ICSTD Training Manual

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ICSTD Training Manual

  1. 1. ICSTDSPECIALIST TRAINING IN DENTISTRY IN IRELANDA MANUAL FOR TRAINING BODIES,TRAINERS AND TRAINEESIRISH COMMITTEE FOR SPECIALIST TRAINING IN DENTISTRYIrish Committee for Specialist Training in Dentistry Tel: + 353 1 402 2256At: Royal College of Surgeons in Ireland Fax:+ 353 1 402 2125123, St. Stephen’s Green Email: smcdonald@rcsi.ieDublin 2, Ireland Web: http://dentistry.rcsi.ie
  2. 2. Manual of Specialist Training in Dentistry 08/12/2010 ContentsPart 1: Introduction..........................................................................................................................6Part 2: Statutory Provisions for the Registration of Dental Specialties and for the Recognitionand Regulation of Specialist Training Courses in Dentistry............................................................8 2.1 EU Law.................................................................................................................................8 2.1.1 Directive 78/686/EEC, 1978...........................................................................................8 2.1.2 Directive 78/687/EEC 1978............................................................................................8 2.1.3 Directive 2001/19/EC 2001 ...........................................................................................8 2.1.4 Other Directives..............................................................................................................8 2.1.5 Advisory Committee Recommendations on Competencies...........................................9 2.1.6 Decisions of the European Court of Justice....................................................................9 2.2 National Legislation..............................................................................................................9 2.2.1 The Dentists Act, 1985...................................................................................................9 2.2.2 Medical Practitioners Act, 1978...................................................................................10 2.3 Actions of the Dental Council in Relation to Specialist Training and Registration...........10 2.3.1 Decisions of the Council...............................................................................................10 2.3.2 Functions reserved by the Dental Council....................................................................10 2.3.3 Dental Council Accord with the Training Bodies on Entry Standards.........................11 2.3.4 Codes of Ethics.............................................................................................................11 2.4 Special Position of Oral and Maxillofacial Surgery...........................................................11Part 3: Non-Statutory Specialties...................................................................................................12 3.1 Introduction.........................................................................................................................12 3.2 Advisory Committees in the Unrecognised Specialties......................................................12Part 4: Irish Committee for Specialist Training in Dentistry.........................................................13 4.1 Constitution.........................................................................................................................13 4.2 Director of Specialist Dental Training................................................................................16Part 5: Recognised Training Bodies..............................................................................................17 5.1 National University of Ireland Cork...................................................................................17 1 http://dentistry.rcsi.ie
  3. 3. Manual of Specialist Training in Dentistry 08/12/2010 5.2 University of Dublin...........................................................................................................17 5.3 The Royal College of Surgeons in Ireland..........................................................................17Part 6: Approval of Training Courses............................................................................................18 6.1 Obtaining Approval............................................................................................................18 6.2 Validity of Approval...........................................................................................................19 6.3 Facilities for Training.........................................................................................................19 6.4 Provision of Training..........................................................................................................19 6.5 Competences.......................................................................................................................20 6.6 Case Mix.............................................................................................................................20 6.7 Course Documentation.......................................................................................................20Part 7: Enrolment of Trainees and Allocation of Training Numbers............................................21 7.1 Enrolment of trainees..........................................................................................................21 7.2 Training numbers................................................................................................................21Part 8: Assessment of Trainees: Irish Specialist trainees Assessment Process.............................23 8.1 Trainee Review...................................................................................................................23 8.2 Trainee Self-Assessment.....................................................................................................23 8.3 Specialist Registration and Issuing of Certificates of Specialist Dentist............................23Part 9: Oral Surgery.......................................................................................................................24 9.1 Definition............................................................................................................................24 9.2 Objectives...........................................................................................................................24 9.3 Components of the training programmes............................................................................24 9.4 Clinical Education...............................................................................................................24 9.5 Competences.......................................................................................................................25 9.6 EU Draft Competences ......................................................................................................25Part 10: Orthodontics....................................................................................................................26 10.1 Objectives .........................................................................................................................26 10.2 Components of the training programme...........................................................................26 2 http://dentistry.rcsi.ie
  4. 4. Manual of Specialist Training in Dentistry 08/12/2010 10.3 Competences.....................................................................................................................27 10.4 Training Rotations ............................................................................................................28 10.5 Treatment Experience and Caseload..................................................................................28 10.6 Supervision........................................................................................................................29 10.7 Training Capacity .............................................................................................................29 10.8 EU Draft Competences and Erasmus Recommendations..................................................29Part 11: Prosthodontics..................................................................................................................30 11.1 Definition...........................................................................................................................30 11.2 Objectives:.........................................................................................................................30 11.3 Components of the training programme:...........................................................................30 11.4 Competences......................................................................................................................32 11.5 Training Rotations ...........................................................................................................32 11.6 Treatment Experience and Caseload..................................................................................33 11.7 Supervision........................................................................................................................33 11.8 Training Capacity .............................................................................................................33Part 12: Periodontics......................................................................................................................34 12.1 Definition...........................................................................................................................34 12.2 Objectives ........................................................................................................................34 12.3 Components of the Training Programme...........................................................................34 12.4 Education and training.......................................................................................................36 12.5 Competences.....................................................................................................................36 12.6 Training Capacity and Supervision....................................................................................37 12.7 Training Rotations ............................................................................................................38 12.8 European Federation of Periodontology Guidelines..........................................................38Part 13: Endodontics......................................................................................................................39Part 14: Paediatric Dentistry..........................................................................................................40 14.2 Objectives of training .......................................................................................................40 3 http://dentistry.rcsi.ie
