Clinical skills examination as part of the Swedish proficiency test of dentists educated outside of the EU/EEA.

INTRODUCTION: The increase in the migration of dentists educated outside the EU/EEA calls for the sharing of information and evaluation of recognition processes within countries in the EU. In 2017, the Swedish National Board of Health and Welfare implemented the Proficiency test, a recognition process for dentists who have completed an education programme outside the EU/EEA. The Proficiency test consists of a theoretical and an integrated clinical skills examination, followed by a 6-month clinical practice. The clinical skills examination is a two-part examination that includes an OSCE and an operative test on a dental manikin. This paper presents data from proficiency tests between 2018 and 2022, and explores factors related to grade fail, that is, demographics, theoretical exam scores and language comprehension. MATERIALS AND METHODS: In a cohort study, demographics and factors associated with grade fail were explored using test results from theoretical and clinical skills examinations (n = 181) from 2018 to 2022. Pearson correlation coefficient and linear regression analysis were used for studying correlations and associations between exam results. Univariable linear and logistic regression models were used for background variable associations with clinical skills exam outcomes. RESULTS: Higher age was a significant risk factor for failing the clinical skills examination and the OSCE. Higher scores in the theoretical exam reduced the odds of failing the OSCE but were not associated with results in the operative test or the overall results of the clinical skills examination. Regarding the OSCE there was a statistically significant difference within all professional qualifications explored between participants who passed and participants who failed the OSCE. CONCLUSIONS: Four years of data collection reveal that age and previous theoretical exam results influence the odds of failing the clinical examination. The study results also highlight the necessity of multiple assessment formats to assess clinical and communication skills of foreign-trained dentists.

Are we passing the acceptable? Standard setting of theoretical proficiency tests for foreign-trained dentists.

INTRODUCTION: Dentists educated outside the EU, EEA and Switzerland have the option to undergo proficiency testing to practice dentistry in Sweden. A standardised evidence-based procedure for proficiency tests is crucial. This paper explores if the standard setting of the theoretical examination in the Swedish proficiency test for foreign dentists is fit to differentiate candidates who meet the acceptable standard for licensure from those who do not, by analysis of inter-rater reliability and credibility of Angoff panels and the test's ability to differentiate candidates regarding learning outcomes and dental disciplines. MATERIALS AND METHODS: In a cohort study design, test results were collected from seven examinations during 2018-2019 (n = 316), combined with Angoff judgements and demographic data from The National Board of Health and Welfare. Intraclass correlation, Pearson correlation and linear regression were calculated. RESULTS: All exams demonstrated substantial judge inter-rater reliability using the Angoff procedure (0.65-0.82). Item difficulty predicted by the expert panels showed significant positive correlations with the item difficulty by candidate results (0.69-0.77). Candidates who did not meet the requirements for pass mark in the theoretical test revealed a significantly reduced performance overall in professional qualifications (i.e., learning outcomes) and reduced performance within dental disciplines. CONCLUSIONS: The results indicate that a modified Angoff method is a feasible, simple, and defensible method for setting the pass mark for the theoretical examinations. The standard setting appears to differentiate candidates who do not meet the requirements of the professional qualifications of the dental degree. Adjustments could be undertaken to further discriminate for competence within single dental disciplines.

The association between root canal filling and treatment outcome.

The aim of the study was to evaluate the technical quality of endodontic treatment per- formed by postgraduate students in Karolinska Institutet, Stockholm, Sweden during the years (2008-2011) and to evaluate the treatment outcome. In addition, possible influencing factors to treatment outcome were analyzed. All maxillary first molars that received endo- dontic treatment between 2008 and 2011 were included in the study. Pre, post and follow up radiographs were collected.The apical status (PAI-score),the quality of the root canal treat- ment (RCT) and the treatment outcome were assessed. Analysis of the treatment outcome in relation to the quality of root canal treatment and other possible influencing variables was performed by Chi2 or Fisher's Exact test, and the statistical significance was set at P<0.05. A total of 73 teeth were included in the study. Out of these, sixty-three teeth (86,3 %) had periapical lesions at the time for RCT. An initial root canal treatment was performed in 46 teeth (63 %) and 27 teeth (37 %) were retreated.There was no significant as- sociation between the outcome and the type of treatment.The majority of the RCT's (58 %) had good seal and correct length. In total, the treatment outcome was successful in 59 (81 %) of the cases. The success rate was 88% in cases with high quality root fillings, compared to 71% in cases with less good quality.There was a non- significant trend (P =0.066) of an association between RCT quality and treatment outcome. In conclusion the association between the quality of the root filling and the treatment outcome was not verified with statistical significance, but the results indicate a trend that satisfactory root fillings are associated with a favorable outcome.This study was limited by its retrospective nature and a relatively small sample size.

Application of laser technology for removal of caries: a systematic review of controlled clinical trials.

OBJECTIVE: To evaluate the scientific evidence regarding laser technology for removal of carious tissue. MATERIAL AND METHODS: A search for literature on the effect of treatment and on economic aspects of laser technology identified 23 papers. No relevant studies on economic aspects were found. Regarding the effect of treatment, 16 papers were selected for assessment according to established criteria. RESULTS: Cavity preparation and caries excavation by erbium laser were evaluated in three studies of medium quality. The time required to remove carious tissue was evaluated in five studies assessed as being of medium quality for this outcome. In four studies the effect of laser treatment on the dental pulp was included as an outcome but, due to the short follow-up time, the quality was assessed as low. Two studies that included the longevity of the restoration as an outcome were also assessed as being of low quality because the follow-up time was inadequate. Patient response was evaluated in three studies, which were assessed as being of medium quality with respect to this outcome. CONCLUSIONS: There is limited scientific evidence that laser treatment is as effective as a rotary bur for removing carious tissue. Treatment time is prolonged. There is limited scientific evidence that adults prefer laser treatment. No conclusions can be drawn regarding biological or technical complications, children's perception of laser treatment or the cost-effectiveness of the method.

Health-related quality of life and symptoms in patients with experiences of health problems related to dental restorative materials.

OBJECTIVES: The question of health risks associated with dental materials, especially dental amalgam, has long been controversial and remains unresolved. For the past 10 years, people in Sweden with perceived adverse reactions to dental restorative materials have been entitled to apply to their local county council for subsidized replacement of restorative materials. The aim of the study was to investigate symptoms, perceived health changes over time and health-related quality of life (HRQoL) in this population, comprising subjects with subjective health impairment, allegedly because of dental materials. A further aim was to compare their HRQoL with that of the general population. METHODS: A comprehensive questionnaire was sent to 515 people who had applied for subsidized replacement of dental restorations. The questionnaire covered general and oral symptoms, HRQoL, health ratings over time and dental restoration replacement. RESULTS: The response rate was 54.4% (n=280). Most (83.2%) answered that they had undergone replacement of restorative materials because of impaired health, perceived to be related to dental restorative materials. The most common symptoms were musculoskeletal pain (67.5%), sleep disturbance (60.0%) and fatigue (58.6%). The HRQoL of the study subjects was significantly lower than that of the Swedish population in general. CONCLUSIONS: Subjects who had undergone subsidized dental restoration replacement reported persistent subjective symptoms and low HRQoL. The results indicate that replacement of restorative materials alone is insufficient to achieve improved health in patients with symptoms allegedly attributable to dental restorations.