Interview with a Prosthodontist. Andrew Wallace talks with Paul McLornan. 30 OCTOBER 2017 // dentaltownuk.com. Click here to listen to the interview

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Interview with a Prosthodontist Andrew Wallace talks with Paul McLornan Dr Paul McLornan qualified from Queens University in Belfast in 1996 and worked in general practice for 7 years.

training in prosthodontics, he is now a Professor. Paul also works in Private Practice, limited to prosthodontics and the treatment of snoring and Obstructive Sleep Apnea (OSA) using oral appliances.

1 Interview with a Prosthodontist Andrew Wallace talks with Paul McLornan Dr Paul McLornan qualified from Queens University in Belfast in 1996 and worked in general practice for 7 years. In this interview, Andrew Wallace talks to him about his Prosthodontic residency at the University of Texas Health Science Centre at San Antonio (UTHSCSA), where following his speciality certificate training in prosthodontics, he is now a Professor. Paul also works in Private Practice, limited to prosthodontics and the treatment of snoring and Obstructive Sleep Apnea (OSA) using oral appliances. Paul is a board certified Prosthodontist, (a Diplomate of the American Board of Prosthodontics) and a Fellow of the American College of Prosthodontists. He has lectured extensively at local, national, and international meetings and has authored numerous published articles. He has served as President of the Texas Section of the American College of Prosthodontics. He is also a member of the American Academy of Dental Sleep Medicine and the American Academy of Sleep Medicine. Additionally, he is an active member of the American Dental Association, the Texas Dental Association and the San Antonio District Dental Society. Click here to listen to the interview 30 OCTOBER 2017 // dentaltownuk.com

2 Andrew Wallace: Obviously, you qualified in Belfast and you worked in general practice for 7 years, did you own your practice? Paul McLornan: Yes, I became a partner in the practice at a young age, maybe a little too young actually in hindsight! AW: Was it all general practice or did you have any particular interests while you were there? PM: It was a general dental practice but because it was a practice situated on the border we got exposure to a substantial NHS practice base as well as a pretty substantial private patient base coming from the Republic of Ireland. Not so much people travelling from Dublin or anything like that but because we were on the border we were as close as any dental practice for the people there, to be honest. In that respect, we got to practice a lot more private dentistry than the average practice. AW: In that point in time that was fairly prevalent wasn t it? PM: It was yes. There was a lot of patients travelling from the Republic to Northern Ireland, really for cost reasons, but typically we found that we weren t one of those practices getting coming up on the train from Cork for therapy. Mostly our patients were coming from counties Louth and Monaghan and many times we were as close to them as their local dentist, so it was kind of a different practice in that way. AW: When did you move to the US? PM: I moved and started my prosthodontic residency in 2004 in San Antonio. AW: What prompted the move? PM: The short answer to that question is that I met a girl from Texas, I met her in Belfast but I ultimately followed her back to Texas. But I think it was one of those stars aligning situations, I d really reached a point in my general dental career where I was really wanting to expand my knowledge base, I d started realizing what I didn t know over what I did know. More cases were coming to me that needed more complex restorative options and I didn t feel confident delivering them, the need for dental implants was starting to grow and the patient s demand for them had too. So, I d really reached a point where I could do a programme and try and keep my practice going at the same time or but what happened was, when I met Sarah, who s now my wife, from Texas and I started to look at moving to the United States and what that would involve. What I found out was that I d either need to go back to medical school and do another 2 years or you could do a three-year special lead programme and I really wanted to do the special lead programme I didn t want to go back to dental school. Prosthodontics was really the obvious one for me because what I was really interested in was learning more extensive restorative treatment and getting an education in implant dentistry, so prosthodontics was the right fit. AW: Was that typical to walk into the special lead programme as a non-us graduate? PM: Going into any residency in the US, you re going to be competing against US dental students and that makes it pretty difficult because there s a system where they have a GPA and they get scored on everything they do in school, just as they do in university. AW: So they have a track record up until that point? PM: Exactly and really what was surprising was when they wanted to see my transcripts from Queens, they wanted to see every exam result. All it was, was a list that has multiple passes, with maybe a fail, a repeat and a pass and ultimately at Queens what you got was a pass degree and that made it hard for these directors who are trying to get a feel for your educational background. That made it a little trickier. Really what helped me, when I look back on it, was that there had been three other Irish dentists who had done the residency over the 15 years before I went and all of them had done well in the programme so I had no illusions that I got in on their coattails. The only thing I can say in my own credit is that, since I left there have been a further three Irish residents that have been accepted so I cant have damaged the reputation too much. AW: Your training is implants and restorative dentistry, so how did you get into the sleep end of things? PM: As part of the prosthodontic residency, you have to do a special research project, present it, get it published and then you get your masters and at the time dentaltownuk.com \\ OCTOBER

