If you rebuild it they will come

New Dublin Dean, Professor Brian O’Connell, talks about his plans for the dental school

Retrenchment, austerity, cuts – the last few years have been a period when the Dublin Dental University Hospital has suffered in much the same ways as the rest of the country. However, recently appointed Dean, Professor Brian O’Connell, believes it’s time for renewal, regrowth and rebuilding. Equally notable, he says the profession is on the cusp of becoming an even more important part of people’s lives.

Every leader needs a clear set of priorities and O’Connell is precise about his immediate concerns. “I’m keen that we rebuild the staffing and infrastructure that we lost during the cutbacks and renew a sense of purpose and momentum. It’s vital that people can come here and be confident that they are able to carve out a career in everything from hospital dentistry to academic dentistry, teaching, and research. They should feel that they are embarking on a path that’s worthwhile, promising and rewarding.”

The challenges facing dentistry have been played out widely in the media, he believes. Reductions to the support systems for patients, which provided a simple but very important level of service, have been dramatic. “We have certainly witnessed the effects of that as patients who were interested in their oral health have found that they are no longer eligible for treatment, except very basic emergency care such as extractions. It has been very difficult to see people who were trying to look after their oral health frustrated by a system that does not give them the support they need.”

O’Connell also cited the seemingly perennial issues of access to care for different elements of society, including those living in institutions and some who live in more remote parts of the country. “Those concerns remain in the background,” he said.

Closer to home, he highlighted the substantial cuts suffered by the School – and University – during the financial crisis. “We lost quite a high number of senior staff through retirement, such as my predecessor, Professor June Nunn. Of course, they took a great deal of institutional memory and knowledge with them. It’s very important that we try to replace that experience and expertise.”

Similarly, he emphasised the need to move forward and develop an educational philosophy and system that is fit for purpose. “We hope to see more teamwork in dentistry. There will be an expanding and more active dental team, and we have to be ready to educate all of the members of that team.

“In the same way, dentists should be part of a bigger primary care service, so that your dentist isn’t simply there to fix your teeth when you have a problem, but instead plays a role in your general health. This is something I hope we will move to more and more over the coming years. We have to be ready to support that, both in the way we teach students and the way we treat our own patients.”

Atlantic crossing

Brian O’Connell’s readiness to help rebuild an institution, and recast a profession, springs from a career – and life – spent on both sides of the Atlantic. His early years were lived in New York with his Irish parents, before the family moved back to Ireland in the ı960s. He finished his schooling in Cork and went to dental school at University College Cork. “I never dreamed of going anywhere else; why would you?” he asked.

Like most Irish dental graduates in the ı980s, on finishing education he headed off to the UK to work in practice. “All of my class, bar one person, did the same.” Initially working in Kent, he went on to the Royal Dental Hospital in Leicester Square, London, just as it was closing down. Indeed, he was in the last group of staff to work there in its final six months. With that option no longer available he moved back to Kent, this time working in Canterbury Hospital.

In ı986, after two years practice and hospital work, he decided to go back across the ocean and joined the Eastman Institute in Rochester, New York. It was that opportunity that led him to specialise in prosthodontics. “I always felt I wanted to do something in more depth. I enjoyed prosthodontics and liked the way it was taught in the US. The chance came up to undertake joint prosthodontics training with a PhD and that was exactly what I wanted. I was interested in research, and to be able to combine it with something clinical seemed ideal. I packed my bags and headed for Rochester.”

When that episode came to a natural end in 1992 he subsequently joined the National Institute of Health at Bethesda, Maryland. For the next seven years he was involved in a variety of tasks and research. “I started in the heart, blood and lung institute learning to do gene transfer and then took that to the dental institute a year or two later. I had my own research lab and group – it was a terrifically stimulating environment in which to do research.”

At that time, the difference between post-graduate education in the US and Ireland/the UK was striking. “Here, though things were changing, it was very far from the way we view it now. There were a couple of places, including, I believe, Guy’s in London, offering a masters-type programme in what we recognise as specialty training.

