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FDI STATEMENT

Basic Dental Training / Support Paper

RECOMMENDED OUTCOME (COMPETENCES) OF UNDERGRADUATE TRAINING

Adopted by the FDI General Assembly: 18tn September 2003

CONTENT
1. INTRODUCTION
2. PREREQUISITES FOR COMPETENCES
3. CLINICAL COMPETENCES
3.1. Patient Examination Assessment and Diagnosis
3.2. Communication and Patient Education
3.3. Ethics and Jurisprudence
3.4. Treatment
3.5. Medical Emergencies
3.6. Practice Management

1.1. INTRODUCTION

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 knowledge 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 implies 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 world. Nevertheless it is possible to agree on certain basic clinical competences common to all members of the dental profession.

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 broad 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 anaesthesia 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 surgical 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 the 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 implications of surgical intervention for the patient. The clinician must also be competent to safely prescribe appropriate therapeutic agents, such as antibiotics.

2. PREREQUISITES FOR COMPETENCES

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 dentist can be considered competent in tasks enumerated from 3.1 -3.6.
2.1. Having a sufficient understanding of the basic, biological, behavioural
and medical sciences on which modern oral health care and
maintenance of health is based.
2.2. Practising the full range of general dentistry in the context of whole
patient care without harm to the patient or the environment.
2.3. An understanding of the dentist's moral and ethical responsibilities in
patient care, as an individual and within the context of the community.
2.4. Prioritising care according to need, and participating with others in
setting attainable targets in reducing oral diseases within the
community.
2.5. Knowledge of the aetiology, principles of the molecular biological
processes, pathogenesis, demographic features, prevention and
treatment of oral and dental diseases.
2.6. 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.
2.7. Knowledge of the biomaterial sciences as required for the practice of
dentistry.
2.8. Providing dental care within the ethical and medico-legal constraints of
the member state in which the dentist practices.
2.9. Controlling cross infection and preventing physical, chemical or
microbiological contamination in the practice of dentistry.
2.10. Application of the full range of modern safe pain and anxiety control
methods when carrying out dental treatment.
2.11. 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.
2.12. 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.
2.13. On graduation a new dentist must be capable of objectively judging the
quality of care provided for patients under his or her care.
2.14. Capable of analysing relevant scientific literature and applying research
findings appropriately in the safe and predictable care of patients.

3. CLINICAL COMPETENCES

Please note that the clinical competences listed from 3.1. - 3.6. are the minimum competences required for the safe practice of dentistry. They do not cover the full range of competence required of a modern dentist and should 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 without these basic competences a person could not safely carry out the practice of dentistry.
In order to practice dentistry 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 be able to demonstrate clinical competence in all of the following procedures listed below according to each patient's needs.

3.1. Patient Examination Assessment and Diagnosis

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 long term treatment plan and carrying out appropriate treatment or referral if necessary. This includes the craniomandibular joints and cranio-facial anomalies.
2. Recognition and appropriate management and/or referral of patients who have oral manifestations of systemic disease.
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.
4. Searching or screening for oral* diseases.
5. Diagnosing and recording of developmental anomalies and oral*
diseases using an internationally accepted classification.
6. Diagnosis and management or appropriate referral of patients with oro-
facial, dental and cranio-mandibular related pain.
7 Diagnosis and management or appropriate referral of common oral and dental disease including cancer, mucosal lesions and bone pathology.
8. Carrying out routine dental imaging techniques e.g. periapical, bitewing
and appropriate extra-oral views while protecting the patient and the
dental team from ionising radiation.
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 whole patient care.

3.2. Communication and Patient Education

1. Effective communication with patients.
2. Health education of individual patients especially in appropriate and
effective oral hygiene techniques.
3. Participating in public health promotions with specific responsibility to
promote oral and dental health.

3.3. Ethics and Jurisprudence

1. Providing each patient with sufficient information, based on current
scientific knowledge, in order to gain informed consent for treatment.
2. A proper understanding of the legislation concerning the practice of
dentistry for the particular country in which the dentist practices.
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.

3.4. Treatment

1. The prescription of appropriate drugs for dental patients.
2. The removal of materials which accumulate on teeth and the planing of
root surfaces.
3. Incision, elevation and replacement of a mucosal flap for minor oral
surgical procedures.
4. Basic periodontal flap surgery and gingivectomy.
5. Completion of endodontic treatment on single and multi rooted teeth.
6. Periapical surgery associated with apical pathology.
7. Routine extraction of teeth.
8. Surgical excision of buried roots, root resection and impacted teeth.
9. Excisional and incisional biopsies.
10. 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 refer as appropriate.
11. The restoration to function of teeth utilising the full range of currently
acceptable and available restorative materials.
12. Carrying out orthodontic corrections of minor occlusal problems and
knowing when to refer patients with more complex problems.

3.5. Medical Emergencies

1. Carrying out cardio-pulmonary resuscitation and first aid.

3.6. Practice Management

1. Working as leader of the oral health care team using the full range of
available dental auxiliary personnel.
2. Managing a dental practice in accordance with the appropriate
regulating entity.

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 basic competences are not restrictive and should constitute only part of the educational and training objectives of a dental school's curriculum.
The Dental Practice Commission of the FDI recognizes the important work undertaken by The Advisory Committee on the Training of Dental Practitioners in the European Union in establishing the Document: