[Reform efforts in dentistry - national and international approaches]. / Reformbemühungen in der Zahnmedizin ­ nationale und internationale Ansätze.

The Study of dentistry in Germany is in need of reform. The actual regulation on licensing dentists in Germany is from 1955, with the last changes made in 1993. Recently there have been different initiatives related to reform: a national catalogue of competency-based learning objectives in dental education (NKLZ), changes and stipulations in the respective rules relating to undergraduate curriculum in dental medicine, and an initiative of the Germany Ministry of Health to tackle and reorganize dental education in Germany.This article presents and reflects on these reform efforts in the context of actual teaching in Germany, Europe, and the United States.The reform process is an opportunity for dental education in German faculties of medicine. New dentistry programs are allowed at all faculties with model educational programs in medicine. Therefore, an example of actual reform efforts are presented based on the experiences of Hamburg. Research on dental educational programs revealed interesting approaches in dental education in other European faculties of medicine. Selected faculties were visited. These experiences led to the formulation of five main goals of reform: interdisciplinary study, problem- and symptom-based learning, early patient contact, science-based education, and communication training. The main goal is a dental education program designed along science-based, prevention-oriented, multidisciplinary, and individualized dental care that contributes to the life-long oral health of patients.

Perspectives of New York State Dental Residency Directors on Licensure by Residency.

In 2003, New York State enacted legislation that allowed graduating dentists to undertake a one-year postgraduate residency in place of a licensure exam. In 2007, it became mandated throughout the state. This was a paradigm shift for the dental community, and overall opinions varied widely on the topic. On one side, proponents of a board exam claim that the point of dental school is to produce competent practitioners and weed out those who would be dangerous to the practice of dentistry. Contrarily, proponents of residency see the need for further evaluation and assessment of practitioners in order to even understand their levels of competence. In the current residency model of licensure, it is up to attending dentists and residency directors to deem the dentists ready to practice. At this point, there is no standard way of assessing residents, nor are there any guidelines as to what should be used to assess prospective dentists. This puts a lot of responsibility on specific directors to decide what is appropriate in their own situation. The purpose of this survey was to collect and assess residency directors' perspectives on the current licensure model of a residency. The survey response rate was 57% of all residency directors in New York State. The results show how the biggest stakeholders view their role in licensure, what levels of assessment they use and what improvements they would choose to utilize if available.

Regulators and regulations: who will guard the guards? (or 'Quis custodiet ipsos custodes' as old Juvenal used to say).

Overbearing regulators with their various labyrinthine regulations have had adverse impacts on dentists and their teams' behaviours. This has produced the perverse outcomes of demoralizing dental teams as well as reducing their capacity and/or desire to deliver compassionate oral healthcare. These adverse outcomes do not seem to have benefited patients, or dentists, or their teams, in any sensible or measurable way. CPD/CLINICAL RELEVANCE: The vastly increased burdens on the UK dental profession of intrusive, bullying regulations, emanating from the various UK agencies, such as the supposedly fair and independent GDC, but including the increasingly politically controlled NHS and the CQC, have had unfortunate, perverse, effects on many dentists' clinical practices and affected dental teams' desires, or willingness, to be as compassionate as they used to be about helping to solve some patients' dental or oral problems.

How Will the U.S. Supreme Court's Decision in North Carolina Dental Affect the Regulation of the Professions?

The contract between the public and the professions is between two parties; so it is reasonable to expect that there might be at least two perspectives when a ruling is given regarding the interpretation of the contract. The Citizen Advocacy Center recently convened a conference to look at the U.S. Supreme Court decision in the functioning of the North Carolina Dental Board in balancing protection of the public with availability of oral health services. New questions are being asked.

A Closer Look at the North Carolina Board of Dental Examiners and Who Can Practice Dentistry.

On February 25, 2015, the U.S. Supreme Court rendered a six-to-three opinion in favor of the Federal Trade Commission in their dispute with the North Carolina State Board of Dental Examiners concerning teeth-whitening services provided by nondentists. That decision was the culmination of almost nine years of arguments and allegations that began with a disagreement regarding the definition of the practice of dentistry. The ethical aspect of this dispute resides in the one's perspective regarding the motivation behind the actions taken in the North Carolina State Board of Dental Examiners.

