Career Advice

A career in Oral Pathology

A career in Oral Pathology is something that only a minority of dentists will ever consider. There are few oral pathologists in the UK (less than 30) and it is not likely that you will have had the opportunity to work closely with them and discover what a challenging specialty this is. This specialised field of diagnostic histopathology deals with diseases of the mouth and jaws and their associated structures such as the ear, nose and throat, and structures in the neck. Although Oral Pathology is the name of the specialty currently recognised by the GDC, Oral and Maxillofacial Pathology is the term more commonly used in the UK and internationally.

What is an Oral Pathologist?

Oral pathologists are dentists who, following a minimum 2 year period of General Professional Training (GPT) or Foundation Training, have undertaken a 5 year training programme in diagnostic histopathology. When they have passed their exams and obtained a Certificate of Completion of Specialist Training (CCST), they can be registered as a specialist with the General Dental Council. They are not required to be medically qualified, despite the fact that their work overlaps medicine and dentistry.

What do Oral Pathologists do?

The majority of Oral Pathologists work in dental schools, in their associated dental hospitals or acute medical NHS Trust hospitals. Most have four strands to their work: diagnostic histopathology, teaching, research and administration.

Diagnostic pathology involves the diagnosis of disease by microscopic examination of biopsy and excision specimens and examination of resection specimens from cases of head and neck cancer. This may occupy half or almost all a pathologist’s time, depending on his/her job plan. This time is not all spent looking down the microscope (though a fair proportion of it can be). The pathologist also dissects surgical specimens, provides advice on diagnosis and treatment and participates in clinico-pathological case conferences and Multidisciplinary Team Meetings (MDTs). Most oral pathologists are also involved in management and organisation of service laboratories and some are involved in NHS hospital management.

Teaching is mostly based in the dental schools. Oral Pathologists may be involved in delivering courses in basic science, pathology, microbiology, human disease, oral medicine and pathology, radiology or surgery depending on their experience and skills. These subjects are among the more academic and complex in the dental course and teaching students to understand disease and develop their diagnostic skills is a rewarding part of the job. It also keeps you in touch with dentistry.

Research is a major part of the job for some. If this is you, you will need a PhD and continuing research interest; this could be in oral pathology, pathology in general or a basic science subject. The ability to gain research grants is necessary to obtain a post in some schools. In most specialties and schools, a PhD is required for promotion to Senior Lecturer/Consultant anyway so this is no different from other branches of academic dentistry.

Other opportunities are also available for those with particular interests. Some undertake forensic odontology, others are involved at the highest level in the management of dental schools or other aspects of undergraduate or postgraduate dental education.

What about a NHS post?

There is a handful of Oral Pathologists that have full time NHS contracts. However, as most are attached to dental schools they are still required to help with teaching and undertake NHS service and research. Even fewer hold posts in District General Hospitals and work full time in Histopathology. These latter opportunities have arisen partly because of a shortage of medical histopathologists and it is not clear whether such posts will be available in future.

Are there private oral pathologists in the UK?

No, not at present, though most services undertake a small amount of private practice. As the NHS changes, this may increase as pathology becomes more businesslike.

Any other perks?

Oral Pathology is a good specialty for flexible training and part time working. As a clinical academic or NHS dentist you will have 6 weeks annual paid leave plus study and professional leave as well as a relatively generous University or NHS final pension or superannuation scheme. The diverse nature of the job, especially in an academic environment, provides a lot of variety and considerable job satisfaction. There are also opportunities to travel and you don’t have to get up in the middle of the night like the surgeons do.

How long does all this training take?

After a minimum of 2 years broad based, general professional (or foundation) training you would undertake a minimum 5 years training to become a diagnostic pathologist. For a career as a clinical academic a further period of 3 –4 years is needed to complete a PhD.

What sort of person becomes and Oral Pathologist?