“The focus was mainly on working your way up through the ranks from SHO (senior house officer) to registrar, senior registrar, and consultant. Training was done on the job and there was very little formal education. The masters type of programmes being offered by that very small group of institutions operating on this side of the water had become the norm in the US after the war. The country had founded many of its training programmes in the period immediately before and after 1945. They had such a track record in well organised programmes with great content, and that was one of the things that appealed to me when I decided to make the move there.”

He says he loved his time in the US and it was a significant period in his life – he was married and became a father for the first time. The family moved to the Washington area when he took up his post in Bethesda, while his wife was able to work in nearby Baltimore.

“The way the National Institute of Health was set up as a research institute you seemed to get most benefit over a five to seven year period. When the end of that time was approaching in ı999 we had three children and were thinking of leaving Washington,” he said. The initial idea was to move to another location in the US, but a call from Derry Shanley, Dean of Dublin at the time, changed things. “He asked if I’d be interested in coming here. I paid a visit and liked what I saw. The School was going in an exciting direction with a far-sighted educational programme, and there was a feeling that something new was being built. There was a great buzz about the place.”

Reorganised

O’Connell took up a post as professor of restorative dentistry, and one of his first tasks was to reorganise the School’s postgraduate training. Working closely with colleagues, the existing programme was changed to become three-year specialist tuition. Prosthodontics was the first discipline to be treated this way, and others soon followed.

At the same time, he maintained a research group which initially continued doing the type of work he had been carrying out in the US. “However, things became more interesting locally,” he said. “A bone research group here in Trinity became very active and we joined with them and wound up looking into bone and implants. In more recent years we have moved into areas such as ageing and connected health, which are the two topics I’m most interested in at the moment.”

Prior to becoming Dean, O’Connell was twice elected to the School’s board. He first joined in 2012 and was re-appointed when elections came around again in 2015. “I’m very happy and proud to say that I am one of the IDA (Irish Dental Association) nominees on the board. I’ve always been an IDA member and believe that the view of practitioners is extremely important as we develop education and policy.”

Following the retirement of Professor Nunn last year, O’Connell took up his new role in November.

To say he is enthused by the prospect of working with young people who are keen to enter the profession would be something of an understatement. “If you look at the people coming into dentistry there is a pool of amazingly talented people,” he said. “We are talking about school leavers who can be classed as high achievers. They are very clever and motivated. Among them are those who are eager to go into practice and others who will seek to pursue a career in specialisation, policy, research and other important areas.”

He is equally excited by developments within the profession. “For example, take the digital revolution that is going on right now, particularly in restorative dentistry, although also in areas such as implant dentistry, oral surgery, and orthodontics.” In the wake of this, the School intends to roll out a programme over the next two years that will bring digital workflow to its clinics.

“This year, we are acquiring scanners, milling machines and so on which will become part of our portfolio in the future. Our students will have the chance to familiarise themselves with this new equipment – clearly, this technology is something they will need to know about as they move into practice.”

Emphasis on access

O’Connell believes the requirement for students is to focus on the ability to undertake complex dentistry and have the desire to roll it out to those who need it. He underlined the School’s emphasis on access to care and making sure that its students are able to treat the widest range of patients without having to refer them to specialists.

As with priorities, every leader needs a clear set of goals and O’Connell pondered what might constitute his own measures of success. “From the School’s point of view we would like Dublin to be the place where both students and staff want to come to learn and work. We already attract very good people and we want to continue to be a very desirable place to learn.

“From a broader perspective I would love it if, in five years time, people in the community – other healthcare professionals and especially patients – have started to see dentists as more than the people you call on when you have a toothache. I hope dentists will be viewed as experts who you see regularly, are part of your healthcare team, can give advice on a wide range of topics and can refer you on to other professionals such as your GP, pharmacist, occupational therapist and so on.”

He remains convinced that a sense of positivity is justified. “There’s a feeling that we are through the worst of austerity and it’s time to rebuild. You can’t stay in a bunker mentality forever and I think people are ready to look forward rather than back. I, for one, am optimistic.”

Published: 2 May, 2016 at 16:40