Association for Dental Education in Europe

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Patient Centered Care

“The Graduating European Dentist” specifically stresses the importance of Patient‐Centred Care.

This approach is becoming increasingly prominent within the literature and within policy documents and is defined by the Institute of Medicine (2011) as “Providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.”

Whilst working to an evidence base is critical, dentists must also be aware of the scientific basis that underpins the treatment they provide.

The evaluation process, which supports treatment planning, also requires dentists to be able to listen, collate, and record pertinent information effectively. The degree to which a dentist can assess and discriminate patient emotion will undoubtedly affect the quality and accuracy of history taking. The ability to read and manage emotions is therefore considered to be an important skill for any healthcare professional (Birks & Watt 2007).

In addition, the ability to account for a patient's social, cultural and linguistic needs (cultural competence) will result in a practitioner who is able to treatment plan for patient‐centred care (Scambler 2016). This often results in patients being more satisfied and more likely to actively participate in their treatment (Cuevas et al. 2017, Brunett & Shingles 2016).

The Areas of Competence in this Domain are described below. They include the following:

  • The Scientific Basis of Oral Health Care
  • Clinical Information Gathering and Diagnosis
  • Treatment Planning
  • Establishing and Maintaining Oral Health

3.1 Applying the Scientific Basis of Oral Healthcare

The scientific basis of Dentistry is vast, and within this Domain the recommendation is made that educators refer to specialist societies and the curricula/guidelines, that they have published.

it is recognised that integrating relevant science teaching into an outcome‐based curriculum can be challenging, and vertical integration is recommended in order to provide a coordinated appreciation of structure‐function‐disease relationships (Bennett et al. 2016, Moxham et al. 2017). Finally, ADEE recommends that specialist societies and organisations use these Domain documents as a basis from which to develop or formulate their own curricula.

Notwithstanding the 21 learning outcomes below, it is expected that curricula will cover:

  • The scientific basis of oral and related biosciences, including the relevant biomedical sciences, the mechanisms of knowledge acquisition, scientific method and evaluation of evidence
  • The biological processes in the body to a sufficient depth to be able to exploit new emerging biological technologies in clinical practice, especially in regenerative medicine
  • Mechanisms of behaviour change in order to effectively lead clinical teams, implement tailored oral healthcare regimes for patients and manage patient behaviours which are potentially harmful to general and oral health
  • The complex interactions between oral health, nutrition, general health, medications, ageing and disease

3.1.1. The aetiology, pathology, diagnosis and management of oral diseases and disorders

The aetiology, pathology, diagnosis and management of oral diseases and disorders including (but not exclusively): i) caries, ii) tooth surface loss, iii) gingival, periodontal and peri‐implant diseases, iv) apical periodontitis, v) temporomandibular joint dysfunction and occlusal disharmony, vi) mucosal conditions and salivary pathology, vii) odontogenic cysts and tumours, viii) craniofacial disorders, dental and maxillofacial trauma and orofacial pain.

3.1.2. Craniofacial growth

Normal craniofacial growth and development from birth through to adolescence

3.1.3 Tooth development

Normal and abnormal tooth development, tooth eruption and occlusal development of the primary, transitional and adolescent permanent dentition

3.1.4 Age related changes

Age‐related changes in oral tissues and their associated functions

3.1.5 Social and behavioural science

Social and behavioural sciences, including factors that facilitate the delivery of oral health care

3.1.6 Communication and language development

Communication and language development, specifically of children and adolescents and those with special needs

3.1.7 Decontamination

Sterilisation, disinfection and decontamination, and the core principles of infection prevention and control

3.1.8 Ionising radiation

The hazards of ionising radiation and the regulations relating to its use

3.1.9 Chronic orofacial conditions

Disease processes relating to acute and chronic orofacial conditions, and how inflammation, disorders of the immune system, degeneration, neoplasia, metabolic disturbances and genetic disorders can impact on these

3.1.10 Common disorders of major organ systems

The aetiology and pathological features of common disorders of the major organ systems and their relationship with oral healt

3.1.11 Pharmacology

Pharmacology and therapeutics relevant to clinical practice

3.1.12 The science of dental materials

The science of dental materials, their risks, benefits and limitations including environmental/political issues relevant to their use

3.1.13 Dental technological procedures

The potential limitations, risks and benefits of dental technological procedures

 

3.1.14 Methods of imaging

Methods of imaging relevant to Dentistry, including the principles that underpin dental radiographic and relevant imaging techniques

