Current Status of Postdoctoral and Graduate Programs in Dentistry.

Advanced dental education has evolved in the context of societal needs and economic trends to its current status. Graduate programs have positioned their role in the context of health systems and health science education trends in hospitals, interprofessional clinical care teams, and dental schools and oral health care systems. Graduate dental education has been a critical factor in developing teams in trauma care, craniofacial disorders, pediatric and adult medicine, and oncology. The misalignment of the mission of graduate dental programs and the demands of private practice has posed a challenge in the evolution of programs as educational programs have been directed towards tertiary and indigent care while the practice community focuses on largely healthy affluent patients for complex clinical interventions. Those seeking graduate dental education today are smaller in number and include more international dental graduates than in the past. Graduate dental education in general dentistry and in the nine recognized dental specialties now includes Commission on Dental Accreditation (CODA) recognition of training standards as part of its accreditation process and a CODA accreditation process for areas of clinical education not recognized as specialties by the American Dental Association. Current types of programs include fellowship training for students in recognized specialties. This article was written as part of the project "Advancing Dental Education in the 21st Century."

Cross-Sectional Analysis of National Dental Residency Match Data.

The Dental Residency Match (DRM) program provides an ethical and unbiased selection process for applicants to postdoctoral dental programs, based on mutual interests of applicants and programs. The aims of this study were to conduct a descriptive analysis of DRM metrics for the years 2008 to 2015 and to test the hypothesis that there was a difference in number of ranks submitted between programs that filled all their offered positions and those that did not. DRM metrics data from years 2008 to 2015 were obtained from the National Matching Service. Trend analyses and panel data assessments were made. Six types of postdoctoral dental programs (GPR, AEGD, oral and maxillofacial surgery, pediatric dentistry, orthodontics, and dental anesthesiology) participate in the DRM program. The results showed that the number of programs participating and number of residency positions offered increased over the study period. The programs that filled all their positions ranked more applicants than the programs that did not fill their positions (p<0.05). The number of acceptable applicants increased over the study period for all programs except those in dental anesthesiology. These results suggest that participation in DRM is increasing, most programs are able to fill their positions with acceptable applicants, and programs seeking to fill all their positions need to submit a large number of ranks.

Factors affecting scientific productivity of German oral-maxillofacial surgery training centers: a retrospective cohort study.

PURPOSE: To identify factors associated with scientific productivity (SP) of German oral-maxillofacial surgery (OMFS) training centers. MATERIALS AND METHODS: This retrospective cohort study was composed of a set of data from German OMFS training centers. A total of eight predictor variables were grouped into demographic, structural, and personal categories. The outcome variables were average publications in 2013 per senior staff, and percentage of OMFS trainees with >1 publications. Descriptive and univariate statistics were computed using P < 0.05. RESULTS: The sample included outputs from 62 OMFS departments (34 [54.8 %] university-based; 46 [74.2 %] in large cities). Average publications were 2.4 ± 3 per senior staff (range, 0-27), and 160 trainees (31.7 %) published >1 papers. The number of publications and productive trainees was not linked to department name and number of female senior staffs, but publication count was significantly increased when the hospital was in a metropolis (P = 0.018) or university-based (P < 0.0001), the OMFS' chairperson and >3 staffs within the department had a postdoctoral degree (German "Habilitation") (P = 0.013 and <0.0001), and the chairperson had h-index >10 or the first/last authorship in 2013 (P < 0.0001). Female senior surgeons were less scientifically productive than the male ones (P = 0.01). CONCLUSION: SP of German OMFS training centers is greatly different across the country and influenced by city size, university base, educational backgrounds, and research activities of chairpersons and senior staffs. This helps students, trainees, and young surgeons to reach the career choice that is personally appropriate. The involved organizations may need to encourage research output of less productive surgeons/centers. Increasing postdoctoral-qualified staffs will increase SP of the department.

Provision of specific dental procedures by general dentists in the National Dental Practice-Based Research Network: questionnaire findings.