  5. 5. Manual of Specialist Training in Dentistry 08/12/2010 14.3 Training Rotations ...........................................................................................................42 14.4 Treatment Experience and Caseload.................................................................................42 14.5 Supervision.......................................................................................................................42Part 15: Oral Medicine...................................................................................................................43 15.1 Definition..........................................................................................................................43 15.2 Objective...........................................................................................................................43 15.3 Components of the Training Programme...........................................................................43 15.4 Clinical Education..............................................................................................................44 15.5 Practical training should lead to competence in the following:........................................44 15.6 Training capacity...............................................................................................................44 15.7 Entry Qualifications...........................................................................................................44Part 16: Oral Pathology..................................................................................................................45 16.1 Definition: .........................................................................................................................45 16.2 Objectives:.........................................................................................................................45 16.3 Components of the training programme............................................................................45 16.4 Outline of specifics of training:.........................................................................................46 16.5 Competence.......................................................................................................................46Part 17: Oral Radiology.................................................................................................................47Part 18: Dental Public Health........................................................................................................48E. RESEARCH AND DEVELOPMENT......................................................................................50F. TEACHING AND TRAINING.................................................................................................50H. MANAGEMENT......................................................................................................................51Part 19: Special Care Dentistry......................................................................................................53Schedule of Recognised Dental Specialist Societies.....................................................................59 Restrictions on Membership and Control of Society Affairs: ..................................................59 Recognised Societies:................................................................................................................59Appendix A: Obtaining Approval from the ICSTD for A Specialist Training Course.................61 4 http://dentistry.rcsi.ie
  6. 6. Manual of Specialist Training in Dentistry 08/12/2010Appendix B. Application Forms for a Visit to a Specialist Training Course................................64Appendix C: Guidelines for Visitors to Specialist Dental Training Courses................................77Appendix D: Proforma Visitors’ Report on Training Course........................................................80Appendix E: EU Advisory Committee Draft Competences..........................................................85Appendix F. Irish Specialist Training Assessment Process...........................................................91Appendix G. Forms for Irish Specialist Training Assessment Process.........................................93Appendix H: Clinical Logbooks..................................................................................................103Appendix I: Three years Postgraduate Programme in Orthodontics: the Final Report of theErasmus Project...........................................................................................................................105 5 http://dentistry.rcsi.ie
  7. 7. Manual of Specialist Training in Dentistry 08/12/2010PART 1: INTRODUCTIONThe Irish Committee for Higher Training in Dentistry was established in the 1960s to overseehigher (consultant) training. However, it carried out its remit through the UK based JointCommittee for Higher Training in Dentistry (JCHTD), which operated a UK and Ireland systemof Specialist Advisory Committees (SACs).With the introduction of specialist registration in the UK and Ireland, both of these committeeschanged their names to reflect their roles in specialist rather than higher training and the IrishCommittee for Specialist Training in Dentistry (ICSTD) is now responsible to the DentalCouncil in Ireland for providing evidence of completion of specialist training while the JointCommittee for Specialist Training in Dentistry (JCSTD) carries out a similar role for the GeneralDental Council in the UK.The Dental Council has recognised two specialties in dentistry for registration: Oral Surgery andOrthodontics. The Council has requested the Minister for Health and Children to approve theunrecognised specialties viz. Prosthodontics, Periodontics, Endodontics, Paediatric Dentistry,Oral Medicine, Oral Radiology, Oral Pathology, Dental Public Health and Special CareDentistry.The ICSTD has established Advisory Committees in Oral Surgery and Orthodontics. Their roleis to inspect training courses provided by the three recognised training bodies (NationalUniversity of Ireland Cork, University of Dublin/Trinity College and the Royal College ofSurgeons in Ireland), to monitor the progress of the trainees and to recommend to the DentalCouncil when an individual trainee has completed training in the specialty.The ICSTD has also established Advisory Committees in the unrecognised specialties. Thesecommittees operate in a less formal manner and certify the completion of training equivalent toEU and national standards.The ICSTD has established Advisory Committees in the remaining (unrecognised) specialties.These will carry out informal supervision of training courses until these specialties are formallyrecognised by the Dental Council. Advisory Committees have been established in RestorativeDentistry (covering Prosthodontics, Periodontics and Endodontics), Paediatric Dentistry, DentalPublic Health and the Additional Dental Specialties (covering Oral Medicine, Oral Pathologyand Oral Radiology). The ICSTD has established an Advisory Committee in Special CareDentistry and a new course has been introduced. 6 http://dentistry.rcsi.ie
  8. 8. Manual of Specialist Training in Dentistry 08/12/2010The ICSTD has no role in the recognising of training experiences gained outside the state or inthe examination of those claiming entry on the basis of specialist experience prior to theestablishment of the Register.In 1999 the JCSTD issued a Manual of Specialist Training in Dentistry in the United Kingdomand Ireland (the “Red Book”). This manual replaces the Red Book for Irish trainees. It ispublished on the ICSTD website (http://dentistry.rcsi.ie) and is updated regularly ascircumstances change and as new dental specialties are recognised.While every effort has been made to ensure the accuracy of the information, no guarantee can begiven that all errors and omissions have been excluded. The ICSTD cannot accept anyresponsibility for any loss occasioned by any person as a result of any such error or omission.This manual has been assembled from a series of separately written documents. While everyeffort has been made to ensure that there are no inconsistencies between sections, readers areasked to notify any such inconsistencies or any other errors to the ICSTD (icstd@rcsi.ie)This book is intended for use by trainees, trainers and training bodies.Thérèse GarveyChair, Irish Committee for Specialist Training in DentistryDavid RyanDirector of Specialist Training in Dentistry 7 http://dentistry.rcsi.ie
  9. 9. Manual of Specialist Training in Dentistry 08/12/2010PART 2: STATUTORY PROVISIONS FOR THE REGISTRATION OF DENTAL SPECIALTIES AND FOR THERECOGNITION AND REGULATION OF SPECIALIST TRAINING COURSES IN DENTISTRYThere are five principal pieces of legislation covering specialist dental training in Ireland: threeEuropean and two national. In addition there are advisory documents and informal agreementsof relevance.2.1 EU Law2.1.1 Directive 78/686/EEC, 1978This Directive provides for the mutual recognition of specialist training. Each state with aspecialist dental register must recognise the certificates of formal qualifications of specialists inoral surgery and orthodontics as equivalent to its own specialist qualifications when consideringapplications from EU nationals for admission to the specialist dental register. In Ireland, thequalifications are the Certificate of Specialist Dentist in Oral Surgery and the Certificate ofSpecialist Dentist in Orthodontics granted by the Dental Council.The Directive requires the Dental Council, when specifying the training to be followed by EUnationals, to take into account any training period completed and certified by another EU stateand to advise them of the content and length of any additional training required.The EU has the power to recognise other dental specialties if they are recognised in at least threemember states. There are a number of such specialties in other European states but it wouldseem that the EU is unlikely to recognise them.2.1.2 Directive 78/687/EEC 1978This Directive lays down the following requirements for a specialist training course:it shall provide for a five year recognised EU dental undergraduate training;it shall comprise theoretical and practical instruction;it shall be a full-time course of a minimum of three year’s duration supervised by the competentauthority or authorities (in Ireland, the Dental Council);it shall be in a university centre, in a treatment, teaching or research centre or, where appropriate,in a health establishment approved for this purpose by the competent authority or authorities (inIreland, the Dental Council);it shall involve the personal participation of the dental practitioner training to be a specialist inthe activity and in the responsibilities of the establishments concerned.The Directive also provides for part-time training for an interim period. This provision has notyet been repealed.2.1.3 Directive 2001/19/EC 2001This amends 78/686/EEC effectively to require the Dental Council (as the competent authority)to take into account any professional experience, additional training and continuing dentaleducation that nationals of other EU states may possess and to advise them of the content andlength of any additional training required.2.1.4 Other DirectivesThere are a number of other directives, mostly dealing with the treatment of qualifications fromthe new Member States. Of particular importance is Directive 2005/36/EC which, as part of the 8 http://dentistry.rcsi.ie
