XV/E/8316/8/93
Section II
ADVISORY COMMITTEE ON THE TRAINING OF DENTAL PRACTITIONERS
Competences Required for the Practice of Dentistry in the European Union
Introduction
Patient care is the primary responsibility of the health professions. All persons are entitled to be assured that health professionals practising in the European Union possess the basic knowledge and skill essential for their patients'
protection and safety. In dentistry there are definable clinical skills and competences without which a dentist would be unable to provide basic dental care and without which patient safety could not be assured. Such knowledge skill and competence is c
ommon to the many and diverse approaches taken in undergraduate dental education and training throughout Europe.
Directive 78/687/EEC) provides a list of subjects to be studied as basic minimum requirements for European dental schools. The profile of the dentist in the EC was identified in document III/D/617/5/86. While these provide useful guid
elines in respect of subjects to be learned, responsibilities and general attributes, they do not identify the level of competence required of a dentist practising in the European Union in order to safeguard the health and safety of the patient and indeed
the dental team.
This document proposes that an annexure be added to the Dental Directives on basic clinical competences required of all newly graduated and/or newly registered dentists in the European Union.
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 kno
wledge 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 impli
es 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 European Union. Nevertheless it is possible to agr
ee on certain basic clinical competences common to all member states of the European Union.
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 bro
ad 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 a
naesthesia 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 s
urgical 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 t
he 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 implica
tions of surgical intervention for the patient. The clinician must also be competent to safely prescribe appropriate therapeutic agents, such as antibiotics.
Please note that the clinical competences listed from 1 - 6 are the minimum competences required throughout Europe for the safe practice of dentistry. They do not cover the full range of competence required of a modern dentist and shou
ld 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 wi
thout these basic competences a person could not safely carry out the practice of dentistry.
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Prerequisites for competences listed on pages 3, 4, 5 and 6
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 d
entist can be considered competent in tasks enumerated from 1 - 6 on pages 3, 4, 5 and 6.
- Having a sufficient understanding of the basic, biological, behavioural and medical sciences on which modern oral health care and maintenance of health is based.
- Practising the full range of general dentistry in the context of whole patient care without harm to the patient or the environment.
- An understanding of the dentist's moral and ethical responsibilities in patient care, as an individual and within the context of the community.
- Prioritising care according to need, and participating with others in setting attainable targets in reducing oral diseases within the community.
- Knowledge of the aetiology, principles of the molecular biological processes, pathogenesis, demographic features, prevention and treatment of oral and dental diseases.
- 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. This implies competence in safely pr
escribing appropriate drugs for dental patients.
- Knowledge of the biomaterial sciences as required for the practice of dentistry.
- Providing dental care within the ethical and medico-legal constraints of the member state in which the dentist practices.
- Controlling cross infection and preventing physical, chemical or microbiological contamination in the practice of dentistry.
- Application of the full range of modern safe pain and anxiety control methods when carrying out dental treatment.
- 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.
- 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.
- On graduation a new dentist must be capable of objectively judging the quality of care provided for patients under his or her care.
- Capable of analysing relevant scientific literature and applying research findings appropriately in the safe and predictable care of patients.
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Clinical Competences
In order to practice dentistry in the European Union 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
have an appropriate understanding of the subjects set out in the Dental Directives (document 78/687/EEC) and in addition be able to demonstrate clinical competence in all of the following procedures listed below according to each patient's needs.
1. Patient Examination Assessment and Diagnosis
1.1 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 longterm treatment plan and carrying out appropr
iate treatment or referral if necessary. This includes the craniomandibular joints.
1.2 Recognition and appropriate management and/or referral of patients who have oral manifestations of systemic disease.
1.3 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.
1.4 Searching or screening for oral* diseases including cancer.
1.5 Diagnosing and recording of developmental anomalies and oral* diseases using an internationally accepted classification.
1.6 Diagnosis and management or appropriate referral of patients with oro-facial, dental and cranio-mandibular related pain.
1.7 Diagnosis and management or appropriate referral of common oral and dental disease including cancer, mucosal lesions and bone pathology.
1.8 Carrying out routine dental radiographic techniques e.g. periapical, bitewing and appropriate extra-oral views while protecting the patient and the dental team from ionising radiation.
1.9 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 who
le patient care.
2. Communication and Patient Education
2.1 Effective communication with patients.
2.2 Health education of individual patients especially in appropriate and effective oral hygiene techniques.
3. Ethics and Jurisprudence
3.1 Providing each patient with sufficient information, based on current scientific knowledge, in order to gain informed consent for treatment.
3.2 Aproper understanding of the legislation concerning the practice of dentistry for the particular country of the EU in which the dentist practices.
3.3 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.
4. Treatment (Refer to 3.3 as appropriate)
4.1 The removal of materials which accumulate on teeth and the planing of root surfaces.
4.2 Incision, elevation and replacement of a mucosal flap for minor oral surgical procedures.
4.3 Basic periodontal flap surgery and gingivectomy.
4.4 Completion of endodontic treatment on single and multirooted teeth.
4.5 *Periapical surgery associated with apical pathology.
4.6 Routine extraction of teeth.
4.7 Surgical excision of buried roots, root resection and impacted teeth.
4.8 *Excisional and incisional biopsies.
4.9 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 ref
er as appropriate.
4.10 The restoration to function of teeth utilising the full range of currently acceptable and available restorative materials.
4.11 Carrying out orthodontic corrections of minor occlusal problems and knowing when to refer patients with more complex problems.
5. Medical Emergencies
5.1 Carrying out cardio-pulmonary resuscitation and first aid.
6. Practice Management
6.1 Working as leader of the oral health care team using the full range of available dental auxiliary personnel.
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 ba
sic competences are not restrictive and should constitute only part of the educational and training objectives of a dental school's curriculum in the European Union.
* Desirable but not mandatory for all European Union countries.
