Why I Built My Career Around Minimally Invasive Dentistry

I never set out to be a dentist. I certainly never set out to spend more than twenty years at one practice. Yet here I am, twenty-one years into my time at BDS Dental, partner here since 2014, and still teaching at King’s College London, where I’ve now been for seven years. People sometimes ask how that happened — what drew me in, and what’s kept me here. The honest answer is a chance conversation with a headmaster, a chemistry A-level, and a practice principal whose approach to dentistry didn’t quite fit the mould.

I want to use this first article to introduce myself properly, explain what brought me to BDS, and set out what we actually mean when we say we practise minimally invasive dentistry — because the phrase gets used a lot. It’s the kind of thing every practice website will tell you they do. Whether they really do is another matter, and that’s what the rest of this series will get into.

A path into dentistry that started on a school field trip

I was good at science at school. My mother taught chemistry A-level, and she made sure I kept my options open by sticking with chemistry and biology. I’d never thought about dentistry — my own childhood experiences in a dentist’s chair were actually quite traumatic (through no fault of our family dentist, who is a lovely guy!), and the idea of doing that as a career would have struck me as absurd at the time.

What changed things was a biology field trip up to Manchester University Medical School to look at the electron microscope. I was bowled over by it. Everyone in white coats, doing work that looked genuinely interesting, and I came away thinking that was what I had to do. Some sort of white-coat job. I just didn’t know which one.

I was also very artistic. The other thing I’d been considering was architecture. So I went to see my headmaster and told him I was torn between something scientific and something more creative. He looked at me and said, “Have you ever thought about dentistry?”

I genuinely hadn’t. But the more I sat with it, the more it made sense — and after some work experience with a friend of my parents who happened to be a more modern, forward-thinking dentist than the one I’d grown up with, I applied. I was studying in Israel at the time, and to my surprise I came back with an unconditional offer from Manchester. I’d never had to justify the choice to myself.

What I found, once I was inside the profession, was that dentistry is genuinely the blend of art and science I’d been looking for. Every day is both. When work experience students come to shadow me now, I sometimes ambush them with the chemistry: I’ll be doing a composite restoration and ask them whether hydrofluoric acid is a strong acid or a weak one. Most people who study chemistry never end up using it in their working life. In restorative dentistry, the things you learned in A-level chemistry are relevant every single day. So is the artistry. Building a tooth back up so it looks like it grew there is, on a good day, the closest thing I get to making something with my hands.

Joining BDS Dental — and a prosthodontist who didn’t behave like one

I joined the practice in 2005, drawn in by the reputation of the principal at the time, Harris Sidelsky. Harris was — and is — a very highly regarded prosthodontist. And here’s the thing that made BDS unusual, then and now: prosthodontics is, in many ways, the antithesis of minimally invasive dentistry. It’s the specialty that deals with crowns, bridges, and replacing missing teeth — what I sometimes describe as expensively closing the stable door after the horse has bolted. Minimally invasive dentistry is about not getting to that stage in the first place.

Yet Harris had built a practice with minimally invasive dentistry sitting right at its core. Twenty-plus years ago, in the UK, that simply wasn’t a thing most practices marketed themselves around. The whole concept was, if not unheard of, certainly unusual to put at the centre of a practice ethos — and almost unheard of when the person driving it was a senior prosthodontist. I haven’t come across another practice quite like it before or since.

That was what brought me in. What kept me, though, was something I didn’t fully appreciate when I joined — a second strand to the ethos, around exceptional patient care. Harris pushed it relentlessly. The idea of looking after people as individuals. The deliberate effort to make the practice feel like a family — both for the patients we see and for the people who work here.

Emma has been with us for thirty-two years. Ute has been with us for nearly thirty. Elisheva, our receptionist, was with us almost as long before she emigrated, and she now works for us remotely — patients still ring up and are surprised to hear her voice answering from the other side of the world. When someone like that moves abroad, it really does feel like a family member leaving. I miss her, even though I still speak to her almost every day. That sounds like a small thing to say in a piece about clinical philosophy, but I don’t think it is. The way a practice treats the people inside it tends to show up in how it treats the people who walk through the door.

What “minimally invasive” actually means at BDS

So, what is minimally invasive dentistry, the way we practise it?

There are two sides to it. The first — and to my mind the most important — is the decision-making side. It’s about choosing, very carefully, when not to intervene. The standard approach in dentistry up until thirty or so years ago was, broadly, if in doubt, drill it out. We’ve moved a long way from that, and the evidence has moved with us. There are many small lesions on x-rays that, given the right hygiene, the right diet, and the right monitoring, simply do not need to be filled. Some can be arrested. Some can even, over time, be reversed — and in the next article I’ll explain how we decide which ones to leave alone.

The second side is what we do when treatment is needed. Modern bonded composite techniques mean that when we do step in, we can often remove the minimum amount of healthy tooth structure and glue new material onto what’s already there — avoiding the spiral that turns a small filling, over the years, into something far bigger. That cycle is real, and once you’ve started it, you can’t undrill what you’ve drilled. So the goal is to delay starting it for as long as possible — and, where possible, never to start it at all.

Both halves of that approach take the same thing to do well: clinical knowledge, materials, equipment, and the willingness to have the longer conversation with the patient instead of the quicker one.

Why I teach this — and why we still have to argue for it

Minimally invasive dentistry is now formally taught. King’s, where I teach, has a whole department devoted to it. My official title there until a few years ago was Clinical Teacher in Minimally Invasive Dentistry. So the profession has moved.

But — and this is where I’d push back a little on what’s said about the field — I’m not convinced everyone has fully bought in. Most younger dentists qualifying today will have heard the concept and hopefully learned the evidence behind it. Whether they’ve had enough clinical experience to really practise it, and whether they’re then working in an environment that allows them to, is a different question. It’s one thing to know that you shouldn’t drill a small lesion you could monitor. It’s another to have the time, the materials, the confidence and the patient relationship to do that well.

That’s what I try to bring to the practice, and that’s what I try to pass on to the students I teach. It’s also what the rest of this series is going to dig into. In the next piece, I’ll go through what we actually do when we choose not to drill — how we make that call, how we monitor, and how we get patients on board with the partnership that makes it work. After that, I’ll get into how we rebuild worn-down teeth with bonded composite (often for a fraction of what crowns would cost), why your Diet Coke is doing more damage than you think, and how to think clearly about cosmetic dentistry in an Instagram age.

If you’ve ever wondered why some dentists seem to want to do less work on your mouth than others — and why that’s almost always a good thing — stick with me. This is the series for you.

Dr Ellie Bergin is a partner at BDS Dental and a clinical teacher at King’s College London. To book a consultation, contact the practice here.