  10. 10. Manual of Specialist Training in Dentistry 08/12/2010SLIM (“Simpler Legislation for the Internal Market”) process, consolidates provisions onrecognition of professional qualifications, including dentistry.2.1.5 Advisory Committee Recommendations on CompetenciesThese lay down competencies for Oral Surgery and Orthodontics but have no force of law. (SeeAppendix E)2.1.6 Decisions of the European Court of JusticeThe European Court has made a number of interpretations of the Treaties and the Directive. Ingeneral, the effect of these judgements has been to liberalise national requirements for freemovement of specialists where the Court considers that these are too restrictive, even where theymay seem to be in line with the directives. The Court has taken the view that freedom ofmovement and of establishment is provided for by the Treaties and that any provision of theDirectives can only amplify or elucidate these fundamental rights. Several decisions also coverthe registration of specialists who, although EU citizens, have received part of all of their basicor specialist training outside the EU.2.2 National Legislation2.2.1 The Dentists Act, 1985The Dentists Act, 1985, $30 (1), states that the following may be registered in the Register ofSpecialist Dentists:  Every dentist who, prior to the establishment of that register, has, in the opinion of the Council, completed his specialist training in a specialty recognised by the Council;  every registered dentist who, following the establishment of that register, is granted evidence of satisfactory completion of specialist training by a body recognised by the Council;  Every national of a member state who has been awarded in a member state a qualification in a dental specialty recognised by the Council, which, pursuant to the provisions of any directive adopted by the Council which, pursuant to the provisions of any directive adopted by the Council of the European Communities, the State is obliged to recognise;  Any person who satisfies the Council that he has completed a programme of training in specialised dentistry of a standard considered by the Council to be adequate.$34 (c) of the Act states:It shall be the duty of the Council from time to time to satisfy itself as to the adequacy andsuitability of postgraduate education and training provided by bodies recognised by the Councilfor the purposes of dental specialist training; (this power is also conferred by EU Directive78/687/EEC).$35 (2) of the Act statesThe Council shall ensure that the requirements relating to education and training in specialiseddentistry shall satisfy the minimum standards specified in any Directive adopted by the Councilof the European Communities relating to such education and training$37 of the Act states:the Council may, from time to time with the consent of the Minister, determine the specialtieswhich it shall recognise for the purposes of specialist registration under this Act; 9 http://dentistry.rcsi.ie
  11. 11. Manual of Specialist Training in Dentistry 08/12/2010the Council may from time to time specify, in relation to each specialty recognised by it, thetitles and designations of qualifications in specialised dentistry granted in the State which may berequired to enable a person to secure registration in the Register of Dental Specialists;the Council shall from time to time determine, in relation to each specialty recognised by it, thebody or bodies which the Council shall recognise in the State for the purpose of grantingevidence of satisfactory training; (this power is also conferred by EU Directive 78/687/EEC);the Council may, with the consent of the Minister, withdraw recognition from any bodyrecognised by it under subsection (3) of this section:the specialties recognised by the Council under subsection (1) of this section shall include suchspecialties as may be determined as applying to the state in any directive adopted by the Councilof the European Communities relating to specialised dentistry.2.2.2 Medical Practitioners Act, 1978The Medical Practitioners Act, 1978, $39-44, established the Postgraduate Medical and DentalBoard as a statutory authority with functions inter alia to promote the development ofpostgraduate dental education and training and to coordinate such developments and to advisethe Minister, after consultations with those universities with medical schools, the RCSI, and suchother bodies as the PGMDB may consider appropriate, on all matters relating to the developmentand co-ordination of postgraduate dental education and training. The PGMDB funds the SACfunctions of the Faculty of Dentistry of the RCSI and also funds the ICSTD.2.3 Actions of the Dental Council in Relation to Specialist Training andRegistration2.3.1 Decisions of the CouncilThe Dental Council, with the consent of the Minister, has established a Register of SpecialistDentists with two divisions: Specialist Dentist in Oral Surgery and Specialist Dentist inOrthodontics. The Council has requested the Minister to approve additional specialties asfollows: Prosthodontics, Periodontics, Endodontics, Paediatric Dentistry, Oral Medicine, OralRadiology, Oral Pathology, Dental Public Health and Special Care Dentistry. It is not knownwhen these might be approved.The Dental Council has designated the National University of Ireland Cork, the University ofDublin and the Royal College of Surgeons in Ireland as bodies recognised by the Council for thepurposes of Dental Specialist training under $34 (c). The Council has designated the IrishCommittee for Specialist Training in Dentistry as a body that the Council recognises in the Statefor the purpose of granting evidence of satisfactory training under $37 (1).2.3.2 Functions reserved by the Dental CouncilThe Dental Council appears to have reserved to itself:In relation to registration:its powers under $30 (1) (a) to determine that a person who trained as a specialist before theestablishment of the register is qualified to be registered;its duty under $30 (1) (c) to accept European CSDs or equivalents held by EU nationals;its powers to accept specialist training that it considers equivalent;In relation to recognition and inspection: 10 http://dentistry.rcsi.ie
  12. 12. Manual of Specialist Training in Dentistry 08/12/2010its duty under $34 (c) as to the adequacy and suitability of postgraduate education and trainingprovided by bodies recognised by the Council for the purposes of dental specialist training;its powers under $34 (c) to recognise bodies for the purposes of dental specialist training;its duty under $35 (2) to ensure that education and training in specialised dentistry satisfyEuropean Directives;its powers under $37 (1) (with the consent of the Minister) to determine the Specialties that itrecognises.Under the Act the Council cannot devolve any of these powers to the ICSTD. However, it maybe that the Council will ask the ICSTD to provide the evidence, by way of review of documentsand of inspections, that the Council would need in coming to its determinations.2.3.3 Dental Council Accord with the Training Bodies on Entry StandardsThe Dental Council has no statutory power in relation to admission requirements. To ensure anadequate quality of entrant, the Council has reached an accord with the three recognised trainingbodies as follows:all entrants will have completed a two year General Professional Training (GPT); the nature andlocation of GPT remain undefined.all entrants will hold the MFD/MFDS or equivalent.2.3.4 Codes of EthicsThe Dental Council has not yet issued any specific code of ethics for specialist dentists.2.4 Special Position of Oral and Maxillofacial SurgeryThe EU recognises a number of related medical specialties in the member states. These includeMaxillofacial Surgery, Oral and Maxillofacial Surgery, and Dental, Oral and MaxillofacialSurgery. The first of these is a medical specialty and does not require any dental training. Thelatter two are medical specialties but require a fully recognised, five-year dental undergraduatetraining.Both the Irish Medical Council and the UK General Medical Council have recognised Oral andMaxillofacial Surgery. This is a medical speciality that requires a fully recognised dentalundergraduate training in addition to medical undergraduate training and appropriate specialisttraining. 11 http://dentistry.rcsi.ie
  13. 13. Manual of Specialist Training in Dentistry 08/12/2010PART 3: NON-STATUTORY SPECIALTIES3.1 IntroductionDentistry in Ireland has traditionally had a number of what are effectively specialties, althoughlegal constraints prevent them from being described as such.Although the Dental Council has requested the Minister for Health and Children to approve OralSurgery, Orthodontics, Prosthodontics, Periodontics, Endodontics, Paediatric Dentistry, OralMedicine, Oral Radiology, Oral Pathology, Dental Public Health and Special Care Dentistry,only the first two have received Ministerial approval. The traditional role of the JCSTD and itsSACs in regulating higher training for consultant accreditation in Ireland in these specialties hasbeen ended as there is no equivalent higher training in the UK.Accordingly the ISCTD has taken over the regulation of training in these specialties and hasbegun a programme of creation of appropriate Advisory Committees to advise it on trainingrequirements and to inspect training courses. Although the role of the ICSTD and the AdvisoryCommittees is, of necessity, informal in the continuing absence of a legal basis, the ICSTDgrants accreditation to training bodies and issues certificates of completion to trainees.3.2 Advisory Committees in the Unrecognised SpecialtiesThe ICSTD has established Advisory Committees in Restorative Dentistry (coveringProsthodontics, Periodontics and Endodontics), Paediatric Dentistry, Additional DentalSpecialties (covering Oral Medicine, Oral Pathology and Oral Radiology), Dental Public Healthand Special Care Dentistry. These Advisory Committees operate in the same way as theAdvisory Committees in the recognised specialties. Applications from training bodies areaccepted and processed and completed trainees are issued with a certificate of completion by theICSTD.As each speciality is recognised by the Dental Council, the appropriate AC will assist the ISCTDto fulfil its statutory role in relation to that specialty. 12 http://dentistry.rcsi.ie
