[Multidisciplinary approach to oral rehabilitation in wounded fighters]

Maxillofacial injuries during military service and in operations in particular, often involve soft and hard tissues, including fractures of bone and teeth. This kind of injury demands a multidisciplinary approach including specialists in oral and maxillofacial surgery periodontists, endodontics, orthodontics and prosthodontics. A comprehensive therapy is achieved by a complete cooperation between the disciplines for a long-term. We present a case report of a complex oral rehabilitation of a fighter wounded in "Zuk Eitan" operation, as an example of the multidisciplinary approach in our department.

Access to dental care and the capacity of the California dental care system

The authors estimated the following levels of technical efficiency for three types of dental practices in California where technical efficiency is defined as the maximum output that can be produced from a given set of inputs: generalists (including pediatric dentists), 96.5 percent; specialists, 77.1 percent; community dental clinics, 83.6 percent. Combining this with information on access, it is estimated that the California dental care system in 2009-10 could serve approximately 74 percent of the population.

Dentistry's oldest specialty: orthodontics and dentofacial orthopedics

The American Association of Orthodontists (AAO) has 15,500 members worldwide and is the oldest and largest of the recognized dental specialties. A strategic planning process has identified six key challenges, and this article describes the progress that is being made in the areas of (a) consumer education, (b) volunteer leadership development, (c) recruitment and retention of orthodontic educators, (d) relationships with ADA and other healthcare organizations, (e) the AAO's role in international orthodontics, and (f) advocacy. The AAO is working for freedom of choice in dental healthcare providers; fee-for-service dental care; orthodontic insurance coverage as a benefit of employment, with direct reimbursement as the preferred plan; self-referred access to specialists; private and public funding that promote quality orthodontic care; and the retention of tax deductibility of dental healthcare benefits, including orthodontic care.

Risk management techniques for the general dentist and specialist

Malpractice litigation is part of everyday clinical practice and is an area of which all dentists need to be aware. With proper forethought and planning, this vexing issue can be controlled and made less anxiety producing. The astute clinician must be as diligent in risk-reduction management and strategies as he/she is in practicing excellent dentistry. This article discusses various preventive measures that can be used to help mitigate malpractice claims and preclude them from developing. Good patient communication, rapport, and excellent documentation are the keys to minimizing, and possibly eliminating future lawsuits.

The cleft and craniofacial team: the whole is greater than the sum of its parts

Cleft and craniofacial healthcare is complex, warranting a specialized, multidisciplinary approach. The modern cleft team is best suited to deliver appropriate care to both affected individuals and their families.

Evidence for Up-to-Date Clinical Dental Practice. Ten Years of the Cochrane Oral Health Group

On 30–31 May 2006, a conference was held in Manchester to celebrate the tenth anniversary of the Cochrane Oral Health Group. This international group has coordinated well over 100 systematic reviews on a wide range of oral health topics. The first day of the conference reviewed what has been achieved. The second day looked to the future and assessed gaps, barriers to progress and opportunities for overcoming them.

An introduction to dentists with special interests

DwSIs are an NHS initiative. The Department of Health will be providing guidance to PCTs on how to assess a practitioner's suitability to provide specific services for the local healthcare community based on local need and circumstance.

Introducing Dentists with Special Interests (DwSIs)— Past, Present and Future Perspectives

This paper provides the national context for the development of practitioners with special interests (PwSIs) in light of the recent introduction of the concept to dentistry. Given the shortage of specialists and consultants in some dental specialities and the fact that a number of referrals could be managed in the primary care sector, the development of an additional tier to bridge the gap between current capacity and demand for services in secondary care seems to be a practical solution. The introduction of the DwSI and the future training opportunities it affords will pave the way for the development of a cadre of accredited primary care practitioners with enhanced skills who, together with their secondary care colleagues, will help widen the choice available to patients in terms of the nature and locality of NHS dental care provided. In time, DwSIs may wish to train to become full specialists or consultants and have their accredited prior learning and experience recognised towards completion of full specialist training.

The American Board of Orthodontics: Diplomate recertification

Although some specialty certifying boards began recommending or requiring recertification of their "boarded" specialists as early as 1986, recertification is a relatively new concept for the specialty of orthodontics. In the mid 1990s, the American Board of Orthodontics (ABO) recognized that many other medical and dental specialty boards had already established voluntary or mandatory recertification policies and decided to establish its own time-limited certifying policy. After a series of field tests involving former directors, council members of the College of Diplomates of the ABO, and volunteer diplomates, the ABO instituted a recertification policy for candidates who applied for initial certification after January 1, 1998. Since then, the total number of diplomates who have been recertified has steadily increased. Surveys of successfully recertified diplomates reflect a positive feeling about the process. When medical and dental specialists are expected to be more accountable, recertification has been shown to be a valid method to help ensure continued competency. The ABO believes that the formulation of educational and certifying processes to document a diplomate's clinical competency throughout his or her career will help to serve the public welfare. The ABO is attempting to make initial certification and periodic recertification attainable for more orthodontists and, in so doing, to provide a standard by which we exist as a specialty.