a lot of people were testing things on instra machines and looking at cells growing with implants and none of that really interested me, I wanted to do something clinically.

3 a lot of people were testing things on instra machines and looking at cells growing with implants and none of that really interested me, I wanted to do something clinically. One of my mentors was a prosthodontist in the air force and he told me that people were looking into sleep apnea and snoring and appliances, which they had been fitting for years in the air force for pilots. So pilots who were suffering from sleep apnea were having devices fitted to help and he said it really works so we need a little research to show everyone else that it works, so that s what I did. I teamed up with the VA dental clinic in San Antonio, we did a research project there showing how effective oral appliances are in treating sleep apnea. AW: Just going to take a step back here, how did you find the transition between dentistry in the UK and Northern Ireland to dentistry in the US? PM: On a personal level, the biggest transition was going from being your own boss, I was coming from being a partner in a dental practice with a team of about 14 people, I went from the head honcho to being a student. It was made very clear as well that I was a student doing a residency now. AW: Residencies in the US are notoriously tough. PM: Yeah, the biggest shock to me at the start was the work and time commitment and the day started at 7.30 in the morning and it wasn t unusual that we walked out of there at or o clock at night. The two worst residencies for that are oral surgery and Pros, pros because of the lab work, it was back to basics. I was making my own dentures from scratch, casting gold crowns and porcelain on metal frameworks, it really was right back to basics. AW: You still have family in Northern 32 OCTOBER 2017 // dentaltownuk.com

4 Ireland, working in dentistry, do you feel there has been any change there from when you left 12 to 15 years ago, to what they describe to you now? PM: I know NHS dentistry was never perfect, I practised it here in Manchester for vocational training and I did quite a bit of it when I was in practice there. All I ve heard and all I ve seen since then, which I m sad about, is kind of the demise of the NHS; the reduction of availability and services to NHS patients, and I kind of feel for dentists working within it. On a positive note, I m always impressed when I come back to Northern Ireland and I talk to friends of mine who are working in dentistry there, there s still a great degree of professional satisfaction, despite the problems you hear about working in the NHS. Also that implant dentistry there is probably where it is in the US, restorative dentistry is being delivered at very high levels and orthodontics is the same way; I think there s a lot to be positive about. There are practices in Belfast that are providing services that are world class. One of my classmates has become a restorative guru in the UK and Europe and he s well known in the US too! AW: Going back to sleep, what do you think is a good starting point for a general dentist looking to get involved in the treatment of snoring or sleep apnea? PM: My view has developed after being involved in this field for over 12 years, I now think that the dentist s primary role is in screening for sleep disordered breathing and the reason I think that s so important is that I don t think other medical professionals are really doing it. It s a problem that s occurring in an area of the body that we probably know better than anybody else, bar maybe our ENT colleagues, it s our area of expertise. If a patient screens positively for sleep apnea then we can get them referred to a medical doctor and get them diagnosed and then all we can ask is that the doctors present them with their treatment options, of which the main three are CPAP, a mandibular repositioning device and or the jaw surgery. The latter two can only be done by dentists. I think screening and treatment for sleep disorders are roles mainly performed by dentists. Diagnosis, particularly of sleep apnea, is going to remain the purview of doctors. AW: There s not many areas within dentistry that we can have such an impact on the patients general health. PM: I couldn t agree more. I think in the era of comprehensive care, I don t think there s anything more comprehensive than this. It s probably the biggest crossover in the industry of medicine that I think there is, bar none. The fact is, there s so much in dentistry that we can do, we can change how patients occlusion is, we can change how patients look aesthetically but when it really comes down to it, when you look at this condition, we can actually change the patients quality and quantity of life. On a very simpler level, we can be the greatest marriage counsellor there is because you can get couples sleeping together who haven t slept together in years because of snoring! We can get patients off high blood pressure medication, we can get them off anti-depressants and it s been proven that treating sleep apnea can increase the quantity of life. That s a profound effect that dentists can have on a patient. AW: Outside of sleep, what s your main interest in dentistry and prosthodontics? PM: Implant Dentistry and implants really. All their forms, all the way through to single crowns to over dentures built on a single implant, over dentures built on a couple of implants, restorations, replacing full arches of teeth. Implant dentistry is a large part of what I do. I still make complete dentures, it s one of my favourite things to do for a patient. I still get a lot of satisfaction out of making dentures. One thing I firmly believe in is that denture education has to stay in dental school, to do any aesthetic of restorative dentistry, you need to know how to build a good denture. I think orthodontists need to be able to build a good denture because they need to know where and dentaltownuk.com \\ OCTOBER