You would be academically strong, possibly with an interest in research from a previous degree or intercalated BSc, you may already know you have good microscope skills. As an applicant for a training post, you would be well organised and have excellent communication skills. You probably did well in dental school at pathology, human disease, oral medicine or oral surgery and you enjoy the detective work of making diagnoses. Pathologists like to get things right. You would accept a challenge and be ready to take on responsibility - patients may have major surgery on the basis of your opinion. You would have gained clinical experience in subjects relevant to the work of a pathologist, particularly oral surgery or oral medicine.

Do you have to be good with a microscope?

Yes, to a degree, though most people who are interested can be trained. Obviously you would be unwise to embark on this career unless you knew that you could get a single focused image with both eyes open. However, not all new trainees have histopathological knowledge or skills.

Will I have to give up seeing patients?

Most Oral Pathologists do not see patients on a regular basis but are often asked to see individual patients when diagnostic problems arise. Some provide consultant services in oral medicine, depending on training and experience. In order to do this at Consultant level you would have to be on the GDC Specialist List for Oral Medicine. At present this would also require a medical degree but this may change in future. This is an area where the individual can influence their job description so that clinical sessions may be included for part of your training if you have no experience in, for instance, Oral Medicine or Dental and Maxillofacial Radiology.

How can I try out the specialty?

There are one or two SHO posts available that give provide one year of experience and training and this is also an excellent environment in which to take MFDS/MJDF. In some schools, SHOs in other departments may rotate through, or be offered attachments in, Oral Pathology. There is always the possibility of spending some time in a department. Contact the Head of Department at one of the dental schools.

How is the training structured?

Training is overseen by the General Dental Council and the Specialty Advisory Committee for the Additional Dental Specialties and examinations are under the control of the Royal College of Pathologists (http://www.rcpath.org). Oral Pathology is known as Histopathology (Oral) in their terminology and details are available on their web site. Usually, the first year is spent in Oral Pathology, acquiring basic skills and knowledge. After that, trainees must spend a minimum of one year in General Pathology and will undertake training with medical specialist registrars (SpRs) in histopathology, including working in cytology and observing or helping undertake post mortems. In some centres, you would visit for defined periods. In others, Oral Pathologists are already integrated into the medical pathology service and you may spend periods throughout the rest of your training rotating through relevant departments, such as dermatopathology.

Training is a mixture of formal training sessions and ‘on the job’ learning with Consultants at double head microscopes followed by work based assessment. At the end of the first year there may also be an assessment just to check that you do possess the necessary microscope skills. The training process is monitored by the Postgraduate Deaneries by an annual review of training, as in other dental specialties.

To gain specialist recognition you must pass the MRCPath examination. This is in two parts. The first part covers mainly theoretical knowledge and is usually taken after 1 to 3 years. The second involves making diagnoses on a series of cases and performing specimen dissection and is usually taken near the end of training.

How will training change in the future?

It is expected that the between now and 2010, two year dental foundation training will be implemented and new foundation posts will become available. In some centres there may be short rotations (probably 3/4 months) through oral pathology. This will be an ideal way to gain a taster of life as an Oral Pathologist. The shape of ‘run through’ training in dentistry after this date is not yet clear, but it is likely to be similar to the current scheme with more formal training and assessment of progress.

How can I get a training post?

These are advertised nationally. If you are serious about the specialty you will already have made contact and sought advice from those in the specialty and will probably know where jobs are coming up. Entry to the specialty is competitive. MFDS/MJDF is not compulsory but it is likely that most applicants will have passed one of these exams. If you are an overseas candidate and are not eligible for full registration with the GDC you would be advised to obtain the IQE examination before looking for a post. You will also need to ensure that you are eligible to stay and work in the UK. It is difficult to combine training with general dentistry and taking the IQE.

Do pathologists have a sense of humour?

Definitely, sometimes considered a fairly black sense of humour by others outside pathology. This is usually developed by ‘on the job training’ and is not assessed in the exam!

Who can I contact for more information?

Your nearest Oral Pathology Department. They will either help you directly or put you in touch with the national specialist society or specialty advisor.