BACKGROUND: Objectives were to: (1) determine whether and how often general dentists (GDs) provide specific dental procedures; and (2) test the hypothesis that provision is associated with key dentist, practice, and patient characteristics. METHODS: GDs (n = 2,367) in the United States National Dental Practice-Based Research Network completed an Enrollment Questionnaire that included: (1) dentist; (2) practice; and (3) patient characteristics, and how commonly they provide each of 10 dental procedures. We determined how commonly procedures were provided and tested the hypothesis that provision was substantively related to the three sets of characteristics. RESULTS: Two procedure categories were classified as "uncommon" (orthodontics, periodontal surgery), three were "common" (molar endodontics; implants; non-surgical periodontics), and five were "very common" (restorative; esthetic procedures; extractions; removable prosthetics; non-molar endodontics). Dentist, practice, and patient characteristics were substantively related to procedure provision; several characteristics seemed to have pervasive effects, such as dentist gender, training after dental school, full-time/part-time status, private practice vs. institutional practice, presence of a specialist in the same practice, and insurance status of patients. CONCLUSIONS: As a group, GDs provide a comprehensive range of procedures. However, provision by individual dentists is substantively related to certain dentist, practice, and patient characteristics. A large number and broad range of factors seem to influence which procedures GDs provide. This may have implications for how GDs respond to the ever-changing landscape of dental care utilization, patient population demography, scope of practice, delivery models and GDs' evolving role in primary care.

Demand for single- and dual-degree oral and maxillofacial surgery residency positions.

PURPOSE: Currently, no consensus has been reached regarding which track, single- or dual-degree, better prepares a resident for oral and maxillofacial surgery (OMS) practice. It is doubtful that such a consensus will ever exist. The purpose of the present study was to explore the trends in the selection of, and competition for, single- and dual-degree residency positions, with the ultimate goal of determining which degree track is in greater demand among recent applicants. MATERIALS AND METHODS: National match statistics were obtained from the American Association of Oral and Maxillofacial Surgeons. Data were drawn from each annual residency match for 1986-1987 through 2009-2010. For each match year, the data included the total number of OMS residency applicants participating in the National Matching Service, the total number of OMS positions offered, and the number of single- and dual-degree OMS positions that had been successfully matched. A piecewise regression analysis was used to evaluate the trends in the data. RESULTS: During the 1996-1997 to 2009-2010 period, both the preference for single- and dual-degree positions and the proportion of single- and dual-degree positions offered remained relatively constant. On average, 50.19% ± 2.27% of applicants preferred single-degree positions, 24.44% ± 2.42% preferred dual-degree positions, and 25.70% ± 2.27% had no preference. The demand for each single-degree position from 1996-1997 to 2009-2010 was 1.44 times greater than that for each dual-degree position (P < .0001). CONCLUSIONS: The proportions of single- and dual-degree OMS residency positions and applicant preference for a single- or dual-degree position have remained relatively constant during the past 14 match years. Recent trends have suggested a significantly greater demand for the single- versus dual-degree OMS residency position.

Residents' perceptions of implant surgical training in advanced education in prosthodontic programs.

PURPOSE: The purpose of this study was to assess residents' perspectives on their implant surgical training in Advanced Education in Prosthodontic programs in the United States. MATERIALS AND METHODS: Questionnaires were distributed to all prosthodontic residents (N = 442). The 27 questions assessed the subjective and objective aspects of implant surgical training from the view of prosthodontic residents. The data were compiled and reported as frequencies. Descriptive statistics were used to analyze the data. RESULTS: One hundred and ninety-eight responses (44.8%) were received and analyzed. Forty-seven percent (94) of the respondents felt that the philosophy of their programs regarding implant placement in prosthodontics was "optional but encouraged," whereas 30% (60) felt that it was "mandatory." The majority of the respondents (73%, 144) stated that their programs allowed them to place implants for their own patients. For those respondents who placed their own implants, 40% (58) of them indicated that the level of their clinical training was "competent." Almost half of the respondents expressed that they would like to have a proficient level of clinical training in implant surgery by the completion of their residency programs. Forty-four percent (87) of the respondents felt their residency training adequately prepared them for implant surgery, whereas the other 37% (73) did not. For those who did not, 74% (55) felt their residency programs should have prepared them for implant surgical training. CONCLUSION: The current generation of prosthodontic residents has an opportunity to place implants in their programs and would like to be trained in surgical aspects of implant dentistry at the level of competency or higher.

Incidence of neurosensory deficits and recovery after lower third molar surgery: a prospective clinical study of 4338 cases.

