General Dentistry Practice Competencies and Subcompetencies

1. GRADUATES MUST BE COMPETENT IN THE ASSESSMENT, DIAGNOSIS, AND THE DENTAL MANAGEMENT OF PATIENTS, INCLUDING MEDICALLY COMPROMISED PATIENTS, THROUGHOUT THEIR LIFECYCLE.

A. Record the chief complaint or reason for the patient's visit.

B. Obtain and interpret a thorough history of present illness, medical history, social history, review of systems and dental history.

C. Conduct an appropriate clinical and radiographic exam and distinguish oral pathological hard and soft tissue abnormalities.

D. Assess the risk of radiation exposure and diagnostic benefits of radiographic procedures, and select the appropriate radiographs required for diagnosis.

E. Make and evaluate for diagnostic quality, periapical, bitewing, occlusal and panoramic radiographs.

F. Use casts mounted in centric relation and centric occlusion for diagnostic and treatment planning purposes.

G. Interpret findings from the history, clinical and radiographic examination and other aids.

H. Using the existing data and resources, including consultations, apply critical thinking and problem solving to recognize oral diseases. Identify the etiology, pathogenesis and significance of common disorders. Establish necessary documentation.

I. Inform the patient in understandable terms about the patient's oral health problems and their significance.

J. Recognize the oral manifestations of systemic disease.

K.  Recognize the presence of systemic disease and how the disease and its treatment affect the delivery of dental care.

L.  Interpret appropriate clinical laboratory and other diagnostic aids and tests.

M.  Initiate an appropriate written medical and dental consultation or referral.

N.  Assess a patient's risk for oral disease and provide appropriate advice for risk reduction.

2. GRADUATES MUST BE COMPETENT IN TREATMENT PLANNING AND CASE PRESENTATION FOR PATIENTS THROUGHOUT THEIR LIFECYCLE.

A.  Develop a comprehensive, properly sequenced treatment plan including appropriate referrals, based on evaluation of all diagnostic data and the personal and economic capabilities of the patient.

B. Discuss the findings, diagnosis, treatment options and consequences with the patient.

C. Present to the patients their responsibilities, time requirement, sequence of treatment, estimated fees and payment responsibilities.

D.   Obtain informed consent and the patient's written acceptance of the treatment plan.

E.  Assess critically and apply new treatment modalities as they relate to the development and modification of patient's treatment plan.

F.  Recognize indications for referring the patient to dental specialist for care beyond the knowledge and skill or the general dentist.

3. GRADUATES MUST BE COMPETENT IN PATIENT EDUCATION AND THE PREVENTION OF ORAL DISEASES IN A MANNER THAT THE PATIENT CAN UNDERSTAND.

A.  Educate patients concerning the etiology and control of oral diseases, oral habits and conditions.

B.  Provide health education designed to motivate patients to assume appropriate responsibility for their oral health.

C.  Provide child, adolescent and adult patients a prophylaxis, topical and supplemental fluorides, sealants and other prevention treatments.

D.  Assess periodically and monitor compliance with the patient's preventive plan, including the recording of appropriate indexes.

E.  Manage effectively the patient recall plan.

4. GRADUATES MUST BE COMPETENT IN CONTROL OF PAIN AND ANXIETY, CLINICAL PHARMACOLOGY AND MANAGEMENT OF RELATED PROBLEMS FOR PATIENTS THROUGHOUT THEIR LIFECYCLE.

A.  Utilize appropriate behavioral techniques in developing patient confidence.

B.  Administer effective local anesthesia.

C.  Write prescriptions and utilize drugs applicable to dentistry.

D.  Apply appropriate behavioral and pharmacological techniques for the control/management of anxiety and pain for all patients.

E.  Recognize, manage and prevent complications related to the potential interaction of local anesthesia agents and other medications taken by the patient.

F.  Utilize appropriate literature (information) in assessing new drugs the patient may be taking and new drugs available for dental use.

G.  Recognize those patients requiring special management expertise in pain and anxiety control and refer appropriately.

5. GRADUATES MUST BE COMPETENT IN THE PREVENTION AND MANAGEMENT OF MEDICAL EMERGENCIES IN THE DENTAL SETTING.

A.  Diagnose and assess medical emergencies and provide basic life support when indicated.

6. GRADUATES MUST BE COMPETENT IN THE MANAGEMENT OF PERIODONTAL DISORDERS FOR PATIENTS THROUGHOUT THEIR LIFECYCLE.

A.  Diagnose the presence of periodontal disease and include appropriate intervention, including referral to a specialist when indicated, in the patient's comprehensive treatment plan.

B.  Perform dental prophylaxis, scaling and root planning.

C.  Evaluate the results of periodontal treatment.

D.  Establish and monitor an appropriate maintenance program.

7. GRADUATES MUST BE COMPETENT IN THE RESTORATION OF TEETH TO FORM, FUNCTION AND ESTHETICS FOR PATIENTS THROUGHOUT THEIR LIFECYCLE.

