollegiate board meetings and a variety of other activities have provided me with a unique perspective of dentistry around the world. You might ask why thirty-seven monthly blogs for a three-year role? Well, the term for the Dean of the Faculty of Dental Surgery and Vice-President (Dental) has now been aligned with that of the other Office Bearers, providing an additional month in office. Therefore, I have reserved this thirty-seventh blog to take one last look at the view from the Dean’s office through the rather eclectic collection of blogs over the last thirty-seven months.
I knew that three years would pass quickly, and the fast lane of leadership has certainly been high tempo. However, becoming a blogger has permitted a diversion each month. Looking through the series, there has been more variety than the initial list of titles I had planned. From artificial intelligence, digital dentistry, CBCT, robotics and teledentistry to photobiomodulation, genetic testing in dentistry and futurism, I hope the innovation theme has been of interest. After all, innovation is one of our College’s key values. There have been contemplative articles on philosophers and philosophies in dentistry, a reflection on dentistry over the first quarter of this century, internet trends related to oral health and influencers, along with a coup d’oeil at the other Dental Digest oral health evangelist.
The series has also looked at other core topics that are embedded across the work of the College involving pedagogy, workforce, examinations and credentials, altruism, access to dental care and sustainability. Patient safety has been a regular feature with tangential topics on Turkey teeth, dental extractions and direct to consumer dentistry among others. The big picture themes of how many dentists the world requires and even whether biotics might colonise the oral healthcare landscape have also been exploratory topics. Along the way there have been diversions into acronyms, history, heritage, literature, culture and, of course, the Edinburgh Fringe each summer. Readers will have noticed that historical characters and events have occasionally found their way into these blogs including my attempt to connect with Robert Louis Stevenson through the College lens. Many will know that I have rarely needed any encouragement to link dentistry with something apparently unrelated to oral health including the Radio 4 shipping forecast and the importance of small potatoes.
There was, however, a serious purpose behind these topics and a reason for investigating a cornucopia of concepts. The dental profession continues to undergo considerable transformation and if one theme connects the blogs, it is “change”. You may well have realised this as you have read each monthly blog. Although the dental profession was vastly different from the world of work these days, I am certain that the graduates of 2026 will also find evolution accompanies their careers. During my term as Dean and Vice-President (Dental), the pace of technological development has been remarkable. Digital workflows have become increasingly routine. Artificial intelligence has progressed to a technology that is increasingly influencing clinical practice. Three-dimensional imaging, intraoral scanning and 3D printing also continue to develop at speed. Teledentistry and remote monitoring are challenging traditional assumptions about treatment delivery, creating new opportunities for direct-to-patient dental care. Robotics is moving gradually from the laboratory towards the dental surgery, while genomics raises the prospect of increasingly personalised prevention and treatment. Digital dentistry is such a topical subject that we have devoted our Dental Triennial Conference to this theme this year.
Whilst I am an early adopter of innovation, enthusiasm should never replace evidence. The question should not be whether we can use a new technology, but whether we should. As ever, dental professionals should always question any new technology, and a suitable list of questions includes the following: Does it improve diagnostic accuracy? Does it improve clinical outcomes? Does it make dental care safer? Does it reduce health and economic inequalities? Is it sustainable? And, crucially, will it benefit our patients? The blog marking thirty years since the introduction of CBCT hopefully allowed readers to ponder the answers to some of these questions. This piece intentionally included the phrase “true power is also restraint”. Technology can provide extraordinary amounts of information, but the availability of an investigation or intervention does not automatically justify its use. The same principle applies to AI, robotics, genetic testing and whatever technology comes to the dental industry as healthcare evolves. Nonetheless, technology requires evidence, and it goes without saying that innovation and patient safety must therefore remain intertwined.
Dentistry is ultimately about people, and writing the series of blogs has allowed me to explore another important lesson from the last three years in office. For all the fascination with technology, dentistry remains a fundamentally human profession. Behind every radiograph, scan, algorithm, examination result and workforce statistic are people. A patient worried about pain. A child experiencing dentistry for the first time. A student or resident anxious about an examination. A dentist trying to provide high-quality care in a difficult environment. An examiner giving up their time. A clinician supporting another colleague. Technology may have changed enormously, but compassion, professionalism, judgement and integrity cannot be digitised and thankfully, remain important within patient care pathways.
Patient safety has also been a recurring theme throughout my term of office. This sits at the heart of the Royal College of Surgeons of Edinburgh and is key to every clinical interaction. The World Patient Safety Day comes around every September and provided a suitable platform for my penultimate blog to consider patient safety in relation to non-communicable diseases, and to remind us that oral health cannot be separated from general health. Dentistry is a major component of healthcare and good oral health is crucial for wellbeing. Prevention of oral disease, early recognition of cancer, medicines safety, antimicrobial stewardship, management of systemic disease and tackling health inequalities all place the dental team firmly within the wider healthcare system.