A prospective study of all lower third molar surgery performed in the outpatient extraction clinic of a teaching dental hospital was conducted from January 1998 through October 2005 to determine the incidence of subsequent neurosensory deficit due to inferior alveolar nerve (IAN) and lingual nerve (LN) injury, to examine possible contributing risk factors and to describe the pattern of recovery. 3595 patients were included (61% female, 39% male; age range, 14-82 years). Of the 4338 lower third molar extractions performed by various grades of operators, 0.35% developed IAN deficit and 0.69% developed LN deficit. Distoangular impaction was found to increase the risk of LN deficit significantly (p<0.001). Depth of impaction was related to the risk of IAN deficit (p<0.001). Undergraduates caused more LN deficits (p<0.001). Sex, age, raising of a lingual flap, protection of LN with a retractor, removal of distolingual cortex, tooth sectioning and difficulty in tooth elevation were not significantly related to IAN or LN injury. Postoperative recovery from IAN and LN deficits was noted most significantly at 3 and 6 months, respectively. By the end of the follow-up period, 67% of IAN deficits and 72% of LN deficits had recovered completely.

Update on the distribution of oral and maxillofacial surgeons 1995 to 2006.

A review of the 2006 and past American Dental Association (ADA) studies on the distribution of dentists provides updated information on the evolving number and distribution of oral and maxillofacial surgeons. Despite an overall increase in the number of oral surgeons, differences continue in practitioner-to-population ratios in the various geographic areas.

Clinical care provided on post-graduate dental clinical training course at Tokyo Dental College Chiba Hospital, Department of General Dentistry.

Number of patients assigned to dental residents, course of treatment and number of various technical tasks performed as described in the Reports on Clinical Training of Dentists published by the Department of General Dentistry, Tokyo Dental College Chiba Hospital since its establishment in 2002 were compared between before (2003-2005) and after (2006-2007) clinical training was made mandatory, and the state of clinical residency evaluated. Number of patients assigned generally increased, and mean number of patients treated by each resident in 2007 (15.08) was approximately 2 times higher than that in 2003 (8.47). Total number of treatments was 1.38 times higher in 2007 than in 2003, and periodontal treatment accounted for approximately 40% of all treatment both before and after clinical training became mandatory. Number of technical tasks in 2004-2007 was less than half the peak in 2003. To further improve clinical training, evaluation and implementation of effective approaches is necessary to secure an adequate number of patients, widen the variety of cases and increase the number of technical tasks.

Perfil dos cirurgiões-dentistas especialistas em Saúde Coletiva, no Estado de Minas Gerais, Brasil / Evaluation od public health dental specialists from the state of Minas Gerais, Brazil

A especialização na Odontologia está tão sedimentada que sua presença na prática clínica não é apenas aceita, mas demandada pelos próprios consumidores. Dentre as variadas especialidades, a Saúde Coletiva, constitui um conjunto de teorias e práticas que se organiza e se diferencia para compreender, explicar e modificar o processo saúde-doença, em seus aspectos materiais e não materiais, na dimensão coletiva, assim como as formas de respostas socialmente organizadas para o enfrentamento das necessidades de especialistas em Saúde Coletiva, no estado de Minas Gerais, Brasil. Realizou-se estudo transversal e descritivo com aplicação de questionário auto-explicativo, envolvendo os especialistas...

Specializations in dentistry are so deeplyrooted that their presence in clinical practices are not only accepted, but also demanded by the consumers themselves. Among the varied specialties, public health consists of a set of theories and practices that organize and differentiate themselvesin such a way as to understand, explain, and modify the health-illness process, in both its material and non-material aspects, in the collective dimension, aswell as in the forms of socially organized answers to confront health needs. The objective of this studywas to assess the different dimensions related to dentists, specialists in public health, in the state of Minas Gerais, Brazil. Cross-sectional and descriptivestudies were conducted...

Assessment of the frequency of routine removal of dental plaque prior to caries diagnosis by dentists in three cities in southern Brazil

The aim of this study was to assess the frequency of routine use of dental prophylaxis prior to visual inspection, in order to diagnose caries, by dentists with different lapses of time after graduating time. One hundred and fifty one Brazilian dentists were interviewed in 3 Brazilian cities to determine if they usually remove dental plaque prior to visual inspection for caries diagnosis. The dentists were stratified according to year of graduation. The association between the lapse of time after graduating and the practice of routinely removing dental plaque before clinical examination was tested using the chi-square test with a significance level of 5 percent. Only 28.5 percent of the dentists reported that they usually remove dental plaque prior to clinical examination. The dentists who graduated in the last 15 years presented the lowest percentages of plaque removal prior to clinical examination (15.1 percent), whereas the more experienced dentists reported that they perform prophylaxis more frequently. Of the professionals who graduated from 1960-1975, 23.9 percent reported that they performed dental plaque removal prior to diagnosis, whereas the figure for those graduating from 1976-1990 was 46.2 percent. Most of the dentists interviewed reported that they did not remove dental plaque prior to performing visual diagnosis of caries.