A.  Properly use rotary and hand instruments to prepare individual teeth for restoration with direct and indirect filling materials.

B.  Select and place direct filling materials to restore teeth to proper form and function in a manner that is durable, maintainable, cost-effective comfortable and, when appropriate, esthetic.

C. Place indirect restorations to restore teeth to proper form and function in a manner that is durable, maintainable, cost-effective, comfortable and, when appropriate, esthetic.

8. GRADUATES MUST BE COMPETENT IN THE REPLACEMENT OF A MISSING TOOTH OR MISSING TEETH TO FORM, FUNCTION AND ESTHETICS USING FIXED PARTIAL DENTURES FOR PATIENTS THROUGHOUT THEIR LIFECYCLE.

A.  Complete indicated preparation of abutment teeth.

B.  Provide a provisional fixed partial denture.

C.  Perform those clinical procedures, including making final impressions, occlusal registrations and, when necessary, shade selections, needed to support the fabrication of a fixed partial denture.

D.  Complete an appropriate work authorization for the dental laboratory technician.

E.  Complete appropriate cementation protocols for the delivery of completed prostheses.

9. GRADUATES MUST BE COMPETENT IN THE REPLACEMENT OF MISSING TEETH TO FORM, FUNCTION AND ESTHETICS USING REMOVABLE PARTIAL AND COMPLETE DENTURES FOR PATIENTS THROUGHOUT THEIR LIFECYCLE.

A.  Make preliminary impressions and use them to create study casts.

B.  Complete the design of removable partial dentures utilizing a survey of study casts.

C.  Complete the appropriate preparation of abutment teeth.

D.  Perform those clinical procedures, including the making final impressions, occlusal registrations and the selection of artificial teeth, needed to support the fabrication of removable partial and complete dentures.

E.  Complete an appropriate work authorization for the dental laboratory technician.

F.  Perform insertion and immediate recall-for-adjustment appointments.

10. GRADUATES MUST BE COMPETENT IN DIAGNOSING OCCLUSAL DISORDERS AND IN DEVELOPING TREATMENT PLANS ADDRESSING SUCH DISORDERS.

A.  Perform occlusal analysis.

B.  Perform limited occlusal adjustment.

11. GRADUATES MUST BE COMPETENT IN THE PREVENTION, DIAGNOSIS, AND MANAGEMENT OF PULPAL AND PERIARADICULAR DISEASE FOR PATIENTS THROUGHOUT THEIR LIFECYCLE.

A.  Prevent pulpal disease through pulpal protection techniques.

B.  Perform non-surgical endodontic therapy in simple cases and recognize and refer complicated endodontics.

C.  Diagnose and manage pulpal and periradicular diseases.

D.  Recognize success and failure of endodontic treatment and indications for re-treatment or surgical intervention.

E.  Diagnose and manage dental emergencies of odontogenic and nonodontogenic origin.

12. GRADUATES MUST BE COMPETENT TO PLAN FOR AND PERFORM UNCOMPLICATED ORAL SURGICAL PROCEDURES FOR PATIENTS THROUGHOUT THEIR LIFECYCLE.

A.  Perform routine dentoalveolar surgery.

B.  Recognize and manage oral pathological abnormalities of hard and soft tissue.

C.  Manage minor infections of dental origin.

13. GRADUATES MUST BE COMPETENT TO RECOGNIZE AND MANAGE MALOCCLUSION IN THE PRIMARY, MIXED AND PERMANENT DENTITION.

A.  Recognize deviations from normal growth, development and/or occlusion and the need for specialty referral for correction.

B.  Describe the indications, contraindications, advantages, and disadvantages of space maintenance appliances.

C.  Recognize and manage oral habits.

14. GRADUATES MUST BE COMPETENT IN FOLLOWING CODES, RULES, LAWS AND REGULATIONS THAT GOVERN THE PROVISION OF ORAL HEALTH SERVICES.

A.  Apply the provisions of the state dental practice act in a dental practice.

B.  Apply the provisions of the ADA Code of Ethics in a dental practice.

C.  Apply the principles of ethical behavior in decision-making, in interactions with patients and staff, and in personal conduct.

D.  Apply the principles of ethical reasoning and professional responsibility as they pertain to patient care practice management.

15. GRADUATES MUST BE COMPETENT IN INFECTION CONTROL PROCEDURES DESIGNED TO PREVENT TRANSMISSION OF INFECTIOUS DISEASE BETWEEN PATIENTS, STAFF, DENTAL HEALTH CARE PROVIDER AND THE DENTAL LABORATORY.