3.1.15 Clinical laboratory tests

Clinical laboratory and other diagnostic procedures and tests

3.1.16 Oral health and quality of life

The impact of oral health on the quality of life

3.1.17 Behavioural change

Behaviour change, in relation to oral and general health

3.1.18 Medical emergencies

Medical emergencies and their immediate management

3.1.19 Sedation

The role of and indications for the use of sedation, particularly in the management of anxious or uncooperative patients, including those with systemic disease

3.1.20 Substance abuse

The effects of tobacco, alcohol and substance abuse on general and oral health, and appropriate methods of intervention and referral

3.1.21 Abuse and neglect

Abuse, neglect and non‐accidental injury, and the safeguarding of individuals at risk of harm, including appropriate referral mechanisms

3.2. Clinical information gathering and diagnoses

It is common for educators to deliver the scientific knowledge base using a “disease” framework (pathophysiology, signs, symptoms and investigations). Often, however, students then become preoccupied with recording their findings and being efficient in making a diagnosis. Students should also appreciate the “illness” framework, as perceived by the patient (ideas, concerns, expectations and feelings). Information should be gathered and recorded comprehensively and contemporaneously, but at the same time appreciating that the patient requires information that they can understand, freedom of choice, respect and adequate time for discussion (Field 2015). Information gathering is about a dynamic exchange of information and should result in shared decision‐making between the dentist and their patient. In order to facilitate recording the patient's presenting condition and reaching a diagnosis, educators are encouraged to refer to indices and screening tools championed by specialist societies (Table 1 of the published document).

Nine learning outcomes have been identified by the GED.

3.2.1. Patient presenting complaints

Patient presenting complaints, including a comprehensive history

 

3.2.2 Patient expectations

Concerns, ideas and expectations of the patients or their carers

3.2.3 Patient history

Medical, family, social and dental history

3.2.4 Extra and Intra oral examinations

Extra‐oral and intra‐oral examination of the soft and hard tissues of the orofacial region, including radiographic imaging

3.2.5

i) caries, ii) tooth surface loss, iii) gingival, periodontal and peri‐implant diseases, iv) apical periodontitis, v) temporomandibular joint dysfunction and occlusal disharmony, vi) mucosal conditions and salivary pathology, vii) odontogenic cysts and tumours, viii) craniofacial disorders, dental and maxillofacial trauma and orofacial pain—and the individual risk factors for each presenting condition

3.2.6 Dietary and behavioural analysis

Dietary and behavioural analysis (particularly relating to oral hygiene practice and the use of tobacco and alcohol), identifying risk factors for oral health

3.2.7 Special investigations

Appropriate special investigations and diagnostic tests

3.2.8 Fixed and removable appliances

Fixed and removable prosthetic appliances and dental implants

3.2.9 Use of information

A graduating Dentist must be able to utilise the information obtained in order to reach an appropriate diagnosis

3.3 Treatment planning

After successfully diagnosing the patient's condition, a graduating Dentist should be capable of writing a logical and comprehensive treatment plan that systematically addresses the patient's oral healthcare needs. It is important to account for any relevant biological, psychosocial or temporal factors that may impact on the timely delivery of safe and effective patient‐centred care.  Nine learning outcomes have been identified within the GED.

3.3.1 Selecting treatment options

Select and prioritise treatment options that are sensitive to each patient's individual needs, goals and values, compatible with contemporaneous methods of treatment

3.3.2 Psychological and social factors

Identify relevant psychological and social factors that may complicate treatment planning, the delivery of care and appropriate maintenance/follow‐up

3.3.3 Patient expectations

Consider patient expectations, desires and attitudes when considering treatment planning and during treatment

3.3.4 Behaviour and lifestyle analysis

Use behaviour and lifestyle analysis, identifying individual risk factors for oral health to develop a comprehensive prevention programme to maintain good oral health

3.3.5 Systemic disease

Consider the implications of systemic disease and polypharmacy

3.3.6 Young and anxious patients

Consider the specific needs of the very young or anxious patient, the older patient or any other patient with special needs, including the need for domiciliary care.

