Competences Required for the Practice of Dentistry in the European Union
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.
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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