Access remains our unfinished business, and you may have noted that the blogs over the last three years have repeatedly returned to the theme of access to dental care. Whilst numbers of dentists vary enormously around the world, the underlying problem is remarkably consistent: geography, income and the availability of the dental workforce remain major determinants for appropriate oral healthcare. In one blog I asked, “How many dentists does the world need?” And whilst this was my attempt to help understand the overall “number”, it was by nature a crude estimate. The more important and nuanced question is: “How do we ensure that the 2.5 million dentists within the dental workforce is adequately distributed, trained and supported to meet the needs of the 8.3 billion people on our planet?”
There is, of course, no single solution. Prevention is crucial, alongside appropriate workforce planning to ensure the whole dental team works effectively. Technology needs to be used intelligently to extend rather than restrict access, with sustainable underpinning services and sensible funding systems. Above all, policymakers around the world need to recognise oral health is integral for positive population health outcomes. Royal Colleges, including our own, have an important part to play. Whilst we do not deliver national dental services, our role in education, assessment, standard setting provides convening power. Drawing on global expertise allows both collectively as a College, and individually to speak up when necessary. I am proud that our Faculty continues to be prepared to tackle important issues.
Education and assessment have inevitably occupied a considerable amount of Faculty time during my term as Dean. Royal College examinations have changed greatly during my career, but their underlying purpose remains: to provide credible and independent evidence that an individual has achieved an appropriate professional standard. As a Faculty, we continue to develop our established examinations while introducing new qualifications and thinking carefully about what postgraduate dental assessment should look like for the next generation. The Dental Diploma Examinations represented a particularly important development, recognising excellence and structured professional development for general dental practice.
More recently, our work on the future architecture of summative postgraduate dental examinations has continued that process of modernisation through the Dental Examinations Executive. I would like to place on record my thanks to everyone, staff and volunteers, for your input to this step-change in postgraduate dental training. The journey started with a meeting of the Dental Deans in November 2023 and, less than three years later, the first diets of the new tri-collegiate MFDS and Dental Specialty Fellowship Examinations have taken place. This has been an impressive achievement. Whilst the journey has been tough at times, we have worked with our sister Colleges to reach a clear consensus on the standard for contemporary summative assessments.
Qualifications, however, are not merely letters after someone's name. At their best, they encourage learning, recognise achievement, support career progression and ultimately contribute to better patient care. For this reason, the maintenance of standards matters.
One of the greatest privileges of being Dental Dean has been meeting our Members, Fellows, examiners, trainees and partners around the world. A personal aim was to try to meet as many people connected to our Faculty as possible. Whilst I haven’t managed to shake hands with every Member and Fellow yet, I hope to be able to close the residual gap in the years to come.
The Faculty of Dental Surgery may have its home in Edinburgh, but we are very much an international Faculty. From the UK to the Middle East, the Far East and many other parts of the world, I have repeatedly been reminded that the challenges facing dentistry are both local and global. Workforce shortages, inequalities in oral health, changing patient expectations, new technology and the need for high-quality education transcend national boundaries. Taking the College to the world as well as bringing the world to our College is not simply about delivering education and assessment activities. True partnership, fostered through engagement illustrates that through a shared community of practice, we collectively develop as a profession for the future.
I am sure this is a message that Professor Richard Cure will develop during his term as your next Dean and Vice-President (Dental). Richard will bring his own ideas, priorities and leadership style to the role, as he should. I wish him every success and hope that he enjoys leading our remarkable Faculty as much as I have.
Thank you to everyone who has read these blogs, contacted me, agreed with them, challenged me on occasion or simply wondered what on earth the Dental Dean would write about next. It has been both enjoyable and liberating to write without having to worry about the scientific journal peer-review process. More importantly, it has been an extraordinary privilege to serve as Dean of the Faculty of Dental Surgery and Vice-President (Dental) for the Royal College of Surgeons of Edinburgh.
So, after three years, all good things invariably come to an end, and it is time for me to leave the Dean's office. The physical view from the window is similar to October 2023. The College gardens, the Playfair Building and Edinburgh have been constant and, whilst the professional view is ever-changing, the mission of the Faculty of Dental Surgery continues through promoting access to high-quality dental care for people across the world, wherever they live. I leave the office enormously grateful for the view I have been able to enjoy over the last three years, and confident that the Faculty will continue to look outward, innovate and promote the highest standards of oral healthcare for both patients and populations.
The Faculty of Dental Surgery is always happy to hear from Members and Fellows dental@rcsed.ac.uk.