Objectives of hospital-based post-doctoral general dentistry programs in Canada were assessed by questionnaire. Seventy percent (14 of 20) of the program directors responded. Educational goals and objectives were assessed in professional skills and practice management, public health and preventive dentistry, oral medicine and pathology, special needs patient care, trauma and emergency care, restorative/prosthodontic care, endodontics, orthodontics/pediatric dentistry, oral surgery, periodontics, pharmacology, and functioning in a hospital. High rankings of proficiency were related to primary care, restorative/prosthodontic, endodontic, and surgical care. Emergency care, sedation, and pharmacology were also ranked highly. Lower rankings of proficiency were reported in orthodontics, aspects of public health dentistry, practice management, and advanced oral and maxiliofacial surgery. When the results of the Canadian survey were compared with those of a survey of US post-doctoral general dentistry programs, substantial similarity was seen. The findings support continuing reciprocity in accreditation standards between the Canadian and American Commissions on Dental Education and Dental Accreditation.
The objective was to identify dental professionals' attitudes and awareness on evidence based dentistry (EBD), and to elucidate perceived barriers and views on how to move towards EBD. A questionnaire was sent to 290 dental professionals (dental hygienists, general dentists, specialist dentists) in the county of Halland, Sweden. The questionnaire consisted of closed questions and free text sections, related to attitudes, awareness and skills on databases, EBD, and terms related to scientific publications, as well as perceived barriers towards EBD. A majority of the respondents had a welcoming attitude towards EBD. The respondents perceived their colleagues less positive towards EBD. The respondents considered EBD, at least partly, useful in daily dental practice. With the exception of general dentists in private practice, a vast majority of the dental professionals thought that EBD would improve the care of their patients. Dental professionals in the county of Halland, in Sweden, had a welcoming attitude towards EBD, and indicated an open attitude for learning more about interpretation of evidence from scientific publications. The most commonly perceived barriers towards EBD, were 'lack of time' and 'poor availability of evidence'.
After consulting a large community of interested parties, the National Dental Examining Board of Canada (NDEB) and the provincial licensing authorities recently made significant changes to the certification process for dentists in Canada. This paper provides a chronology of the evolution of national certification and a summary of the present certification processes for graduates of both accredited and non-accredited programs.
Comment In: J Can Dent Assoc. 1997 Dec;63(11):804-59433021
The purpose of this study was to evaluate the changes in orthodontic care patterns over a sixteen-year period in a university clinical setting. The average numbers of students, clinical procedures, and orthodontic appliances were examined from the time period 1988-2003. Appliance number and type were evaluated as a function of increased predoctoral and postdoctoral class sizes, student to faculty ratios, and decreased operating budgets for faculty recruitment. For the period 1988-98, the insertion of orthodontic appliances by dental students remained constant. A permanent increase in the predoctoral class size occurred in 1996 without an increase in faculty support, contributing to a decline in appliance insertions by students from 1999 to 2003. This time period also saw major increases in the postdoctoral class size and a reorganization of the clinical facility that then began to require the pairing of dental students to provide comprehensive care, thus decreasing their clinical exposure to the care of children. The overall clinical experience at the predoctoral level in orthodontic procedures declined, which resulted in a change in clinical requirements and new methods to ensure clinical competency.
As part of the recommended review of the national competencies for beginning general dentists in Canada, a validation survey was distributed to 731 dentists. The survey asked participants to supply demographic information and rate each of the forty-six competencies on a 5-point Likert scale. The response rate was 43.1 percent (315 total usable responses). Self-reported demographic data was used to create respondent subgroups. The participants rated all of the competencies quite high with thirty-six of the forty-six receiving rankings averaging 4.0 or higher on the 5-point scale. No competency received a ranking averaging lower than 3.0. Competencies rated as most important by the entire sample were also rated as most important by all respondent subgroups. The results of this validation survey provide evidence of content validity and reinforce the value of a national competency document that can serve as a reference for curriculum management, program accreditation, and development of certification examinations.
To compare root canal treatments performed before and after education in a nickel-titanium rotary technique (NiTiR) with respect to costs for instrumentation and number of instrumentation sessions in a County Public Dental Service in Sweden.
Following education, 77% of the general dental practitioners adopted completely the NiTiR. The randomly selected sample comprised 850 root canal treatments: 425 performed after the education, mainly using the NiTiR-technique (group A) and 425 performed before, using mainly stainless steel hand instrumentation (SSI) (group B). The number of instrumentation sessions in root canal treatments in group A and B was calculated. A CMA was undertaken on the assumption that treatment outcome was identical in group A and B. Direct costs associated with SSI and NiTiR were estimated and compared. Investment costs required for implementation of NiTiR were calculated, but not included in the CMA.