Relative frequency of teeth needing conventional and surgical endodontic treatment in patients treated at a graduate endodontic clinic--a Penn Endo database study.

OBJECTIVE: The objective of this study was to identify the most commonly retreated tooth at a postgraduate endodontics program and to compare this result with teeth requiring primary root canal treatment as well as those that required further surgical endodontic treatment. STUDY DESIGN: The study population consisted of 6,894 patients treated between 2000 and 2005 by endodontic postgraduate students at the University of Pennsylvania School of Dental Medicine. Data regarding tooth type and endodontic treatment rendered were obtained from the Penn Endo database. RESULTS: Initial root canal treatment was most commonly done on mandibular molars. Anterior teeth were 1.411 times more likely to undergo NSRT than molars. Maxillary molars were 1.048 times more likely to undergo conventional retreatment than mandibular molars. Maxillary anterior teeth were 3.032 times more likely than mandibular molars to undergo surgical treatment. CONCLUSIONS: Mandibular molars may most commonly receive initial root canal treatment but it is the anterior teeth that are more likely to undergo surgical and nonsurgical retreatment. Maxillary molars are more likely to receive surgical intervention than mandibular molars. These data call for further investigation into the reasons for such discrepancy.

Maxillofacial training is no longer than other surgical specialties.

INTRODUCTION: There is a perception that the training pathway for oral and maxillofacial surgery (OMFS) is unduly long and arduous, as consultant oral and maxillofacial surgeons must be doubly qualified (that is, hold degrees in medicine and dentistry) and be holders of two higher fellowships. MATERIALS AND METHODS: We reviewed the data regarding the average age of National Training Number (NTN) holders and GMC data on the year of first registration and the year of entry onto a specialist surgical list for all 9 surgical specialties. RESULTS: The results showed the average age of the surgical SpR populations ranged from 33.5 to 38.2 years with an average age of 36.14 years. OMFS SpR's average age is 37.69 years. The GMC data showed the average number of months from full to specialist registration ranged from 90.83 months to 135.24 months, with OMFS surgeons having the lowest average. CONCLUSIONS: These data suggest that OMFS surgeons are of a similar age to other surgeons whilst in training. In addition, they have the shortest transit time between full GMC registration and entry onto the specialist list. The length of this training even with dual qualification is similar to other surgical specialties.

Teaching of bioethics in dental graduate programs in Brazil

In the field of human research, researchers are faced with unexpected moral dilemmas, as a result of the development of technologies applied to health. Due to the great importance of this issue, our objective was to evaluate bioethics instruction in the education of researchers in Brazilian graduate programs in dentistry. Eighty-seven graduate programs in dentistry, recognized by CAPES (Coordination for the Improvement of Higher Education Personnel) were evaluated in this study. Data were extracted independently by two researchers from the CAPES website, and from the websites of the graduate programs, directly or via links to the programs available at the CAPES website. Forty-eight out of 87 programs had an ethics/bioethics course as part of their curricula. Of the graduation programs graded 5, 6 or 7 by CAPES, 38 percent included bioethics courses, while 62 percent of the programs graded 3 or 4 by CAPES had bioethics courses as part of their curricula. These findings are an alert to those involved in dental research education, as they showed that, although resolution 196/96 by the National Council of Health regulating human research in Brazil was published ten years ago, bioethics instruction in Brazilian graduate programs in dentistry is still at an incipient stage. This situation indicates a need for ethics pedagogy in the education of young researchers.

O desenvolvimento de tecnologias aplicadas à saúde traz dilemas morais inesperados aos profissionais de pesquisa, em relação às práticas que envolvem seres humanos. Devido à relevância deste assunto, o objetivo deste estudo foi avaliar o ensino de bioética na educação de estudantes de programas de pós-graduação em Odontologia do Brasil. Oitenta e sete programas de pós-graduação em Odontologia, avaliados pela CAPES (2001-2003), foram estudados. Os dados foram extraídos, de maneira independente, por 2 avaliadores, por meio de consulta ao sítio da CAPES e aos sítios eletrônicos dos programas, diretamente ou via links dos programas disponíveis no sítio da CAPES. Dos 87 programas, 48 apresentaram disciplina de Ética/Bioética. Trinta e oito porcento dos programas com conceitos 5, 6 e 7 da CAPES mantêm disciplinas de Bioética, enquanto 62 por cento dos programas com conceitos 3 e 4 apresentaram conteúdos de Bioética. Desta forma, os resultados deste estudo representam um alerta para os educadores envolvidos em ensino da pesquisa odontológica. Estes resultados também mostraram que a instrução em bioética ainda é incipiente nos programas de pós-graduação em Odontologia no Brasil, ainda que a resolução 196/96 do Conselho Nacional de Saúde tenha sido publicada há dez anos. Por este motivo, seria necessário assegurar uma pedagogia ética na formação do jovem pesquisador.