how to position teeth to provide good lip support and to get good occlusion. I think the principles you learn in making a good denture, like smile design, is essential.

5 how to position teeth to provide good lip support and to get good occlusion. I think the principles you learn in making a good denture, like smile design, is essential. I hear the term smile design and 3D smile design and I m like, do you know what that is? The principles behind a good denture! AW: If you had one piece of advice for young dentists starting out in the US, what would it be? PM: I would say that I think they re starting out in the best career there is. I still love dentistry, I loved dentistry from my first day at dental school and I still love it. Dentistry opens up the scope to do so much with your career, I would also say, don t be in a hurry to get that first pay check. Develop your career because you ve got a long time to practice out there and gaining more education gets harder as you get older because life gets in the way. If you re going to dental school and you have a thing for oral surgery, you can t extract enough teeth and you really enjoyed that aspect of it, consider an oral surgery residency, consider a speciality in that direction. Follow your dream in dentistry. AW: I think in dentistry we pigeon hole ourselves very quickly into general practice or hospital roles and it s hard to switch. It s hard to go back and explore different education. One thing that I worry about young dentists in the UK is that they re very keen to have the nice car and the fancy suit and it means that they can t go back but the best specialists are those with a broad range and practice experience. PM: That s a worldwide phenomenon, in the US they have a huge issue with student debt and then the pressure is on to start paying that debt and they end up at a dental corporate where the main focus can be making money. If you look over the span of a career, I think to go into a special lead programme you will get a return on your investment, you will get those debts paid off, it is time well spent. AW: What s the next big thing in dentistry? PM: I m biased but I think its airway. It puts its tentacles into every aspect of dentistry. Except for an ENT, we re the only medical professional who can prevent sleep disorder occurring. Orthodontists could get in there early and prevent it by expanding kids arches, avoid extractions where possible, treat patients that have class two malocclusions. We see these patients all the time, we see children grow up, we probably see them more than their medical doctor so who better to do it. We all took embryology, we all took development courses but we ve done it and it s part of our training. AW: Anything else you d like to say to the DentaltownUK readers? PM: The future of dentistry and how we stop ourselves becoming mechanics of fixing teeth is looking more into comprehensive care. We re part of the patient s medical team and I think that s a key part of the future of dentistry, I think it has to be. Gain valuable experience in Laser dentistry. Including fundamental and advanced techniques in clinical and cosmetic procedures. Includes various dental applications such as decontamination techniques, ablation and therapy treatments Dr Anoop Maini BDS(Lond) DGDP(UK) Call now for London dates Only 265 6CPDs 34 OCTOBER 2017 // dentaltownuk.com

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