28 Jun 2024  •  Blog, Dental Landscape, Uncategorized  •  6min read By  • Fiona Ellwood

Inappropriate behaviour in dentistry– it could affect anyone

Executive Director of the Society of British Dental Nurses, Fiona Ellwood, talks about the investigation and gathering of data, which is revealing to some extent, the level of sexual assaults, harassment and inappropriate and unwanted behaviour at work being experienced by dental teams.

It’s quite scary that this continues to be a problem, after all of these years, and the findings that we’ve had so far are already worrying.

Although the research  I refer to was undertaken by the Royal College of Surgeons of Edinburgh (RCSE), (Sexual assault in surgery – a painful truth), there is a link to dentistry and dental care professionals. So, as I said our data basis comes from the most recent literature and blogs from the RCSE, I think it’s really important that we base our position on good evidence and not just gossip and work provided from a reputable source. The information that’s out there is really quite worrying and a comment from the RCS work simply got us thinking ‘ if this is happening to us, then what about the nurses’. There is evidence in a small number of past fitness-to-practice cases that certainly highlights some unwelcome behaviours within dentistry.

It can happen to anyone

Although a lot of the research previously noted, does speak to sexual assault and harassment, it also covers inappropriate and unwanted behaviour. This includes wolf whistling, comments about clothing, and your body structure as examples. It is not just about sexual harassment and it is so important that this is understood.

A paper from the from Royal College of Surgeons of England, called Breaking of the Silence sets out the scale of the problem from their perspective. This piece of work came on the back of a report from Exeter and Surrey University in 2023. It’s a huge report but I do urge people to read it. The study shows 63.3% of women and 23.7% men have suffered and complained about sexual harassment. I think it’s key to remember inappropriate behaviour is not something that is just directed towards women, it has the potential to happen to everybody.

In addition, 89.5% of women and 81% of men have witnessed sexual misconduct. Now the word ‘witness’ is important as it comes through strongly in our responses so far. However, only 16% of those impacted made a formal report about this. So that’s a huge worry for all of us when you compare how many people say they’ve been impacted by harassing conduct and yet only 16% of people have had the courage, or have taken the time, to record this.

We now have some empirical evidence to support the extent of the problem, or perhaps the tip of the iceberg. The article We Must Stamp Out Sexual Harassment in Surgery appeared in the BMJ in 2023 and brings together both The Painful Truth and Breaking the Silence. It examines the roles of bystanders and allies. It also looks at the hierarchical and social power within the teams, the imbalances when working in close proximity of each other and the normalisation of sexual banter.

This highlights something else we have touched on in our survey which is around what is deemed as inappropriate behaviour or misconduct in the workplace. All too often we jump to the ultimate, such as sexual harassment or rape, and we forget about the everyday challenges, the jokes, the banter, the personal comments; it’s the everyday things that build up. If we don’t address the normalised things, that seem negligible to some, then they get bigger and bigger and become more impactful.

The most recent report is Reporting Unacceptable Behaviour in the Workplace from the Royal College of Surgeons, England. And there’s clear guidance in there about the support to encourage people, particularly students, to speak up; to know how to report, and to feel safe to report. We need to look closer at this in dentistry and especially if our findings are anything to go by.

As well as the Society of British Dental Nurses, I also work in Human Factors and Patient Safety Sciences. This also includes psychological safety and the challenges around when feeling safe should and must be expected. And part of that work also looks at the Health and Safety Executive (HSE) and around reporting rights. There are some fabulous tools available to help the team to learn to speak up.

What I would like to do is to urge people to not think about ‘reporting’ because that word can be a worry and off putting, but rather to start ‘recording’ as that can take some of the fear out of reporting by recording. Recording is a means of starting to normalise the fact that we can have these difficult conversations and that we are safe. We need to normalise recording within staff meetings and other circumstances and situations.


As I’ve said, ‘Breaking the Silence’ links to surgery, but these behaviours could, and do, easily spill over into dentistry, in particular dentistry in secondary care and the community settings as we have seen. So, we need to consider how this plays out in primary care and how we should manage and challenge these behaviours. This has the potential to be more challenging given perhaps the smaller team dynamics, the power dynamics and of course the reporting lines.

We may also come up against people who would rather not deal with the problem, the people who would like us to settle it quietly and go away. But it’s really important that we understand that it is inappropriate for anybody to try and dampen this down. We shouldn’t be asked if we could handle an incident less formally; we have a real issue and we need to be able to talk about it. Neither should we be accepting of the bystander, if you were in a difficult situation, would you want your colleagues to support you, or turn a blind eye?

I urge everybody to read Breaking the Silence, because it really hits hard. The messages are incredible, although disappointing. When you do read it, I suggest you’re sitting down with a strong cup of coffee or tea, because some of the stories are heart wrenching. However, we should not shy away from tackling inappropriate behaviour, not matter what it looks like.


Fiona Ellwood

Executive Director of Society of British Dental Nurses

Fiona Ellwood BEM is the Executive Director of the Society of British Dental Nurses. She is also the Interim Chair of The National Oral Health Group and co-founder of the International Federation of Dental Assistants and Nurses, the founder of Dental Professional Alliance and a member of Dental Mentors UK.

She has an honorary Fellowship from the Faculty of General Dental Practitioners (UK) (the first DCP to do so) and is a former Fellow of the Faculty of Dental Trainers at the Royal College of Surgeons Edinburgh. She has fellowship recognition from the Institute of Administrators and Managers and the Royal Society of Public Health, is a trustee at Dentaid and supports the Mouth Cancer Foundation from an education perspective. Fiona is both a doctoral researcher and a co-investigator in an extensive NIHR programme and of course a former (HON) President of British Society of Dental Hygiene and Therapy and has two roles with the General Dental Council and is trained Expert Witness.

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