  14. 14. Manual of Specialist Training in Dentistry 08/12/2010PART 4: IRISH COMMITTEE FOR SPECIALIST TRAINING IN DENTISTRY4.1 ConstitutionThe Irish Committee for Specialist Training in Dentistry (ICSTD) is constituted as follows:…………………………..1 The Irish Committee for Specialist Training in Dentistry (ICSTD) is a Standing Committee ofthe Faculty of Dentistry of the Royal College of Surgeons in Ireland (RCSI).2 The functions of the ICSTD are:2.1 to inspect, to recommend approval of, and to oversee the conduct of specialist training programmes in dentistry;2.2 to maintain a roll of registered trainees in dental specialties2.3 as a body recognised by the Dental Council under Section 37(3) of the Dentists Act 1985, togrant evidence of satisfactory completion of specialist training to the Council;2.4 to consult with, and to advise, the appropriate bodies on training issues in specialistdentistry;2.5 to ensure continued collaboration and reciprocal recognition of specialist and highertraining programmes by continuing to liaise with the Joint Committee for Specialist Training inDentistry (JCSTD) and other similar bodies within EU countries and to this end to nominate arepresentative to the JCSTD who shall be the chair of the ICSTD or a duly nominated deputy;2.6 to promote collaboration between the institutions involved in specialist training in dentistryin Ireland.2.7 to advise from time to time on the incorporation of additional specialties on to the listrecognised by the Dental Council.3 Composition of the ICSTD.3.1 The members of the ICSTD shall be appointed in the following manner:3.1.1 one person appointed by the Dental Council;3.1.2 one person appointed by the Irish Dental Association;3.1.3 two persons appointed by the National University of Ireland, Cork (NUIC);3.1.4 two persons appointed by the University of Dublin (Trinity College Dublin, TCD);3.1.5 two persons appointed by the Faculty of Dentistry, RCSI;3.1.6 one person elected by and from regional trainers in each specialty or group of specialtiesfor which there is an Advisory Committee;3.1.7 one person elected by and from enrolled trainees in specialist dentistry.3.1.8 one named alternate member nominated or elected by each of the above nominating orelectoral groups (in 3.1.1 to 3.1.7 inclusive) who shall attend and vote in the absence of anominated or elected member;3.1.9 the chair of each Advisory Committee, or, in the event that the chair is unable to attend, aduly nominated deputy as provided for in section 4.3.3;3.2 The following persons shall be non-voting observers:3.2.1 one person nominated by the Postgraduate Medical and Dental Board; 13 http://dentistry.rcsi.ie
  15. 15. Manual of Specialist Training in Dentistry 08/12/20103.2.2 the Chief Dental Officer, Department of Health and Children, or a duly appointednominee;3.2.3 the chair of the JCSTD;3.2.4 one person nominated by the Hospital Dental Committee of the Northern Ireland Councilfor Postgraduate Medical and Dental Education from among academic and regional dentalconsultants in Northern Ireland.3.3 The Director of Specialist Training in Dentistry and the Secretary to the ICSTD (the Directorand the Secretary) shall be in attendance at meetings.3.4 Members and observers shall serve for a period of three years. In the event of a casualvacancy, or where a member is no longer eligible to represent the nominating body, areplacement member or observer shall be sought from the nominating body, such replacement toserve for the remainder of the three-year term. Members shall be eligible for nomination for oneadditional three year term after which they will be required to step down for one year beforebecoming eligible again, save that the member elected by and from enrolled trainees shall servefor one three year period only.3.5 The ICSTD shall elect from among its own members a chair who shall normally serve forthree years. The ICSTD may elect a deputy chair. Nominations for the positions of chair anddeputy chair, each signed by a proposer and a seconder, and with the candidate’s consent tonomination, shall be received by the Director at least two weeks prior to the meeting at whichthe election is to take place. The outgoing chair is eligible to serve a further term on thecommittee provided that he or she does not thereby serve more than two consecutive three-yearterms on the committee.3.6 The quorum at all meetings of the ICSTD and of its sub-committees shall be one half of themembership; the chair of any meeting of the ICSTD, or of any meeting of any sub-committee asappropriate, shall have a deliberative vote and, in the event of an equality of votes, a castingvote. The proceedings of the ICSTD shall not be invalidated by any vacancy or vacancies amongits members or by any defect in the appointments to the ICSTD or in the qualifications of anymember.3.7 The ICSTD shall meet at least twice yearly, normally in November and in May. At leasttwenty-one day’s notice of meetings shall be given to members and observers. Any notice ofmeetings, motions, papers and reports for consideration at meetings, may be given to membersby electronic mail or via a web site maintained by the committee.3.8 The ICSTD may, by a simple majority of those members present and voting, remove fromoffice the chair and/or deputy chair provided that notice of a motion to that effect, duly proposedand seconded, has been given to members at least fourteen days prior to the meeting of theICSTD at which it is to be considered.4 The ICSTD may from time to time establish subcommittees to perform such functions as itshall determine. The acts of a sub-committee established under this section shall be subject toconfirmation by the ICSTD unless the ICSTD, at any time, dispenses with the necessity for suchconfirmation.4.1 In particular there shall be a sub-committee, to be known as the General PurposesCommittee to assist the ICSTD and the Director in maintaining the business of the ICSTDbetween meetings.4.1.1 The members of the General Purposes Committee shall be as follows:4.1.1.1the chair of the ICSTD, who shall chair the General Purposes Committee;4.1.1.2the deputy chair of the ICSTD, if any; 14 http://dentistry.rcsi.ie
  16. 16. Manual of Specialist Training in Dentistry 08/12/20104.1.1.3one person who sits on the ICSTD as the nominee of each of NUIC, TCD and the RCSI;4.1.1.4the chair of each Advisory Committee established under 4.2 below or, in the event thatthe chair is unable to attend, a duly nominated deputy as provided for in section 4.3.3.4.1.2 The Director shall normally attend meetings of the General Purposes Committee.4.1.3 The General Purposes Committee shall make a written report of its meetings andactivities to the next meeting of the ICSTD4.2 For each specialty or group of specialties, the ICSTD shall recognise a specialist societybroadly representative of the relevant registered specialists and shall list in the Schedule to thisConstitution each society and the speciality or specialties for which it is recognised.4.3 For each specialty, or for such groups of specialties as may seem appropriate to the ICSTD,the ICSTD will establish a sub-committee to be known as the Advisory Committee (AC). Personswho are not members of the ICSTD may serve on ACs.4.3.1 The members of the each AC shall be as follows:4.3.1.1one person elected by and from registered specialists in each relevant specialty;4.3.1.2one person nominated for each relevant specialty by the recognised specialist society.4.3.1.3one member nominated by regional consultants in each relevant specialty;4.3.1.4one person nominated by academic consultants in each relevant specialty;4.3.1.5one member elected by and from enrolled trainees in each specialty;4.3.1.6one member nominated by each relevant Specialist Advisory Committee (SAC) of theJCSTD;4.3.1.7each relevant SAC representative of the RCSI;4.3.1.8the chair of the ICSTD, ex officio.4.3.2 Each AC may from time to time co-opt such additional persons as it may see fit to amaximum of one half the number of members. Such additional persons shall sit as observers.4.3.3 Each AC shall elect from among its own members a chair and deputy chair. The deputychair shall represent the AC on all occasions when the chair shall not be available.4.3.4 The term of office of members and observers of the ACs shall be the same as that ofmembers of the ICSTD, save that the representatives of enrolled trainees shall serve for onethree year term only. The term of office of chairs and deputy chairs shall be one year; chairs anddeputy chairs shall be eligible for re-election for not more than two further terms of one year.4.3.5 Each AC shall hold regular meetings at least twice per year. Meetings shall be called bythe chair of the AC, or by the chair of the ICSTD.4.3.6 Each AC shall make a written report of its meetings and activities to the next followingmeeting of the ICSTD.4.3.7 The functions of the ACs shall be as follows:4.3.7.1to inspect and monitor specialist training programmes and to report on such inspectionsand monitoring to the ICSTD.4.3.7.2 to monitor the progress of specialist trainees and to report on such monitoring to theICSTD.4.3.7.3 to provide to the ICSTD evidence of completion of specialist training.4.3.7.4 to advise the ICSTD generally on matters relating to the relevant specialty or specialties. 15 http://dentistry.rcsi.ie
  17. 17. Manual of Specialist Training in Dentistry 08/12/20104.3.8 Each AC may, by a simple majority of those members present and voting, remove fromoffice the chair and/or deputy chair provided that notice of a motion to that effect, duly proposedand seconded, has been given to members at least fourteen days prior to the meeting of the ACat which it is to be considered.5. Any election of members to the ICSTD or the ACs shall be conducted by the Director inaccordance with standard procedures and the Director shall seek any nominations formembership of the ICSTD or ACs from the relevant nominating bodies.6. Written notice of a motion to amend this Constitution shall be duly proposed and secondedand given to members at least two weeks prior to the meeting of the ICSTD at which it is to beconsidered. Any such motion shall have no effect unless it shall have received the votes of atleast two thirds of the members present, always provided that a quorum as defined in section 3.6is present.7. This Constitution shall be reviewed within three years, during the tenure of the next IrishCommittee for Specialist Training in Dentistry.Adopted at a Special Meeting of the Irish Committee for Specialist Training in Dentistry held on29th April 2003.…………………………..4.2 Director of Specialist Dental TrainingThe Director, who is not a member of the Committee, administers the affairs of the ICSTD andits ACs and provides a Secretariat. The Director liaises on behalf of the ICSTD with the DentalCouncil.All normal business correspondence with the ICSTD and the ACs should be addressed to theDirector. Routine inquirers should contact the Ms. Fiona Allen at the Secretariat:Tel: +353 1 402 2256Fax: +353 1 402 2125Email: icstd@rcsi.ie 16 http://dentistry.rcsi.ie