State Dental Boards and Public Protection: Fulfilling the Contract.

Dental boards are agents of the state, sworn to protect the public. They combine the skills of professional training with responsibility to ensure that patients receive safe and effective care. They can play a vital role in ensuring that the profession does not invite more regulation by working to maintain the public's trust. Two cases are presented illustrating that one's perspective can cloud the sense of what is right and that it is wrong to pass ethical responsibilities on to others.

What Contract? With Whom? For What Purpose?

The central point in the U.S. Supreme Court upholding the Federal Trade Commission's action against the North Carolina State Board of Dental Examiners was that they acted without proper supervision from the State of North Carolina in curbing commercial activity: issuing cease and desist orders to teeth-whitening businesses, for example. It appears unlikely that the law of the land will allow professions to enforce and may substantially limit a profession's voice in defining nearby commercial activity. The line between professional services and commercial ones is not clear. Vending whitening agents, as drug stores do, is commercial but may not be professional. Providing such services in the dental office certainly should be professional, but is also certainly commercial. As dentistry becomes more overtly commercial in nature, it is likely that the profession will have less say over defining and enforcing oral healthcare practices.

Supreme Court ruling may determine the future of state-based professionai licensing.

The U.S. Supreme Court heard oral arguments this fall in a case involving the North Carolina State Board of Dental Examiners that could have a dramatic impact on how states license and regulate professionals in America. This paper briefly describes the facts of the case and the history of professional licensing in America and then discuses and evaluates the potential impact of the various legal arguments presented by the parties in the case.

Impact of residency requirement for dental licensure: an update.

As of 2007, New York State Education Law requires successful completion of dental school training and completion of an approved dental residency program for dental licensure. In a transitional period, from 2003-2006, a dental licensure applicant could select the path of an approved residency program or the New York State-recognized regional standardized clinical examination. By contrast, in 2007, the state of Connecticut adopted and continues to abide by regulations that permit licensure by either completion of an approved residency program or passage of the recognized regional standardized clinical examination. A review of the changing number of dentists licensed in these two adjoining Northeastern states under new licensure guidelines is considered in terms of the possible relationship to the new licensing process.

[The profile of the dentist in science and practice: based on the new dental licensure act]. / Zum Profil des Zahnarztes in Wissenschaft und Praxis : Die neue Approbationsordnung als Grundlage.

The profession of dentistry developed essentially based on the rapid progress of research in general. With the law of dentistry in 1952, the dentist became an independent profession in Germany. The EU directive 2005/36 for recognition of professional qualifications now regulates the requirements for practicing as a dentist in the European Union. Today, dentistry is a scientifically based medical discipline which has increased its preventive, diagnostic, and therapeutic possibilities especially over the last 3 decades. The implementation is carried out in dental practice under the framework and basic conditions of present health care policy and conditions. A new order regulating licenses to practice dentistry is under development in which the first 2 years will be nearly identical with the studies of medicine and the medical licensure act. The closer orientation toward medicine is reasonable as more multimorbid patients will have a need for dental treatment in daily practice and co-operation with physicians will be more frequent in the future. New occupational profiles in dentistry are proposed above the level of a graduated dentist as well as below but also in completely new noncurative areas.

Illegal oral care: more than a legal issue.

Affordable, safe and appropriate oral care, including preventive services, is not available for large parts of the world's population. In many low- and middle-income countries patients have to rely on a range of illegal oral care providers who are often socially accepted and part of the cultural context. Although filling a gap in service provision for poor populations, illegal provision of oral care is a serious public health problem, resulting in situations of low-quality care and risks for patients. It is a complex phenomenon going far beyond the legal context. It should be seen as a symptom of underlying health system and society deficits, ranging from lack of access to care and health inequities to problems of governance and law-enforcement. This paper analyses the problem based on the country case of Guyana, explores the public health, legal, professional, social, economical and ethical dimensions of the problem and proposes a differential view on illegal practice by grouping illegal oral care situations in four broad categories; each of them requiring different solutions to tackle underlying issues leading to the problem of illegal oral care.