Building the minority faculty development pipeline.

The shortage of faculty in dental education is well documented, but the data also show a shortage of minorities in postgraduate programs, which develop future faculty. In the last ten years, ADEA's effort to address minority issues in dental education has made some progress. In addition, examples of pipelines for minority faculty development that have shown some success include: a partnership between Harlem Hospital and Columbia University School of Dentistry and Oral Surgery in which the school dedicates one position in its postgraduate training programs to an individual participating in the Harlem Hospital General Practice Residency program; a partnership between the National Dental Association Foundation and Colgate-Palmolive Company, which provides scholarships for advanced dental education study; and the Bronx Lebanon Hospital Center Department of Dentistry, which enrolls underrepresented minorities in its General Practice Residency Program, a new Pediatric Dentistry Residency Program, and a unique program providing hands-on experience in HIV/AIDS health care policy and AIDS development management. Critical elements in the relative success of these programs are environment, selection criteria, mentoring, networking, and finance. The true measure of the outcomes is still to be seen.

Trainees' perceptions of UK maxillofacial training.

Training is a central component of the work of many units around the UK. Many changes to the way that junior doctors are trained have taken place over the past few years and maxillofacial surgery, of all the surgical specialities, has perhaps undergone the most far-reaching. A postal survey of 93 maxillofacial specialist registrars (SpRs) in all regions of the UK was carried out, of whom 81 (87%) responded. The aim was to seek their views on subjects directly related to the quality of, and access to, training. Information was gathered on age of trainees, entitlement to annual and study leave, certification for Advanced Trauma Life Support (ATLS) and office and research facilities.

Gender differences in career and practice patterns of PGD-trained dentists.

This study compares differences by gender in the practice patterns and professional activities of general dentists, specialists, and dentists with Advanced Education in General Dentistry (AEGD) or General Practice Residency (GPR) training. The UCLA School of Dentistry surveyed a random sample of 6,725 dentists graduating from dental school in 1989, 1993, and 1997 as part of an evaluation of the impact of federal funding on postgraduate general dentist (PGD) programs. The survey asked about current practice, services referred and provided, and professional activities. Of the 2,029 dentists (30 percent) who responded, 49 percent were general dentists with no specialty training; 7 percent had AEGD training; 20 percent had GPR training; and 24 percent had specialty training. General dentists were more likely to be in private practice (p < 0.05). AEGDs, specialists, and females were more likely to report faculty positions as a secondary occupation. General dentists were more likely to be practice owners than AEGD- or GPR-trained dentists. The mean number of patients seen was highest for specialists. Females reported fewer patients than males, and this difference was significant for GPR-trained dentists. With respect to services, GPR-trained dentists reported significantly more biopsy procedures, conscious sedation, periodontal surgery, and implants than general dentists. AEGD-trained dentists reported more conscious sedation than general dentists. GPR dentists were more likely to volunteer time than general dentists without specialty training. PGD training appears to result in different types of employment and specific practice patterns that strengthen primary care dentistry. We further conclude that there are gender differences in the types of practice, patients seen, and services provided. These findings occur in addition to training differences.

[Manpower shortage in oral and maxillofacial surgery--a serious problem in the Netherlands]. / Menskrachtontwikkeling in de kaakchirurgie, een niet te onderschatten capaciteitsprobleem.

In the Netherlands there is currently a shortage of oral and maxillofacial surgeons. This shortage will increase between 2001 and 2010. It is analyzed that early retirement and reduction of working hours are the major factors which contribute to the shortage which will cause serious problems till 2010. Solutions will focus on increasing training capacity, reduction of training time and on various forms of substitution.

Survey of Australian and New Zealand Oral and Maxillofacial Surgery trainees and recent specialists--education and experience.

This study examined the demographic characteristics, educational background and attitudes toward training of all recent OMS specialists and all current trainees in Australia and New Zealand in 1996. The early nineties is a key period as it marks the transition from an essentially dentally based speciality (85% dental degree in 1990); to recent specialists with an increasing number with both medical and dental degrees (33% dual degree 1990-1996); to predominantly dual degree training (84.4% dual in 1996). Current trainees had more extensive experience in pathology, preprosthetic and reconstructive surgery. They were also strongly critical of the length and cost of training.