  18. 18. Manual of Specialist Training in Dentistry 08/12/2010PART 5: RECOGNISED TRAINING BODIESThe Dental Council has recognised three training bodies for the provision of specialist training indentistry.5.1 National University of Ireland CorkNUIC (formerly University College Cork, UCC) has trained dentists since 1913 and is anapproved unit for higher (consultant) training in several dental specialties. The College grantsthe degrees of Bachelor of Dental Surgery (B.D.S.), Master of Dental Surgery (M.D.S.) andDoctor of Clinical Dentistry (D. Clin. Dent.) as well as research masters degrees and doctorates.The College provide specialist training in Oral Surgery and Orthodontics, in collaboration, whereappropriate, with regional units. Other dental specialties will be added as they are approved.Enquiries should be made to the university (see www.ucc.ie/admin/graduatestudies/prospectus).5.2 University of DublinThe University of Dublin (Trinity College Dublin, TCD) has trained dentists since 1909 and isan approved unit for higher (consultant) training in several dental specialties. The universitygrants the degrees of Bachelor in Dental Science (B.Dent.Sc.), Master in Dental Science(M.Dent.Sc.) and Master in Dental Surgery (M.Dent.Ch.) as well as research masters degreesand doctorates. The College provides specialist training in Oral Surgery and Orthodontics, incollaboration, where appropriate, with regional units. Other dental specialties will be added asthey are approved. The College provides specialist training in a number of unrecognisedspecialties viz. Prosthodontics, Periodontics, Paediatric Dentistry, Oral Medicine and OralPathology. Enquiries should be made to the Graduate Admission Office (seehttp://global.dental.tcd.ie/Courses/).5.3 The Royal College of Surgeons in IrelandThe Royal College of Surgeons in Ireland had an undergraduate dental school until 1977 whenthe school merged with the TCD School of Dental Science. The Faculty of Dentistry wasestablished in 1963 and provides postgraduate qualifications in Dentistry: the specialistFellowship in a range of specialist disciplines (F.F.D.R.C.S.I.), the Membership of the Faculty ofDentistry (M.F.D.R.C.S.I.) and the Membership in General Dental Surgery (M.G.D.S.R.C.S.I.);the general Fellowship in Dental Surgery (F.D.S.F.D.R.S.C.I.) has not been awarded since 2002.The College has not yet indicated its intention to provide training courses. Enquires should bemade to the faculty office (facdentistry@rcsi.ie). 17 http://dentistry.rcsi.ie
  19. 19. Manual of Specialist Training in Dentistry 08/12/2010PART 6: APPROVAL OF TRAINING COURSES6.1 Obtaining ApprovalA training body wishing to obtain course approval should first consult the document “ObtainingApproval from the ICSTD for a Specialist training Course” (Appendix A), and should makeapplication on the appropriate forms, (Appendix B, which is obtainable on the web site,http://dentistry.rcsi.ie). Training bodies are advised to consult the speciality guidelines preparedby the appropriate Advisory Committee (AC) and to have appointed a Course Director.After the initial application, the Course Director is the primary contact between the relevant AC(for the ICSTD) and the training body where the course is taking place. All correspondence willbe conducted between the Director of Specialist Training in Dentistry (DSTD) and the ICSTDand the Course Director for the training body, but will be copied to the Chair of the ICSTD andthe appropriate AC and to all relevant administrative and training personnel identified for copymailing in the application by the training body.Any correspondence received from the Course Director will be assumed to represent the viewsof the recognised training body. It is important, therefore, that the training body has internalmechanisms for approval of correspondence.Visits to courses will take place at regular intervals, usually five years, to be determined by theICSTD. Visits will involve inspection of the syllabus, the assessment process and the facilitiesand will normally include interviews with the College authorities, the trainers and the trainees.Following the visit, the AC will advise the ICSTD, which can eventually provide the DentalCouncil with evidence that those who have completed the course are eligible for specialistregistration.Training bodies will be expected to pay the direct costs (travel, subsistence, accommodation,etc.) of each visit.The completed application is submitted to the Director of Specialist Training in Dentistry whowill request the AC to examine the submitted documents and to set a date for the visit. Defectivedocumentation will be returned by the Director of Specialist Training in Dentistry to the trainingbody. The documentation must include a detailed description of the competences that the traineeis expected to attain and the curriculum, facilities and assessments that will be used to ensurethese competences. If the AC believes that a visit would be inappropriate, it will report this to theICSTD, which may direct the AC to carry out the visit.The Chair of the AC will nominate a lead visitor and two ordinary visitors, one of whom may bea trainee representative (if a suitable representative is available). If there are widely separatedsites to be visited, the number of visitors may be increased. Normally the AC will approve thevisit team but, to avoid delay, the chair may obtain such approval by direct contact with themembers of the AC. One or more visitors may be appointed from outside the Republic ofIreland. Appendix C contains detailed guidance for visitors.The draft report will be forwarded to the Course Director for factual correction and comment andthe final report will be submitted to the ICSTD. If the report is approved by the ICSTD, theDirector of Specialist Training in Dentistry will inform the Course Director and the DentalCouncil of the approval and of the maximum student numbers that can be accommodatedannually on the course.Only in exceptional circumstances will the ICSTD consider applications for retrospectiveapproval for courses or facilities. 18 http://dentistry.rcsi.ie
  20. 20. Manual of Specialist Training in Dentistry 08/12/20106.2 Validity of ApprovalApproval of courses will normally be valid for five years. The Course Director must notify theICSTD of any substantial change in the trainers, syllabus, facilities or timetable. In case of doubtas to what may amount to substantial change, Course Directors are advised to notify the ICSTDand to seek its opinion. Substantial change may result in a further visit within the five years. Ifthe AC and the ICSTD feel that a specialist training course is no longer satisfactory, arecommendation to this effect will be made in writing to the Dental Council.6.3 Facilities for TrainingThe specialty specific facility requirements are detailed under each specialty. In addition, for allspecialties, the training body must provide, or ensure the provision of, certain core facilities, bothwithin the training body and, to such extent as is necessary, in regional and other peripheral unitsinvolved in training:Adequate clinical facilities including, where appropriate, operating theatre access.Appropriate medical records including maintenance of waiting lists to enable the selection of anadequate case mix for trainees.Appropriate nursing support.Office facilities, including individual computer facilities with access to online services.Adequate secretarial support.Access to clinical photographic services, or provision of individual clinical cameras, and accessto medical illustration servicesWhere appropriate, computerised facilities for the storage, analysis and retrieval ofcephalometric and orthognathic data.Adequate library facilities, including access to a range of relevant journal, access to, andborrowing facilities for, a range of appropriate contemporary texts and access to photocopyingand interlibrary loan services (and computerised literature searches if not provided individually).Any regional or peripheral unit must provide reasonable access to journals and texts and traineesmust have access to any local Postgraduate Medical Centre.Journal clubs, clinicopathological conferences and similar activities.Appropriate teaching facilities, including where appropriate, laboratory simulation of clinicalprocedures.6.4 Provision of TrainingWhile the detailed provision of training is a matter for the individual training bodies, it isassumed that there will be in place an adequate system of supervision of trainees, normally by atleast two qualified trainers who would be registered specialists preferably holding consultant andsenior academic appointments, an internal examination system capable of assessing trainees’knowledge, attitudes and skills, and mechanisms for regularly recording the progress of trainees.While the ICSTD leaves the question of the extent of the involvement of external examiners tothe individual training bodies in accordance with their normal procedures, it would wish to beinvolved in the review process through the presence of an individual appointed by the relevantAC. Any dissertation submitted in part fulfilment of the requirements for the degree must be inaccordance with the standard practice of the training body. 19 http://dentistry.rcsi.ie
  21. 21. Manual of Specialist Training in Dentistry 08/12/20106.5 CompetencesIt is the wish of the ICSTD that training bodies take cognisance of the competences proposed bythe EU Advisory Committee on the Training of Dental Practitioners (see Appendix E). Adetailed schedule of expected attainment of competences should be provided in coursedocumentation and detailed records should be kept of the attainment of each competence byindividual trainees.6.6 Case MixIt is important that trainees be exposed to an adequate case mix, both in terms of cases seen inconsultant clinics and patients treated by the trainee. Where appropriate, specialty specificguidelines are given elsewhere in this manual.6.7 Course DocumentationAll trainees should be furnished, at the commencement of the course, with written informationdetailing:background information about the course;the competences to be attained;the course syllabus;the course timetable;details of supervision;educational guidance, including reading lists, audiovisual material etc.;course material that is not readily available from textbooks;examination structure, marking systems and timetables.Any changes to the course should be notified to the trainees before their effective date. 20 http://dentistry.rcsi.ie
  22. 22. Manual of Specialist Training in Dentistry 08/12/2010PART 7: ENROLMENT OF TRAINEES AND ALLOCATION OF TRAINING NUMBERS7.1 Enrolment of traineesWhen the course has been approved, the Director of Specialist Training in Dentistry will enrolthe trainees and will issue a training number to each enrolled trainee.7.2 Training numbersEach approved training position, and each trainee, has a unique number. The number system isused to ensure that the approved number of trainees on each course is not exceeded and toidentify a particular trainee with a particular training position. When a trainee is not supported byfunding from a health authority, a supplementary number will be issued. When a trainee is notfully registerable in the Dentists Register, an external number will be issued. Thesesupplementary and external trainees will be reckoned in the totals used in calculating the numberof trainees enrolled on any specialist training course.7.2.1 Position numbersTraining body (two letter code)CK NUICTR University of DublinRC RCSIJoint post with funding health authority (two digit code)01 Eastern02 North Eastern03 North Western04 Western05 Midland06 Mid-Western07 South Eastern08 Southern09 Self-funded00 Non-EUSpecialty (two-digit code)OS Oral SurgeryOR OrthodonticsOM Oral MedicineOP Oral PathologyOX Oral RadiologyPR ProsthodonticsPE PeriodonticsEN Endodontics 21 http://dentistry.rcsi.ie
