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  2. 2. SPECIALIST REGISTRAR IN ORTHODONTICS - PERSON SPECIFICATION Training Programme Essential Desirable Requirements Qualifications Qualified Dental Practitioner. Full FDS or MFDS or equivalent. Registered with GDC. Vocational Training Number (if applicable). IQE (if applicable) Academic Achievements Distinctions, prizes, awards, scholarships, other degrees. Presentations. Publications. Training Vocational Training (if applicable Oral & Maxillofacial surgery experience. General experience of dentistry. Experience in paediatric dentistry. None required in specialty. Skills and Attitude Reliability. Computer Skills. Ability to work as a team. Demonstration of organisational ability. Understand and communicate intelligibly with patients. Commitment to specialist training. Other Requirements Satisfactory pre-employment Outside interests and activities health screening and CRB check. that demonstrate drive and enthusiasm. JD/ORTHODONTICS.SpR NOV 2007 2
  3. 3. JOB DESCRIPTION This full-time training programme, commencing in October 2007, is of three years’ duration and satisfies the requirements for the Membership in Orthodontics of the Royal Colleges. The SpRs must also enrol for the degree of Master of Dental Science of the University of Liverpool, which is taken simultaneously. The training programme offers comprehensive training in theoretical, clinical and laboratory aspects of orthodontics with experience in removable, functional and fixed appliance treatment methods including combined treatment with other specialties. The M.Dent.Sci. is a part-time, modular, taught Masters course providing a theoretical and clinical training in orthodontics, together with training in research methodology achieved by the completion of a dissertation. It is a minimal educational requirement that applicants have passed the full examination for the Fellowship in Dental Surgery or MFDS of one of the Royal Colleges or its equivalent and be in possession of a VT number if applicable. Specialist Registrar posts will be available between Liverpool University Dental Hospital (LUDH) with rotations to The Countess of Chester Hospital or Halton General Hospital or Arrowe Park Hospital. PARTICIPATING ORTHODONTIC STAFF ORTHODONTICS Mr G. Barry BDS; MScD; FDSRCPS; M. Orth Mr S. Chadwick BDS; FDS(Orth)RCSEd; MSc; M. Orth Dr S. Dominguez-Gonzalez PhD; FDS(Orth)RCSEng; Lic Odont Dr J. Harrison PhD; BDS; FDS(Orth)RCPSGlasg; M Dent Sci; M. Orth Mr J. Husain BDS; FDS(Orth)RCSEd; MSc; M. Orth Mr C. Melrose BDS; FDS(Orth)RCSEd; M Dent Sci; M. Orth Dr N. Pender PhD; BDS; MScD; FDSRCS (Ed. & Eng.); DDOrthRCPS Mr S. J. Rudge BDS; FDSRCS (Ed. & Eng.); M. Orth Dr J. Russell PhD; BDS; FDSRCPSGlasg; M. Orth Mr T. Morris BDS; FDS(Orth)RCSEd; MSc; M. Orth MAXILLO-FACIAL SURGERY Mr D. A. Richardson FRCS; FDSRCS Mr J. C. Cooper FDSRCS Mr M Boyle FRCS; FDSRCS Mr P McGuiness FRCS; FDSRCS Miss A Begley FRCS; FDSRCS Mr C Jones FRCS; FDSRCS Mr M Dodd FRCS; FDSRCS OTHER DENTAL SPECIALTIES Members of Liverpool University Dental Hospital staff. Visiting speakers are also invited to participate in teaching seminars. JD/ORTHODONTICS.SpR NOV 2007 3
  4. 4. OUTLINE OF THE TRAINING PROGRAMME This training programme will give each SpR a thorough grounding in all aspects of Orthodontics and is broken into four major aspects, namely theoretical, clinical, laboratory work and a research programme. In practice, these aspects will be running, to a large extent, simultaneously. The structure and content of the training programme follows the recommendations of the SAC in Orthodontics of the Royal College of Surgeons of England. 1. THEORETICAL A comprehensive series of seminars will take the SpR through a programme of Orthodontics and allied subjects. A list or relevant literature is available to guide reading and one or more seminars will be delivered on each topic. Relevant articles will be discussed and SpRs will prepare essays on selected topics. 2. CLINICAL WORK The SpRs will be introduced to the Clinic early on in the training programme. Emphasis will initially be placed on diagnosis and treatment planning and the preparation of proper records. Soon after the commencement of the training programme, treatment will be started on patients so as to allow maximum time for the completion of treatment during the three-year training programme period. The majority of patients will be treated using a pre-adjusted edgewise appliance (0.22” slot). The Tip-Edge appliance, functional and removable appliances will also be used. During the first year some sessions will be at the District General Hospitals, but the majority of the sessions will be at LUDH. Throughout the training period approximately four sessions per week will be at a District General Hospital in order to provide greater opportunities for seeing patients in a district centre. However, the first three months of the programme will be spent solely at Liverpool University Dental Hospital. 3. LABORATORY WORK The SpRs will carry out a certain amount of laboratory work under the guidance of the Senior Orthodontic Technician. However, the bulk of the laboratory work will be done by the Orthodontic Technicians to allow SpRs to devote more time for clinical and research purposes. 4. RESEARCH PROGRAMME Each SpR will carry out a research project on a subject agreed between the SpR and the Head of department. The subject will be looked at in-depth and work will be carried out so that a dissertation can be prepared for submission towards part of the M Dent Sci requirements. 5. STUDY LEAVE AND ANNUAL LEAVE Study leave for external courses are allowed where appropriate. Application for Study or Annual leave must be made at least 6 weeks prior to the period of absence and ALL consultants involved in training during the planned dates must be consulted. Application forms are to be submitted to the Postgraduate Dental Dean when signed by the relevant Consultants. JD/ORTHODONTICS.SpR NOV 2007 4