3.3.7 Prescribing devices

Appropriately prescribe direct, fixed and removable restorations, implants and removable devices

3.3.8 Evaluate therapies

Evaluate the results of various therapies, and establishing a monitoring and maintenance programme, involving the wider dental team where appropriate

3.3.9 Prompt and proper referral and coordination of patients with life‐threatening conditions

Participate in the prompt and proper referral and coordination of patients with life‐threatening conditions (such as oral cancer) and in situations where their own knowledge and skills are not appropriate enough to provide adequate treatment (eg in relation to orthodontics, oral medicine, implant therapy or in relation to general anaesthesia)

3.4 Establishing and maintaining oral health

In order to establish the highest standard of oral health, graduating Dentists must be competent to operatively manage dental trauma and disease and to develop appropriate behaviour change with patients. This means communicating effectively with patients at all stages of their lives, including children, adolescents, adults and the ageing population. Current concepts of prevention, risk assessment and treatment should be implemented using materials and techniques that maintain pulp vitality and soft tissue health, and restore tooth form, function and appearance in a way that is acceptable to the patient. For discipline‐specific learning outcomes, educators are encouraged to make reference to existing agreed curricula, published by specialist societies (Table 1). In relation to prescribing, educators are directed to the European Centre for Disease Prevention and Control guidance (ECPDC 2017) and specifically the NICE (National Institute for Health & Care Excellence) guidelines, which has a number of useful associated e‐learning resources on antimicrobial stewardship. This is increasingly important to slow the emergence of antimicrobial resistance and ensure that antimicrobials remain an effective treatment option for infection (NICE 2017).

19 learning outcomes are identified within this GED competence.

3.4.1 Patient oral hygiene regime

Develop strategies to predict, prevent and correct deficiencies in a patient's oral hygiene regime, work with the patient supportively to optimise their oral hygiene regime and provide patients with strategies to control habits that impact negatively on their oral health

3.4.2 Minimally invasive procedures

Prescribe and apply fluoride, provide dietary advice and carry out minimally invasive restorative procedures that prevent hard tissue disease

3.4.3 Periodontal and soft tissue health

Provide preventive advice and carry out operative interventions to promote periodontal and soft tissue health

3.4.4 Restoration failures

Manage the deterioration and failure of restorations in clinical practice

3.4.5 Pain and anxiety management

Select and prescribe drugs for the management of pain and anxiety, whilst acting as a responsible antibiotic guardian

3.4.6 Block anaesthesia

Administer infiltration and block local anaesthesia in the oral cavity for restorative and surgical procedures, and manage potential complications

3.4.7 Periodontal therapy

Perform periodontal therapy (including prophylaxis, stain removal, biofilm removal, supragingival and subgingival root surface debridement) using both powered and manual instrumentation

3.4.8 Pulp vitality

Perform procedures to preserve the vitality of all or part of the pulp and to promote repair mechanisms in the dentine‐pulp complex

3.4.9 Colour of teeth

Perform procedures designed to alter the colour of teeth

3.4.10 Non surgical root canal

Perform nonsurgical root canal treatment of uncomplicated single rooted and multirooted teeth

3.4.11 Dental emergencies

Manage dental emergencies of the primary and permanent dentition including those of pulpal, periodontal or traumatic origin

3.4.12 Restorations

Provide direct restorations, indirect fixed restorations, removable prostheses and occlusal splints

3.4.13 Appliances and procedure design

Design appliances and prescribe laboratory procedures, being able to make appropriate chair‐side adjustments.

3.4.14 Dental implants

Engage with the planning of dental implants, with a view to being able to place and restore straightforward implants following suitable postgraduate training

3.4.15 Extractions

Perform extractions of erupted teeth including surgery for the straightforward removal of fractured or retained roots and partially erupted teeth

3.4.16 Simple malocclusions

Design, insert and adjust space maintainers and active removable appliances to manage simple malocclusions

3.4.17 Failing dentition

Manage failing dentitions using techniques that are sympathetic to the patient's needs and the healthcare setting

3.4.18 Monitor and maintain interventions

Develop a programme to monitor and maintain interventions, most notably in relation to periodontal health, direct restorations and the fitting of fixed and removable prostheses

3.4.19 Dental emergencies

Manage medical emergencies that may occur in the course of dental practice

Supplementary Resources: Cariology

The following links and references will provide supplementary information. If you are an association or relevant body who has developed a curriculum and would like to have it link to this page please get in contact.

Schulte AG, Pitts NB. (2011)

Schulte AG, Pitts NB. First consensus workshop on the development of a european core curriculum in cariology. Eur J Dent Educ. 2011;

https://doi.org/10.1111/j.1600-0579.2011.00707.x.

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