  23. 23. Manual of Specialist Training in Dentistry 08/12/2010PD Paediatric DentistryCD Public Dental HealthSC Special Care DentistryThus TR-05-OS is an approved position in the University of Dublin, jointly with the Midlandhealth region, in Oral Surgery.7.2.2 Trainee numbersThe trainee number is a longer version of the position number for the position in which he or sheis enrolled.The full number consists of two-letter code for training body, the two-digit code for fundingHealth Board/authority and the two-digit code for the specialty, followed by:Year commenced02, 03 etc.Individual trainee numberThese three digit numbers will be allocated sequentially to each enrolled trainee.Thus TR-05-OS-02-015 is a trainee in approved position in the University of Dublin, jointly withthe Midland region, in Oral Surgery, commencing in 2002, and who is fifteenth in the list ofenrolled trainees. Trainee numbers stay with the trainee even if they should transfer to anothertraining body or take time out of training. Thus, at the commencement of training the positionnumber and the trainee number will correspond but this may not be true at the completion oftraining. 22 http://dentistry.rcsi.ie
  24. 24. Manual of Specialist Training in Dentistry 08/12/2010PART 8: ASSESSMENT OF TRAINEES: IRISH SPECIALIST TRAINEES ASSESSMENT PROCESS8.1 Trainee ReviewFor the ICSTD to give evidence to the Dental Council of completion of specialist training for aspecific trainee, the trainee must have completed the course in accordance with the regulations ofthe training body and must satisfy the ICSTD as to their suitability. To this end the ICSTD,through the relevant speciality AC, will review the progress of trainees at regular intervals,normally yearly, and will maintain, with the training body, records of a training review andassessment process (ISTAP) for each trainee. This review will be conducted by the trainingbodies through a formal process that will involve the participation of a person nominated by therelevant AC. As part of the ISTAP process, trainees will be interviewed and will be asked toproduce log books and evidence of completion of any required competences and will be given anopportunity to discuss their progress, and the syllabus, facilities and trainers, in confidence.Full details of the ICSTD’s requirements for trainee review are contained in Appendix F andrecommended forms for recording the outcome of review, and for reporting to the ICSTD arecontained in Appendix G.Trainees should be informed that logbooks are probably subject to the Freedom of InformationAct and that electronic logbooks are subject to the Data Protection Act.Specimen logbooks for each specialty are available from the Secretariat. Specimen logbooks fororthodontics and for oral surgery are contained in Appendix H.8.2 Trainee Self-AssessmentTrainees are also required to complete a self-assessment and a course assessment, the format ofwhich will be determined by the AC in collaboration with the training bodies. The ICSTDregards trainee self-assessment and course assessment as an important part of ISTAP, andtraining bodies are asked to facilitate trainees as far as possible to complete these assessmentswithout fear of reproach.8.3 Specialist Registration and Issuing of Certificates of Specialist DentistWhen a trainee has satisfied the ICSTD that the relevant course has been followed according tothe regulations of the training body, including the satisfactory completion of all examinationsand assessments, and when trainee’s ISTAP is considered satisfactory by the AC, the DSTD andthe chair of the AC will verify completion of training. In the case of the statutory specialties,Oral Surgery and Orthodontics, the chair of the ICSTD and the DSTD will issue a certificate tothis effect to the Dental Council. In the case of the remaining specialties, the certification will beissued to the completed trainee.The granting of a certificate in Oral Surgery or Orthodontics by the ICSTD does notautomatically confer specialist registration. Holders of certificates who wish to have their namesentered in the Register of Specialist Dentists must apply directly to the Registrar of the DentalCouncil, 57 Merrion Square, Dublin 2, on the appropriate form available from the Council andpay the appropriate fee.Certificates of Specialist Dentist are issued by the Dental Council to those wishing to register asspecialists in other EU states. Enquiries should be made directly to the Council.In the case of the non-statutory specialties, the certificate of completion will be issued by theICSTD but will have no legal value. 23 http://dentistry.rcsi.ie
  25. 25. Manual of Specialist Training in Dentistry 08/12/2010PART 9: ORAL SURGERY9.1 DefinitionOral Surgery is considered to be the management of surgical conditions of the mouth, jaws andassociated structures.9.2 ObjectivesCourses of clinical training and academic study will provide:  Competence in diagnosis and management in relation to surgery of the mouth, jaws and associated structures as itemized in 9.5 (below);  The ability to collaborate with specialists from other disciplines;  The ability to pursue self-directed life-long learning;  The ability to read the appropriate clinical and scientific literature employing evidence- based criteria  The ability to conduct clinical audit.9.3 Components of the training programmesRevision of basic sciences, clinical education and practical training will comprise the specialisttraining. Revision of the basic sciences will lead to more in depth knowledge of the basicclinical sciences studied during the acquisition of the MFD (MFDS). It will include:  Applied surgical anatomy of the head and neck including surface, dental and radiographic anatomy;  Principles of applied physiology and biochemistry;  Microbiology;  Pathology and immunology;  Statistics and information technology;  Pharmacology and therapeutics;  Behavioural science.9.4 Clinical EducationThe clinical education will include the integrated application of the sciences defined in 9.3 inaddition to the following clinical subjects.  Diagnosis and management of oral disease;  Oral manifestations of systemic disease;  Management of emergencies and techniques of resuscitation to an advanced level;  The principles and practice of surgery;  The principles of cross-infection control;  The interface between medical and other dental specialties and oral surgery;  The management of pain and anxiety;  Oral and maxillofacial diagnostic imaging and interpretation;  Medico-legal aspects of oral surgery; 24 http://dentistry.rcsi.ie
  26. 26. Manual of Specialist Training in Dentistry 08/12/2010  Principles of management of dental, oral and maxillofacial trauma;  Management of cysts and benign lesions of the mouth, jaws and salivary glands;  Principles of diagnosis and management of orofacial cancer and precancer;  Principles of management of oral and facial deformities;  Preprosthetic surgery including implantology;  Management of temporomandibular joint disorders.9.5 CompetencesPractical training should lead to competence in the following:  Extraction of teeth and retained roots and management of associated complications;  Management of impacted teeth; management of complications;  Surgical endodontics;  Dento-alveolar surgery in relation to orthodontic treatment;  Biopsy techniques;  Treatment of benign lesions and minor soft tissue surgery;  Treatment of benign salivary gland disease;  Insertion of implants including bone augmentation and soft tissue management;  Management of dento-alveolar trauma including fracture of the tuberosity of the maxilla;  Management of uncomplicated fractures of the mandible;  Employment of a range of procedures to control pain and anxiety in relation to oral surgery and the management of chronic facial pain conditions including temporomandibular joint disorders;  The diagnosis of oral cancer and precancer, familiarity with their management and appropriate referral;  The diagnosis of dentofacial deformity; appropriate referral and cooperation in their management.9.6 EU Draft CompetencesProgrammes should use as a guide for their curricula the EU Draft Competences (Appendix E). 25 http://dentistry.rcsi.ie
  27. 27. Manual of Specialist Training in Dentistry 08/12/2010PART 10: ORTHODONTICS10.1 ObjectivesCourses of clinical training and academic study will provide:competence in diagnosis and management of anomalies of facial growth and occlusaldevelopment as itemised in 10.3 below;the ability to collaborate with specialists from other disciplines;the ability to pursue self-directed life-long learning;the ability to read the appropriate clinical and scientific literature employing evidence-basedcriteria;the ability to conduct clinical audit.10.2 Components of the training programmeBasic orthodontic subjectsNormal and abnormal development of the dentitionFacial growth (normal and abnormal)Physiology and pathophysiology of the stomatognathic systemTooth movements and facial orthopaedicsRadiology and other imaging techniquesCephalometrics (including tracings)Orthodontic materialsOrthodontic biomechanicsGeneral orthodontic subjectsAetiologyDiagnostic proceduresDiagnostic assessment, treatment objectives and treatment planningGrowth and treatment analysisLong-term effect of orthodontic treatmentIatrogenic effects of orthodontic treatmentEpidemiology in orthodonticsOrthodontic literatureOrthodontic techniquesRemovable appliancesFunctional appliancesExtra-oral appliancesFixed appliancesRetention appliances 26 http://dentistry.rcsi.ie
  28. 28. Manual of Specialist Training in Dentistry 08/12/2010Biological sciences relevant to orthodonticsCell and molecular biologyGeneticsCraniofacial embryologySomatic and craniofacial growthPhysiology of breathing, swallowing mastication and speechPsychologyResearch moduleMultidisciplinary orthodonticsCraniofacial anomalies - overviewCleft lip and palate patients - overviewOrthodontics and periodontics, prosthodontics and endodonticsOrthodontic/oral surgery interfaceSpecific treatment proceduresGuiding the development of occlusionAdult orthodontics - overviewCraniomandibular dysfunctionsInformation technologyComputer based technologyManagement of oral healthOral healthHealth educationThe practice and business of specialist orthodontic practiceHealth and safetyLegislation and EthicsSurgery ManagementPersonnel ManagementFinanceSelf-Assessment10.3 CompetencesPractical training should lead to competence in:Diagnosis of anomalies of the dentition;Detection of deviations of the development of the dentition, of facial growth and occurrence offunctional abnormalities;Formulation of treatment plans and the ability to predict the course of such plans;Interceptive orthodontic measures;Simple and complex treatment procedures; 27 http://dentistry.rcsi.ie
