Okay first of all I am not a dentist but I happen to be a pharmacist but two immediate members of my family happen to be a dentist so with my understanding of NHS and from what they tell me I can explain the pitfulls.
1) UDA this is the most problamatic issue for dentists in the UK. What is UDA?
From a website:
Since April 2006, UK NHS dentists have been paid according to how many "Units of Dental Activity" they do in a year.
One UDA is worth between £15 and £25 - it varies around the country, and the more desperate an area is for NHS dentists, the more a UDA is worth. The actual cash value of a UDA is set by the local NHS Primary Care Trust, in discussion with the Dental Practice. If a dentist does a "simple" course of treatment, involving perhaps Exam, Radiographs, OHI, Perio Care, they will be awarded 1 UDA.
A treatment that involves fillings or extractions will earn the dentist 3 UDAs, and a course of treatment that needs lab work (like dentures or crowns) earns 12 UDAs.
This is rather similar to the "points" system you work with as a student. The difference is that UDAs go by the completed treatment, not the number of items in the treatment plan.
- If you do a treatment with crowns, you will get 12 UDAs. (£180). It doesn't matter if it is 1 crown or 20 crowns, you still get a total of 12 UDAs.
- If you do a treatment involving endo, you get 3 UDAs (£45). Again, it doesn't matter if it is a simple upper incisor, or 5 difficult molars - the "payment" is the same. (If you then restore the teeth with normal fillings, that is also included in the 3 UDAs for that course of treatment.)
So hear lies the dilemma for dentist they get paid per course of treatment not per items in the treatmeant. As a result it forces them to see more patients because otherwise they can't earn a decent income. This causes them to work in a conveyor built fashion. Since in the UK oral hygeiene is not great for the payment of 3 UDA you are probably doing work worth £200+ of private work. A private post is not viable option until you have 5+ years of experince but with increase graduates more competition.
2) Dental therapist: with these people on the scene you will have less barganing power for salary because they will do the job for a fraction of the cost. Again no solution to these areas
What about specialism? I did ask them:
If you take orthodontics as an example its funding has been cut and general practitioner can do many of the treatments now. As a result you could spend a fortune specialising but it may give little in returns. In dentistry current high paying niche areas for long term are endodontics; however endodontics is quite a difficult practice which is why it is a specialised area. Another area is oral surgery/prosthodontics but it takes time to develop expertise but dentist who do get paid handsomely for it. However its likely to be a part time post as they often spend time in lecturing/teaching in local dental hosptial.