‘There’s lots of blood. But you can alleviate pain very quickly’

Vijay Sudra overcame his own squeamishness to build a career as a dentist in Birmingham. Here the 53 year-old reveals the secrets of his profession.

I’ve spent my working life – 30 years – building up my own NHS dental practice here in Birmingham. I’d studied science as an A-level student, then found that I was a bit too squeamish, so became a dentist instead. But then, ha, dentistry is pretty squeamish itself: there’s lots of blood when you’re pulling teeth. I do love the job, though, I love my team, I love interacting with patients.

And it’s a nice thing to be able to administer immediate pain relief to those who need it most. I suffer from back pain, and it’s horrible and difficult to manage, but with dental pain, you can alleviate pain very quickly.

It’s helping someone in need, and they’re always very grateful. You know, patients will often come in in tears, literally tears; they’re in agony, almost on the floor. But once you give them a local anaesthetic, they’re a different person. They leave walking on water, so happy are they to be free of pain at last!

Before the pandemic, we – like every practice around the country – were seeing routine patients, sending out electronic reminders that your checkup is now due. These days, we don’t send a single reminder out, simply because everyone who comes to us is presenting with a problem: toothache, a broken tooth, an abscess, whatever. The work they need is urgent.

This is of course very challenging for us, but then Covid was, too. A dental practice has always been a very safe clinical environment, but we are working in the oral cavity, which is not far from the oral pharynx, which is where the virus lives. There were procedures we couldn’t do.

We couldn’t drill without wearing very enhanced PPE, and in the early months of the pandemic, you’ll remember, there was no PPE for dentistry. This created a backlog, and we’re still catching up. The most common complaint we get is toothache, but we’re finding increasingly that people know how to take care of their teeth.

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That whole “British teeth” thing is a myth, it’s rubbish. As a nation, our dental health is nowhere near as bad as you might believe. Ever since the introduction of water fluoridation here in Birmingham, for example, we’ve seen much lower levels of tooth decay. And there are lots of people now who do everything by the book, and therefore tend not to have issues.

The people who need our service the most are those with social issues. With the cost of living crisis getting worse, everyone concerned about being able to bring food to their table, dentistry falls lower on their list of priorities. They stop flossing, they neglect their teeth. So when they do get to us, it’s often too late, and they arrive stressed, which stresses the staff.

Every day, the reception staff get it in the neck from people desperate to be seen because they’re in pain. But we’re still having to maintain social distancing, and the dental environment tends to be small. It’s… difficult. We see all sorts of unpleasant things in the mouth, but oral cancer is particularly unpleasant. During the pandemic, one patient came in, and we knew immediately it wasn’t good news, a young adult, barely 30 – not a regular attender – and she died, sadly.

We always look for oral cancer in routine checkups – we’ve a responsibility to check the soft tissue in the mouth – but because I haven’t seen a lot of my regular patients due to the backlog, I’m concerned that until we do get everyone back in, we may be missing cases, especially amongst those of a higher risk: people who drink more; smokers.

Every year, more and more dentists are getting out, and going private. Since 2005, when the Government looked at how much each practice generated in a financial year, we’ve had to focus on hitting our “activity target”. I’ll try to explain: if I have a patient who needs one filling, and the next needs 20 fillings and five extractions, both still just register as three units of activity.

This means that we don’t get paid for spending time with patients to educate them on prevention, which is important. We’re only getting paid on churning out units of activity. And so a lot of my colleagues just want to retire out of the NHS, and to practise dentistry as they were taught.

So, yes, stress levels are always high. I’m exhausted at the end of every day. How do I decompress? I go into my shed, and I whittle wood; I play with my children. And, no, I don’t dream teeth. I dream of racing cars and Formula One, of yachts in the south of France, and I dream of having more time to watch the cricket.”