Instrumentation sessions were counted in 418 (98%) root canal treatments performed in group A and 419 (99%) in group B. The number of instrumentation sessions in group A was significantly lower; 2.38, compared with 2.82 in group B (P
Espoo City Social and Health Services and Network of Academic Health Centres, Institute of Clinical Medicine, Department of General Practice and Primary Health Care, University of Helsinki, Finland. firstname.lastname@example.org
To compare treatment of heavy and low users of dental services among adults in the Public Dental Service (PDS) in one of the biggest cities in Finland and to identify reasons for heavy use and to suggest improvements to care provision.
All adults who attended the PDS in Espoo (pop. 227,500) in 2004 were allocated to a group (n = 3,173) who had made six or more dental visits and a comparison group (n = 22,820) who had three or fewer dental visits. The data were obtained from the patient register of the PDS. A sample of 320 patients was randomly selected from each group. Information on age, gender, number and types of visits, oral health status, treatment provided and fees paid was collected from treatment records.
10.5% of the adults were found to be heavy users and their treatment made up 31.6% of all adult dental visits. The proportion of men was greater among heavy users and the heavy users were on average 6.6 years older than the low users. The mean total treatment time for heavy users was 5.5 hours and 2.0 hours for low users. Heavy users had more untreated and treated caries and more periodontal pockets than low users. Restorative, endodontic and prosthetic treatment needs characterised the heavy user group, while the low users most often received restorative and periodontal treatment only.
Our study indicates that complicated treatment needs of heavy users and lack of experience among the caregivers in dealing with them resulted in high numbers of dental visits for individual patients. The PDS should offer appropriate continuing education for its oral health care teams and organize a referral system offering specialist care for difficult endodontic, periodontal and prosthetic treatments.
As part of a review of the undergraduate curriculum to assess its relevance for a future general practitioner, a survey of self-perceived competency at graduation based on the competency list developed by the Association of Canadian Faculties of Dentistry was circulated to recent graduates and the graduating class. The overall response was 67.5 percent, and revealed that approximately 70 percent of the respondents felt well prepared in approximately 69 percent of the competencies. These were the common "bread and butter" items of dentistry, such as basic restorative dentistry, examination, diagnosis, treatment planning, local anaesthesia, and scaling. Those areas reported as less well-prepared for included financial and personnel management, performance of soft-tissue biopsies, and management of chronic orofacial pain. Clarification of the raw survey results in focus groups was needed to uncover specific details that could lead to remedial action in problem areas.
The aim of the study was to test the hypothesis that a further education programme relating to nickel-titanium rotary instrumentation (NTRI), with the concurrent activation of social/professional networks amongst all general dental practitioners (GDPs) in a public dental service in Sweden, would increase the adoption rate and improve root-filling quality.
To activate the networks, the GDPs at the 25 clinics elected training coaches from amongst themselves. The coaches were educated by a specialist and were then free to organise and conduct the training of the local GDPs. However, collective hands-on training and discussions were mandatory. Lectures were held by an endodontist. The rate of adoption and root-filling quality was evaluated just before and 6 months after the education. Statistical tests were performed with chi-square using a 95% confidence interval.
Nickel-titanium rotary instrumentation was adopted by 88%. Excellent root fillings (score 1) increased from 45% to 59% (P = 0.003). The rate of poor-quality root fillings (score 4 and score 5) was not affected. The quality ratio (score 1/score 5) increased from 5.36 (118/22) to 9.5 (133/14). Eleven dentists (17%) at nine different clinics produced 49% of the poor-quality root fillings (score 4 and score 5). Seventy-three per cent of these dentists stated that they had adopted NTRI.
The introduction of NTRI will increase the adoption rate and the frequency of good-quality root fillings. However, it will not overcome the problems associated with dentists producing a low-quality level, even if a local professional network is activated.
Reduced caries rates and an increased percentage of children with dental insurance have made it more difficult for dental schools to provide undergraduates with sufficient numbers of pediatric dental patients requiring restorative procedures. This may result in graduates who are not competent and are reluctant to treat children after graduation. To ensure the quality of the undergraduate clinical training program, the Division of Pediatric Dentistry at the University of Manitoba changed from a comprehensive-based clinic to a block system in 1998-99. Specific communities with limited access to dental care (neighboring core area schools and Hutterite colonies) were specifically targeted as potential sources for child patients. This format increased the exposure of students to patient management as well as to complex pediatric dentistry procedures. To assess the learning experiences before and after the changes to the clinical pediatric dentistry program, sixty general dentists who had graduated from the University of Manitoba were randomly selected using the Manitoba Dental Association Directory. Surveys were sent to twenty general dentists who graduated in each of the following years: 1993, 2000, and 2002. Forty-five dentists responded, fifteen from each of the three surveyed classes. Dentists who graduated after the changes to the program (2000, 2002) reported that they performed a greater number of complex pediatric dentistry procedures and treated more toddler and preschool children than the group that graduated before the changes (1993). Referrals to pediatric dentistry specialists were higher in the 1993 group than in the 2000 and 2002 groups. In conclusion, an adequate pool of pediatric patients is critical to provide dental students with sufficient learning experiences. The dentists who graduated from the program after the changes were implemented are providing more comprehensive treatment to younger children.