Comparison of dental licensure, specialization and continuing education in five countries

Dental practice and education are becoming more globalized. Greater practitioner and patient mobility, the free flow of information, increasingly global standards of care and new legal and economic frameworks (such as European Union [EU] legislation) are forcing a review of dental licensure, specialization and continuing education systems. The objective of this study was to compare these systems in Canada, France, Germany, the UK and the US. Representatives from the five countries completed a 29-item questionnaire, and the information was collated and summarized qualitatively. Statutory bodies are responsible for licensing and re-licensing in all countries. In the two North American countries, this responsibility rests with individual states, and in Europe, with the countries themselves, mainly governed by the legal framework of the EU. In some countries, re-licensure requires completion of continuing education credits. Approaches to dental specialization tend to differ widely with regard to definition of specialities, course and duration of training, training facilities, and accreditation of training programmes. In most countries, continuing education is provided by a number of different entities, such as universities, dental associations, companies, institutes and private individuals. Accreditation and recognition of continuing education is primarily process-driven, not outcome-orientated. Working towards a global infrastructure for dental licensing, specialization and continuing education depends on a thorough understanding of the international commonalities and differences identified in this article.

Sports dentistry and dental traumatology

Sports dentistry had its origins in the 1980s. More recently, the Academy for Sports Dentistry joined forces with the International Association of Dental Traumatology in cosponsoring the World Congress on Sports Dentistry and Dental Traumatology. It is the intent of the present paper to introduce readers to the arena of sports dentistry, suggest future areas for collaborative research, and stimulate authors to submit high quality, scientifically based manuscripts on sports dentistry to Dental Traumatology.

Why undertake outreach into general dental practice?

There are many reasons why patients are referred to consultants in restorative dentistry and these range from general practitioners requiring treatment planning advice, to the desire for the consultant to undertake the treatment. The consultation process should be seen as an opportunity to educate the patient about the nature of their dental problem, to make them aware of the various treatment alternatives as well as to inform them of their role in the prevention of further disease. The nature of the hospital-based consultation means that the general dental practitioner is to a large extent a passive onlooker. The educational value for the practitioner will be dependent upon the nature of the written report (or other forms of communication) sent to the general dental practitioner following the consultation. In some cases this may be very limited, so when the practitioner is faced with a similar case, because they have not been actively involved with the previous examination and consultation, they will have no alternative but to also refer the new case for treatment planning advice.

Accreditation as an alternative to specialty recognition

The Commission on Dental Accreditation does not currently accredit postdoctoral training in general anesthesia. This is related to the traditional linkage of accreditation of postdoctoral training programs to ADA specialty recognition. The aforementioned ADA Guidelines are important because they provide the foundation for the continued use of sedation and general anesthesia within dentistry. The one mechanism that would "ensure safety and effective use," maintain "a strong educational foundation," provide "access to adequate training ... develop programs at the postgraduate level" and support expansion of both basic and clinical research is CDA accreditation of postdoctoral programs. Prior to 1991, hen general anesthesia training was acquired by dentists primarily through accredited medical programs, there was little need for anything more than guidelines to protect the public. With the development of non-accredited dental anesthesiology programs in accredited dental schools (primarily in the late 1980's) and the loss of access to general anesthesia training in accredited medical anesthesiology residency programs in the summer of 1991, primary responsibility for all general anesthesia training of dentists shifted to organized dentistry. However, the ADA House declined to recognize dental anesthesiology as a dental specialty on three separate occasions even though the ADA Council on Dental Education felt all requirements were met and favorably recommended specialty recognition in all three instances. Specialty recognition would have provided the needed accreditation mechanism to validate dentistry's continued use of deep sedation and general anesthesia by those practitioners not classified as oral and maxillofacial surgeons. As an alternative to the specialty recognition process and in view of the need to accredit postdoctoral general anesthesia training for dentists, the American Society of Dentist Anesthesiologists has recently requested the CDA offer accreditation for these dental programs. To address this issue and those of other non-ADA-recognized disciplines, the CDA is currently in the initial stages of developing requirements for accrediting non-ADA recognized postdoctoral training programs. This material will be circulated to communities of interest for their input. Details of the process will be forthcoming from ADA sources in the near future.

The changing role of specialist care in NHS dentistry

Specialisation and Specialist Training in Dentistry in the UK have been central issues for debate in the last few years. The profession has emerged stronger in understanding the respective roles of the generalist who should remain free to practise across the whole spectrum of dentistry and the specialist who can work in primary and secondary care. The overriding principle is that the patient remains the true beneficiary of a specialised service within the NHS.

Who wants to be a specialist?

The UK has not developed the degree of limited practice which is common overseas and is now growing in Europe. However, changes in European legislation have brought about a recognition of these specialist disciplines within dentistry.

Specialisation in oral surgery

The 1994 report by the chief dental officer on specialist dental training in the UK focuses on the need for a more structured approach to post-graduate education and practice. As the report is designed to produce a broad choice of specialist dental services that will be based in the primary rather than the secondary care sector, specialist services will become more accessible to both the dental profession and patients.

Dentistry in another EC country: Germany

There are many similarities between dental education and treatment provision in the UK and Germany but also some important differences. V Hadden was interested to learn about the health care system in Germany, especially as the UK may soon follow European practice.