Competences Required for the Practice of Dentistry in the European Union

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Patient care is the primary responsibility of the = health professions. All persons are entitled to be assured that health = professionals practising in the European Union possess the basic = knowledge and skill essential for their patients' protection and safety. In dentistry there are definable clinical = skills and competences without which a dentist would be unable to = provide basic dental care and without which patient safety could not be = assured. Such knowledge skill and competence is c ommon to the many and diverse approaches taken in undergraduate dental = education and training throughout Europe.

Directive 78/687/EEC) provides a list of subjects = to be studied as basic minimum requirements for European dental schools. = The profile of the dentist in the EC was identified in document = III/D/617/5/86. While these provide useful guid elines in respect of subjects to be learned, responsibilities and = general attributes, they do not identify the level of competence = required of a dentist practising in the European Union in order to = safeguard the health and safety of the patient and indeed the dental team.

This document proposes that an annexure be added to = the Dental Directives on basic clinical competences required of all = newly graduated and/or newly registered dentists in the European Union.

In the context of this document the term clinical = competence is applied to a combination of skills, attitude and knowledge = which provides the clinician with sufficient competence to undertake a = specific clinical task. The requisite kno wledge embraces an appropriate understanding from molecular biological = principles, through anatomical and physiological features to the = pathogenesis of disease processes. It is not simply a technical ability = or a prescribed amount of knowledge, it impli es more than this. The acquisition of clinical competence may be = achieved through a diversity of educational and training programmes. = These may be assessed and examined in different ways throughout the = European Union. Nevertheless it is possible to agr ee on certain basic clinical competences common to all member states of = the European Union.

The following is an example of one such clinical = competency (excision of a buried tooth root):

If a clinician is deemed to be clinically competent = in the surgical removal of a buried root, this implies much more than = the technical and surgical ability required to excise a buried piece of = root from the alveolus. It embraces a bro ad range of preclinical and clinical knowledge and understanding on = which surgical treatment is based. It also implies competence in = patient assessment, management, anxiety and pain control, infection = control, knowledge and skill to provide appropriate a naesthesia and an awareness of the dentist's own limitations. This = dental surgical competence implies knowledge of the biological, = physiological and anatomical principles involved to safely complete the = procedure and communicate properly with the patient to ensure the patient may give informed consent for treatment. = Competence requires minimal surgical trauma, proper tissue management, = correct incisions, elevation, reflection and management of the = mucoperiosteal tissue prior to gaining access for the s urgical removal of bone and tooth substance as appropriate in order to = excise the buried root. It also requires acceptable replacement and = stabilisation of the tissues with minimal disturbance to the surgical = site. Clinical competence also requires of t he clinician an appropriate awareness and understanding of the = implications of this minor surgical intervention on the general health = and the necessary pre and post-operative advice and care to ensure = optimal conditions for healing and recovery. Implicit in clinical competence is an appropriate understanding of the processes = of wound healing and the influences which might delay or promote = healing. The clinician must have a thorough understanding of the = appropriate pharmacological and therapeutic implica tions of surgical intervention for the patient. The clinician must also = be competent to safely prescribe appropriate therapeutic agents, such as = antibiotics.

Please note that the clinical competences listed = from 1 - 6 are the minimum competences required throughout Europe for = the safe practice of dentistry. They do not cover the full range of = competence required of a modern dentist and shou ld not limit the further expansion of dental education and training nor = should they be used or interpreted to promote specialisation in = dentistry. These competences represent the lowest common denominator = and should be expanded in the future. However wi thout these basic competences a person could not safely carry out the = practice of dentistry.

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Prerequisites for competences listed on pages 3, = 4, 5 and 6

A dentist could not be considered clinically = competent unless he or she is sufficiently well informed and is capable = of carrying out the task within currently acceptable clinical = parameters. The following prerequisites apply before a d entist can be considered competent in tasks enumerated from 1 - 6 on = pages 3, 4, 5 and 6.

  1. Having a sufficient understanding of the basic, biological, = behavioural and medical sciences on which modern oral health care and = maintenance of health is based.
  2. Practising the full range of general dentistry in the context of = whole patient care without harm to the patient or the environment.
  3. An understanding of the dentist's moral and ethical responsibilities = in patient care, as an individual and within the context of the = community.
  4. Prioritising care according to need, and participating with others = in setting attainable targets in reducing oral diseases within the = community.
  5. Knowledge of the aetiology, principles of the molecular biological = processes, pathogenesis, demographic features, prevention and treatment = of oral and dental diseases.
  6. Being familiar with the pharmacology of drugs directly and = indirectly related to the practice of dentistry and understanding the = implications of drug therapy for systemic conditions in respect of = dental treatment. This implies competence in safely pr escribing appropriate drugs for dental patients.
  7. Knowledge of the biomaterial sciences as required for the practice = of dentistry.
  8. Providing dental care within the ethical and medico-legal = constraints of the member state in which the dentist practices.
  9. Controlling cross infection and preventing physical, chemical or = microbiological contamination in the practice of dentistry.
  10. Application of the full range of modern safe pain and anxiety = control methods when carrying out dental treatment.
  11. Being aware of the importance of continuing professional development = and education in order to keep abreast of relevant advances in all = facets of dental practice.
  12. As a member of a health sciences discipline to participate in health = promotion in the community with specific responsibility to promote oral = and dental health.
  13. On graduation a new dentist must be capable of objectively judging = the quality of care provided for patients under his or her care.
  14. Capable of analysing relevant scientific literature and applying = research findings appropriately in the safe and predictable care of = patients.
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Clinical = Competences