A.  Utilize universal precautions in preventing transmission of infectious diseases.

B.  Utilize appropriate sterilization and disinfection procedures in preventing transmission of infectious diseases.

C.  Educate office staff in the principles and practice of prevention of disease transmission and recognition and management of critical incidents.

16. GRADUATES MUST BE COMPETENT IN PATIENT MANAGEMENT AND INTERPERSONAL SKILLS.

A.  Manage the child, adolescent, adult, geriatric and medically compromised patient by recognizing the needs, expectations and values of patients, by recognizing the role of psychological development in patient management and by demonstrating the ability to identify abnormal patient behavior.

B.  Establish a professional and confidential dentist-patient relationship.

C.  Manage a diverse patient population and have the interpersonal and communication skills to function successfully in multicultural work environment.

D.  Demonstrate behavior that is respectful of patients and coworkers.

17. GRADUATES MUST BE COMPETENT IN THE FUNDAMENTAL ELEMENTS OF MANAGING A DENTAL PRACTICE.

A.  Coordinate and evaluate services provided by auxiliaries.

B.  Describe the management of a dental practice including: associateships, purchasing practices, contracts, personnel hiring, training and evaluation and management, staff management and training, patient care management including patient recall and legal responsibilities.

C.  Evaluate different models of oral health care management and delivery.

D.  Apply the use of information technology resources in contemporary dental practice.

E.  Apply principles of radiation biology and physics compatible with current radiation safety principles.

F.  Apply the principles of risk management to dental practice.

18. GRADUATES MUST BE COMPETENT TO EVALUATE CRITICALLY AND INCORPORATE NEW DENTAL PROCEDURES WHEN THESE PROCEDURES HAVE BEEN PROVEN EFFECTIVE.

A.  Access information dealing with clinical dentistry, basic sciences and behavioral science topics using available resources.

B.  Read, discuss and critically evaluate published dental literature.

C.  Make judgments about the safety and efficacy of new diagnostic and treatment modalities and make appropriate decisions regarding the use of new procedures on patients.

D.  Evaluate critically continuing education programs, advertising, and other sources of new information.

E.  Recognize the role of life long learning, self-assessment and continuous improvement in maintaining competency and uses outcome of patient care to guide professional development.

19. GRADUATES MUST BE COMPETENT IN THE DIAGNOSIS AND TREATMENT PLANNING FOR ENDOSSEOUS DENTAL IMPLANTS AND THE MAINTENANCE OF THESE DEVICES.

A.  Describe the principles of implantology.

B.  Apply the principles of implantology to the treatment plan in consultation with appropriate specialists.

C.  Describe maintenance of implants and recognize problems.

20. GRADUATES MUST BE COMPETENT IN THE EVALUATION OF THE OUTCOMES OF TREATMENT.

A.  Identify criteria for acceptable outcomes.

B.  Differentiate between proximal, surrogate and ultimate outcomes of care (proximal = marginal ridge discrepancies, surrogate = attachment loss, ultimate = tooth loss and QOL).

C.  Differentiate clinically acceptable from unacceptable outcomes.

D.  Develop treatment plans to remediate clinically unacceptable outcomes.

Clinical Evaluation

Evaluation of your performance in all clinical disciplines is based on the attainment of competency. A competent graduating dentist is one who is able to independently and consistently deliver quality general dentistry as defined by the statements of General Practice Competencies. See the appendix to review this document. (Individual courses may have specific exercises that are delineated in their course syllabi.)

To show that you are progressing toward competency, two different kinds of evaluation are used in the clinic. One kind of evaluation is called Formative Evaluation. This is non-graded and used to help you improve over time. The second kind of evaluation is called Summative Evaluation. This is graded and used to help you demonstrate what you have accomplished at certain points in time.

Formative feedback is given to students at each clinic session by the clinical faculty and is recorded in the student’s journal. The journal documents the quality of the student’s performance and the extent to which the student is becoming independent. Students use this journal to monitor learning. Faculty use the journal to ascertain a student’s clinical performance prior to beginning a clinical procedure and adjust instruction. It is not, however, utilized in any way to formulate grades or attainment of competency. Attainment of competency and grading is measured via summative examinations in each discipline. Using a system of qualifiers and milestone, students can with faculty approval take summative examinations as they become independent according to policies and procedures set by each department. All students receive quarterly feedback related to their progress from their Group Practice Faculty. Information is shared with Program Directors, the Clinical Director and the Promotions Committee. Students having consistent problems in clinical performance receive a program of remediation.

In the competency-based learning and evaluation system students formulate and express their thoughts at the beginning of each patient appointment. Students articulate their patient’s needs their proposed treatment to meet this need and the expected outcomes.

The system leads students to evaluate their performance at the completion of each appointment. The competency-based learning and evaluation system increases the focus of the student-patient-faculty interaction. In addition to focusing on the completion of clinical procedures, the system encourages critical thinking, communication, and self-evaluation and quality assurance