  29. 29. Manual of Specialist Training in Dentistry 08/12/2010Understanding the multi-disciplinary approach for the treatment of compromised (adult) patients,orthodontic surgical cases and cleft palate patients;Evaluation of the need for orthodontic treatment;Understanding the psychological aspects of orthodontics;Development of a scientific attitude and an inquiring mind and the stimulation of professionalcuriosity;Understanding scientific methodology and interpretation of literature.10.4 Training RotationsThe preferred training pathway is a combined and integrated training between a dental teachinghospital and a single regional hospital. All three years may be spent within the dental teachinghospital. It is important that several trainers are able to make a substantial contribution totraining.In two centre programmes considerable emphasis is placed on the need for integration of thetraining programme between teaching hospital and regional hospital. This requires closecommunication, collaboration and a common philosophy and sense of purpose between trainersin the dental teaching hospital and the regional hospital.It may be necessary to involve more than one regional hospital in the training programme. Thisis permissible provided a high degree of programme integration is maintained such as in thefollowing circumstances:where a trainer in a regional hospital main base visits peripheral hospitals and takes the trainee tothe peripheral unit;where a training centre has a part-time trainer and supervision cannot be adequately provided onthe clinical sessions when the trainer is not present;The trainee should spend at least six sessions per week involved in patient contact with at leastfive of these sessions devoted to personal treatment sessions. The non-clinical sessions willinclude an average of 0.5 sessions for non-clinical management, two sessions for research, studyand audit and the remainder for non-clinical teaching activities.A balanced programme will, for all trainees, allow personal treatment sessions, diagnosticsessions, review clinics, formal and informal teaching, research and reading time.10.5 Treatment Experience and CaseloadWhile it is appreciated that the clinical practices will vary from institution to institution, thereshould be some degree of uniformity in the quantity and quality of training achieved. Theobjective should therefore be to treat a sufficient number of patients to a high standard undersupervision over the three years.The following case mix is suggested as a basis for postgraduate training. There must be someflexibility in these numbers which can only act as guidance.Total case numbers:If the trainee has treated a large spectrum of malocclusion it would be reasonable to expect80-120 cases to have been treated.The trainee should have acquired expertise in a specific appliance technique that could beutilised in all cases.An objective of 60-90 cases with the primary appliance system might be appropriate.Knowledge of other techniques: 28 http://dentistry.rcsi.ie
  30. 30. Manual of Specialist Training in Dentistry 08/12/2010Knowledge and practice of other techniques such as Tipedge, Damon, Speed would be a uniqueexercise from which expertise could be developed for future practice.Growth modification:10-25 cases involving the use of functional or orthopaedic appliances should be seen.Interdisciplinary dental careA trainee should be equipped to deal with 5 to 10 straightforward interdisciplinary dental casesinvolving restorative dentistry and paediatric dentistry.Orthognathic treatment:Although detailed knowledge and experience of orthognathic planning could not be expectedwithin three years. Nevertheless the trainee should be exposed to a number of orthognathicclinics, and in particular to be involved in case conferences.The trainee might therefore participate in the planning for 5 to 10 cases.Cleft Lip & Palate:It would be useful if trainees were involved in the diagnosis and planning for cleft lip and palatecases.Transfers:Not more than 25% of a caseload should involve case transfers in which the trainee had not beeninvolved in the planning process.Supervision of retention:It is unlikely the trainee will gain much experience of this. Some of this experience should begained at diagnostic clinics and in the transfer of patients.These numbers are intended as guidelines, and are no to be taken as prescriptive10.6 SupervisionTo run effective programmes, dental teaching hospitals ideally require at least two WTEspecialists (including the Course Director), preferably at a senior academic level, with asignificant teaching input to run effective programmes. Where the training programme has morethan four trainees at any one time, additional staff will be required.10.7 Training CapacityIn a unit with adequate physical and human resources the training capacity is limited principallyby the staff: student ratio.Any course that exceeds the guidelines below may be seen to have gone beyond the ability of itsresources to deliver an acceptable quality of training.Clinical training:The staff student ratio should not exceed 1:4.Didactic teaching:In seminars the staff student ratio should be between 1:3 and 1:8;Other teaching formats may well accommodate larger numbers.10.8 EU Draft Competences and Erasmus RecommendationsProgrammes should use as a guide for their curricula the EU Draft Competences (Appendix E)and Erasmus Recommendations (Appendix I). 29 http://dentistry.rcsi.ie
  31. 31. Manual of Specialist Training in Dentistry 08/12/2010PART 11: PROSTHODONTICS11.1 DefinitionProsthodontics is considered to be the diagnosis and management of problems related to missingteeth and related tissues, worn teeth and includes the prescription and delivery of fixed,removable and implant retained prostheses.11.2 Objectives:Upon completion of clinical training and academic study, trainees will:be competent in the diagnosis of problems caused by missing teethbe competent in the management of patients who have lost some or all of their natural teethdemonstrate knowledge of the behavioural, clinical and technical procedures involved in thetreatment of patients requiring fixed, removable and implant retained prosthesesdemonstrate knowledge of general and clinical epidemiology of oral diseasesdemonstrate knowledge of materials’ science and technology in relation to Prosthodonticsdemonstrate knowledge of the impact of systemic diseases on oral tissues and of oral diseases onsystemic healthprovide treatment to the highest ethical and technical standards in line with current knowledgeand with the full and valid consent of patientsmanage time effectively and have good personal, teamwork, IT and operational skills in order tocontribute to the efficient delivery of healthcare to an optimum quality standardcommunicate individually with patients and other professionals and in general educational andprofessional settingsshow evidence of ability to undertake research11.3 Components of the training programme: Management of oral disease Aetiology of tooth loss Aetiology of tooth wear Epidemiology of tooth loss Management of oral health Management Ethics Practice management Health and safety Basic subjects Radiographic imaging techniques Interpretation of tomograms Basic pharmacology Biological aspects of ageing Bone and muscle physiology 30 http://dentistry.rcsi.ie
  32. 32. Manual of Specialist Training in Dentistry 08/12/2010 Microbiology of dental plaque Biomaterials science Genetic defects of teeth General subjects Diagnostic procedures Treatment planning Dental technology Assessment of tooth wear Assessment of TMD Management of the ageing dentition Prosthodontic techniques Diagnostic waxing Articulators Facebow transfers (arbitrary and kinematic) Diagnostic mounting Occlusal analysis and splints Provisional restorations Removable partial dentures Fixed bridgework Inlay/onlay restorations Full veneer crowns (all-ceramic and metal) Porcelain laminate veneers Resin bonded bridgework Die preparation Complete dentures (clinical and laboratory stages) Tooth supported overdentures Precision attachments Management of non-vital teeth Implant retained prostheses Interface with other disciplines Prosthodontics/oral surgery interface, including implant surgery Prosthodontics/periodontology interface, including implant surgery Prosthodontics/orthodontics interface Management of medically compromised patientsResearch/critical review Literature review techniques Evidence based dentistry 31 http://dentistry.rcsi.ie
  33. 33. Manual of Specialist Training in Dentistry 08/12/2010 Basic statistics Research methods Research project Basic computer skills11.4 CompetencesUpon completion of training, the trainee should demonstrate competence in:Diagnosis of causes and consequences of tooth lossRecording accurately the appropriate occlusal relationship including the use of facebows orequivalent technologiesCommunication skills with internal and external laboratories and techniciansProvision of complete and comprehensive prescriptions to the laboratory technicians for theconstruction of prostheses and restorationsMount casts on appropriate articulators and undertaking diagnostic and occlusal analysisPreparation of teeth for partial and full veneer restorationsObtaining accurate impressions for fabrication of all types of laboratory restorations andprosthesesProviding appropriate provisional restorations for intermediate stages of treatmentFitting restorations using appropriate adhesives or cements ensuring that aesthetics, occlusionand function are in concordance with the remaining dentition and patient’s wishesUndertaking the clinical stages necessary to construct and deliver satisfactory conventionalcomplete denturesManagement of the prosthodontic needs of the medically compromised patientPlanning and provision of removable partial dentures with the appropriate clinical and technicalprocedures utilised to ensure overall health of the remaining teeth and oral structuresPlanning and provision of prostheses for patients with toothwearFormulation of multidisciplinary treatment strategies and plans for fixed or removable prostheses(including implant retained prostheses), liasing effectively with colleagues in planning andmanagement including the use of appropriate radiographic imagesEvaluation of the role of dental implants in the management of partially dentate and edentulouspatientsCompletion of the clinical prosthodontic stages necessary to construct and deliver satisfactoryprovisional and definitive implant retained or supported prostheses, and be familiar with thesurgical stages involved in placing implantsAssessment, diagnosis and management of patients with TMD and construction of appropriateocclusal appliances for the diagnosis and treatment of TMJ problemsUnderstanding scientific methodology and interpretation of the literatureUnderstanding of ethical and legal issues as related to the practice of Prosthodontics11.5 Training RotationsTraining programmes must be for a period of three years. It is important that several trainers areable to make a substantial contribution to training. 32 http://dentistry.rcsi.ie