In order to practice dentistry in the European = Union at the primary or general dental care level (i.e. treatment which = is usually carried out by a dentist and which does not require referral = to a specialist) the qualified dentist should have an appropriate understanding of the subjects set out in the Dental = Directives (document 78/687/EEC) and in addition be able to demonstrate = clinical competence in all of the following procedures listed below = according to each patient's needs.

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1. Patient Examination = Assessment and Diagnosis

1.1 Taking a proper case history, including a = medical history, carrying out an oral* examination, recognising = deviations from normal, diagnosing oral and dental diseases and = formulating a longterm treatment plan and carrying out appropr iate treatment or referral if necessary. This includes the = craniomandibular joints.

1.2 Recognition and appropriate management and/or = referral of patients who have oral manifestations of systemic disease.

1.3 Demonstrating an appreciation of the general = health of the patient and the relationship between general health and = disease and the oral_ cavity and the implications of general diseases on = planning dental treatment.

1.4 Searching or screening for oral* diseases = including cancer.

1.5 Diagnosing and recording of developmental = anomalies and oral* diseases using an internationally accepted = classification.

1.6 Diagnosis and management or appropriate = referral of patients with oro-facial, dental and cranio-mandibular = related pain.

1.7 Diagnosis and management or appropriate = referral of common oral and dental disease including cancer, mucosal = lesions and bone pathology.

1.8 Carrying out routine dental radiographic = techniques e.g. periapical, bitewing and appropriate extra-oral views = while protecting the patient and the dental team from ionising = radiation.

1.9 An ability to recognise radiographic signs of = deviations from normal in oral radiographs.
*The term "oral" is not intended to be confined to the oral = cavity but extends to relevant areas of the head and neck and indeed the = whole body as may be relevant to an examination of a patient by a = dentist in the context of comprehensive or who le patient care.

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2. Communication and = Patient Education

2.1 Effective communication with patients.

2.2 Health education of individual patients = especially in appropriate and effective oral hygiene techniques.

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3. Ethics and = Jurisprudence

3.1 Providing each patient with sufficient = information, based on current scientific knowledge, in order to gain = informed consent for treatment.

3.2 Aproper understanding of the legislation = concerning the practice of dentistry for the particular country of the = EU in which the dentist practices.

3.3 An ability to recognise his or her own = limitations in providing patient care and knowing when it is appropriate = to refer a patient for related medical or dental care.

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4. Treatment = (Refer to 3.3 as appropriate)

4.1 The removal of materials which accumulate on = teeth and the planing of root surfaces.

4.2 Incision, elevation and replacement of a = mucosal flap for minor oral surgical procedures.

4.3 Basic periodontal flap surgery and = gingivectomy.

4.4 Completion of endodontic treatment on single = and multirooted teeth.

4.5 *Periapical surgery associated with apical = pathology.

4.6 Routine extraction of teeth.

4.7 Surgical excision of buried roots, root = resection and impacted teeth.

4.8 *Excisional and incisional biopsies.

4.9 The replacement of missing teeth when indicated = and appropriate with fixed bridges, removable partial dentures (tooth = and/or tissue borne) and complete dentures. Also to know when implants = are indicated and provide treatment or ref er as appropriate.

4.10 The restoration to function of teeth utilising = the full range of currently acceptable and available restorative = materials.

4.11 Carrying out orthodontic corrections of minor = occlusal problems and knowing when to refer patients with more complex = problems.

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5. Medical = Emergencies

5.1 Carrying out cardio-pulmonary resuscitation and = first aid.

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6. Practice = Management

6.1 Working as leader of the oral health care team = using the full range of available dental auxiliary personnel.

The newly qualified or newly registered dentist = must be capable of carrying out these procedures as appropriate on = adults, children, medically, physically and mentally compromised = patients in the context of whole patient care. These ba sic competences are not restrictive and should constitute only part of = the educational and training objectives of a dental school's curriculum = in the European Union.

* Desirable but not mandatory for all European Union = countries.

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