My Dental Elective in Ireland...

I became interested in paediatric dentistry as soon as I started on clinics in 3rd year.  I really wanted to use my elective in fourth year as an opportunity to gain more experience and see if it was something I might want to take further after graduation. I started reaching out to paediatric consultants at hospitals in the UK and Ireland. After contacting several people, I connected with Dr. Fitzgerald at Children’s Health Ireland and arranged to spend a week in Dublin shadowing her. I was excited to experience a new hospital environment and see a different approach to paediatric dentistry compared to what we are exposed to at Newcastle. As an undergraduate, we typically do not encounter children with complex medical needs. 

I thought it would be valuable for me to observe how these patients are managed and to learn new techniques for behaviour management.

The healthcare system in Ireland is structured very differently from that of the UK. They do not have specific dental hospitals.  The dental department I worked with was linked to the two children’s hospital (Crumlin - oncology, haematology, cardiology and Temple Street - neurological, craniofacial, ENT). All the children seen in the unit have complex medical needs.  Many require a general anaesthetic for any treatment and due to their complex medical needs require a specialist anaesthetist.  As this is a highly specialised unit with limited capacity only very specific cases are accepted. The unit also must ensure they have space for emergencies, such as severe dental pain or swelling that presents in the A&E department, along with space for inpatients who may develop dental issues while having other treatments.

During my week there I encountered cases that I would not have been exposed to as part of the undergraduate dental training.

I observed how different treatment pathways are required for children with more complex medical needs.  It really highlighted the importance of treating each child on an individual basis and how it is important that the clinician adapts their clinical approach according to the child’s needs. For example, some children preferred not to use a dental mirror, some were more comfortable being examined while seated on a parent's lap or in a chair of their choice. The goal was always to ensure the child’s comfort. The team treated many patients with learning difficulties, so the clinic environment was adapted to avoid overstimulation.  They used space-themed light projections on the ceiling instead of bright lights, toys, mirrors, and water light features, which all helped to create a more comfortable atmosphere.

The attention to detail shown by the consultants was incredible and it inspired me to adopt these techniques when treating my own patients.

I observed in theatre during my elective. It was fascinating to observe the entire process, from admission to recovery.   It was interesting to see how the dental team and the medical team had to work together to provide safe treatment for the children.  From my undergraduate training I was aware of how certain medical or genetic conditions can have an effect on the oral cavity, but I don’t think I had fully appreciated how difficult this could potentially make even just the logistical aspect of providing dental care to be. In some cases, it was a struggle to fit standard dental instruments in their mouths.

In the theatre, comprehensive care was provided.  Such as addressing any potential dental issues and applying preventive measures like fluoride varnish and fissure sealants. Although delivering care this way is not ideal, for many of these patients, it is the only viable option.

I also learned about new treatments that I hadn't encountered before. 

For example, photobiomodulation, which is used to treat mucositis in cancer patients. This simple treatment encourages cell regeneration.  It involves directing an LED light at different areas in the mouth while the patient remains seated. It is especially effective because, under supervision, the patient can eventually carry out the treatment themselves which encourages their involvement.

I thoroughly enjoyed my time in Dublin, during dental school, you are taught a lot of information, but it can be difficult to apply that knowledge without seeing it in practice. This experience therefore was an incredible opportunity to apply theoretical knowledge to clinical practice. Reinforcing learning and also interest in paediatric dentistry.

I am so grateful to the staff and patients in Dublin who have inspired me to work in this field in the future.

Leonie Watson Stage 5 BDS student