  34. 34. Manual of Specialist Training in Dentistry 08/12/2010The trainee should spend at least six sessions per week involved in patient contact with at leastfive of these sessions devoted to personal treatment sessions. The non-clinical sessions willinclude an average of 0.5 sessions for non-clinical management, two sessions for research, studyand audit and the remainder for clinical teaching activities. The breakdown of the timetable toreflect this balance of activity is: 60% Clinical activity; 25% research activity; 15% teachingA balanced programme will, for all trainees, allow personal treatment sessions, diagnosticsessions, review clinics, formal and informal teaching, research and reading time.11.6 Treatment Experience and CaseloadWhile it is appreciated that the clinical practices will vary from institution to institution, thereshould be some degree of uniformity in the quantity and quality of training achieved. Theobjective should therefore be to treat a sufficient number of patients to a high standard undersupervision over the three years.The following case mix is suggested as a basis for postgraduate training. There must be someflexibility in these numbers which can only act as guidance.The trainee should complete 25 cases, including provision of: Complete dentures Removable partial dentures Overdentures Full and partial veneer crowns Onlay restorations Porcelain laminate veneers Fixed bridges (conventional and resin bonded) Implant retained restorations (complete fixed/complete removable/short span fixed/single tooth), including surgical placement of fixtures11.7 SupervisionTo run effective programmes, dental teaching hospitals ideally require at least two WTEspecialists (including the Course Director), preferably at a senior academic level, with asignificant teaching input to run effective programmes. Where the training programme has morethan four trainees at any one time, additional staff will be required.11.8 Training CapacityIn a unit with adequate physical and human resources the training capacity is limited principallyby the staff: student ratio.Any course that exceeds the guidelines below may be seen to have gone beyond the ability of itsresources to deliver an acceptable quality of training.Clinical training: The staff student ratio should not exceed 1:4.Didactic teaching: In seminars the staff student ratio should be between 1:3 and 1:8; Other teaching formats may well accommodate larger numbers. 33 http://dentistry.rcsi.ie
  35. 35. Manual of Specialist Training in Dentistry 08/12/2010PART 12: PERIODONTICS12.1 DefinitionPeriodontics is generally considered to be the diagnosis and management of conditions affectingthe periodontal tissues, the placement of dental implants and the long term periodontalsupportive care of patients.12.2 ObjectivesUpon completion of clinical training and academic study, trainees will:Demonstrate the relevant knowledge of basic sciences that related to dentistry in general and toperiodontology in particular.Demonstrate knowledge of the relevant aspects of dental public health and clinical dentistry.Demonstrate comprehensive understanding of the relationship between oral and systemicdiseases and be competent in the management of medically compromised patient.Be able to communicate with patients and with other professionals and demonstrate that in aneducational and professional capacityBe able to present data and clinical findings for diagnosis and management of all known diseasesand disorders of the periodontium.Have the understanding of the importance of teamwork in the management of the periodontalpatient.Demonstrate comprehensive knowledge of clinical aspects of periodontics.Have the expertise and use the relevant evidence treatment planning for implant patients as wellas the surgical aspects of oral implantology.Have the knowledge of the relevant scientific literature and the ability to undertake research ofpublishable standard in a peer review journal.Demonstrate the ability to carry out a clinical audit project.Demonstrate an ability to pursue self-directed learning.Demonstrate an understanding of and an appropriate attitude to ethical issues.12.3 Components of the Training ProgrammeBasic subjectsFunctional anatomy of the head and neck.Bone and muscle physiologyCell biologyMicrobiology and cross infection control.Radiology and other imaging techniques.PharmacologyBehavioural sciences.Biostatistics At a stage convenient to the host institution, perhaps during the second year, the student willbe given the opportunity to follow a course in biostatistics. The organization of the course, 34 http://dentistry.rcsi.ie
  36. 36. Manual of Specialist Training in Dentistry 08/12/2010number of contact hours and preparation time will be determined not later than thecommencement of the second year.PeriodonticsBiology of the periodontium and oral physiology.Microbiology of dental plaque and oral microbial ecology.Pathogenesis of plaque-associated periodontal diseases: The role of the host response.Clinical features and diagnosis of periodontal diseases.Therapy of periodontal diseases - initial treatment.Epidemiology of periodontal diseases.Antimicrobial treatment of periodontal diseases.Therapy of periodontal diseases - periodontal surgery.Treatment of bony defects and attachment loss.Biological basis, selection criteria, indications and contra-indications for the placement of osseo-integrated dental implants.Supportive care for the treated periodontal patient.ManagementEthicsPractice managementHealth and safetyHealth care economicsAuditInterface with other disciplinesManifestations of systemic disorders in the oral cavity.Medically compromised patients.Occlusal trauma.PainInterrelationships of periodontal disease and therapy with other dental disciplines.Epidemiology of oral diseases.Craniofacial growth and developmentResearch/critical reviewOngoing analysis and review of the scientific literature.Evidence based dentistryResearch methodsResearch projectBasic computer skills 35 http://dentistry.rcsi.ie
  37. 37. Manual of Specialist Training in Dentistry 08/12/201012.4 Education and trainingThe trainee must be able to recognize the various forms of periodontal disease in order to make adiagnosis and prepare a treatment plan for each patient. Knowledge must be demonstrated in thefollowing areas:The composition of plaque and the chemical and microbial structure and also be familiar with theliterature pertaining to the relationship of plaque to inflammatory periodontal disease.Basic understanding of culture techniques and tests to identify bacterial strains and theirdiagnostic potential.Understand the histopathological development of periodontal diseases and the pathogenicmechanisms of inflammation.Diagnosis of both chronic and acute forms of gingivitisDiagnosis of chronic periodontitis, aggressive periodontitis and periodontal disease in childrenand the differential diagnosis of these problems.Understanding of the systemic disorders, that may modify the response of the periodontal tissuesto plaque, associated inflammatory disease.Understanding of the historical background to the development of dental implants and thevarious types of implant material currently in use.Each trainee is required to fully document each phase of treatment (photographs, models,records) in order to subsequently present these cases at clinical conferences at various stagesduring their training. The trainees will be required to present the various phases of treatment oftheir patients for discussion within the group. This will provide trainees with the opportunity tosee and discuss a wide range of problems.Each trainee is required to competently perform each phase of treatment.Each trainee is required to evaluate the success of treatment and plan a supportive periodontaltherapy programme, in conjunction with a dental hygienist member of the team.Trainees will be given the opportunity to attend clinics in which patients, referred by generaldental practitioners, are treated by individual staff members.The trainee will attend interdisciplinary treatment planning clinics in order to gain insight intothe problems of treatment planning the advanced case (combined problems of periodontaldisease plus systemic, restorative, prosthetic, orthodontic, paedodontic, surgical and medicalconsiderations). Trainees are encouraged to see the results of treatment of cases in which suchproblems were present in combination with periodontal disease.At the completion of the course it will be expected that each trainee has been able to carry out awide range of therapeutic modalities. The documentation of these various phases of treatmentwill contribute to the construction of case reports.Trainees will be required to be knowledgeable about the current range of implant therapies, theirindications, contraindications and method of placement. Trainees will actively participate in theplacement of implants as well as the restorative follow up procedures.12.5 CompetencesUpon completion of training, the trainee should demonstrate competence in:Investigation, diagnosis and documentation of periodontal conditionsTreatment planning, with various possible alternatives 36 http://dentistry.rcsi.ie
  38. 38. Manual of Specialist Training in Dentistry 08/12/2010The (evaluation) interpretation of both normal and pathological structures found on radiographsin the oral cavity.Carrying out non-surgical periodontal therapy successfullyThe use of appropriate chemotherapeutic agents as an adjunctive in the management of gingivitisand periodontitis.Analysing the risk factors and the degree of risk present.The understanding of the action and use of analgesics, anti-inflammatory, antimicrobial agentsand drug interactions.The different options for management of trauma from occlusion and associated complicationsAll the surgical procedures for the management of gingival and periodontal conditions,including:Gingivectomy and electrosurgery proceduresapically positioned flapmodified Widman flap with and without bone surgerygingival extension techniques (mucogingival surgery)crown lengtheningroot resection proceeduresguided tissue regeneration (GTR)ridge augmentation with soft and hard tissue graftsgingival biopsyThe diagnosis and management of furcation lesions.The management of periodontal-pulpal diseases.The management of cases that are in interface with orthodontic, restorative and prosthodontics.To understand the importance of evaluation of treatment carried and of long-term periodontalsupportive therapy.To understand the scientific basis behind alteration of behaviour patterns (including oral hygienepractices, dietary habits and smoking cessation).Working with other team members and colleagues in different disciplines in relation to patientcare.Assessing patients and provide treatment plans for patients requiring implantsPlacement of implant fixtures and carry out the necessary maintenance therapy.12.6 Training Capacity and SupervisionIn a unit with adequate physical and human resources principally the staff limits the trainingcapacity: student ratio.Any course that exceeds the guidelines below may be seen to have gone beyond the ability of itsresources to deliver an acceptable quality of training.Clinical training:The staff student ratio should not exceed 1:4.Didactic teaching: 37 http://dentistry.rcsi.ie

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