  5. 5. MASTER OF DENTAL SCIENCE (M. Dent. Sci.) AIM The purpose of the research modules of the M. Dent. Sci. is to demonstrate that the candidate has achieved an understanding of research methodology. To this end, a project, designed to answer a simple relevant question, will be completed. The subject matter does not need to be either orthodontic or clinical but the candidate, in order to complete the project, must have empathy with it. QUALITY AND DURATION Candidates for the M. Dent. Sci. may wish to develop a project suitable for either publication in a peer-reviewed journal or submission for competition. Thus, the quality of the project must allow for this eventuality. TIMING OF THE ELEMENTS OF THE DISSERTATION During the first term of the M. Orth programme, possible projects and supervision should be agreed so that protocols can be written in the second term. At this stage, any funding or ethical issues must be resolved. By the third term of the first year the materials and methods should be identified and data collection started if possible. The time allocation within the timetable in this first year should be putatively one session per week. The second year should be dedicated to data collection and analysis. The time allocation should be a consistent day per week. The third year should include, initially, preparation of the kernel of the results for publication. This process will help focus the dissertation writing and lead to a paper in press before the end of the M. Orth programme. The time allocation should be putatively one day per week. MONITORING OF PROGRESS An informal process is in place such that the progress of each dissertation and the level of concordance with the timing of the elements of the dissertation are maintained. This allows noticeable deviation from the programme to be corrected at an early stage. JD/ORTHODONTICS.SpR NOV 2007 5
  6. 6. OBJECTIVES OF THE M.DENT.SCI COURSE The graduate, during the course, will receive tuition so as to: 1. Be able to diagnose anomalies of the dentition, facial structures and functional conditions. 2. Detect deviations of the development of the dentition, of facial growth and occurrence of functional abnormalities. 3. Formulate a treatment plan and predict its course. 4. Carry out interceptive orthodontic measures. 5. Execute simple and complex treatment procedures. 6. Work together in multidisciplinary teams for the treatment of compromised (adult) patients, orthodontic surgical cases and cleft palate patients. 7. Evaluate the need for the orthodontic treatment. In addition, emphasis is placed on: 1. Psychological aspects relevant to orthodontics. 2. Development of a scientific attitude in an inquiring mind and the stimulation of professional curiosity. 3. Training in scientific methodology. 4. Interpretation of literature. 5. Research activities. 6. Oral and written presentation of clinical and research findings. JD/ORTHODONTICS.SpR NOV 2007 6
  7. 7. A. GENERAL BIOLOGICAL AND MEDICAL SUBJECTS 1. GROWTH AND DEVELOPMENT OF THE HUMAN BODY General body growth and its variations. Adolescent growth spurt and its relation to growth of the craniofacial complex. Genetic and environmental factors that influence physical growth. Different biological ages and determination of skeletal age, dental development and sexual development stages. 2. ANATOMY OF THE HEAD Growth of the craniofacial skeleton. Occurrence of skeletal deformities. Facial orthopaedics. Orthognathic surgery. 3. GENETICS Genetic principles that are essential for the understanding of the development of the head and craniofacial malformations. 4. EMBRYOLOGY OF THE HEAD Embryology of craniofacial structures as far as it is essential for the understanding of teratogenesis and development of clefts and other facial congenital malformations. 5. CELLULAR BIOLOGY Knowledge of histological and cytological aspects that are essential for the understanding of: Development of the dentition. Facial growth temporomandibular joint Tooth movements and reactions in tooth supporting tissues. Facial orthopaedics. Bone metabolism under normal and abnormal conditions. Soft tissue changes related to orthodontics. Mechanisms of root resorption. 6. PHYSIOLOGY OF BREATHING, SPEECH, SWALLOWING AND MASTICATION A thorough knowledge of different modes of breathing and be familiar with: Normal and abnormal speech. Various ways of swallowing. The process of mastication. 7. SYNDROMES IN WHICH THE HEAD IS INVOLVED The classification of syndromes in relation to aetiology, prognosis and reaction to orthodontic treatment. JD/ORTHODONTICS.SpR NOV 2007 7
  8. 8. 8. PSYCHOLOGY OF THE CHILD, ADOLESCENT AND ADULT Concepts and principles in developmental psychology. Possibilities and limitations in behaviour modification. Aspects involved in motivating patients and estimation of co-operation. Psychological aspects of puberty and adolescence. Impact of facial appearance on self-esteem. Psychological aspects in orthognathic surgery patients. 9. STATISTICS Be familiar with commonly used statistical methods. Understand statistical aspects in current dental literature. Evaluate validity of statistical conclusions in clinical and research papers relevant for Orthodontics. Be familiar with data processing procedures. 10. RESEARCH METHODOLOGY Be familiar with philosophies of scientific methodology. Be familiar with ethical aspects of research on animals and humans. BE able to write a protocol for a research project, evaluate validity of conclusions in research papers, interpret own research findings and be able to present research findings in an oral and written form. B. BASIC ORTHODONTIC SUBJECTS C. 1. DEVELOPMENT OF THE DENTITION (NORMAL AND ABNORMAL) Acquire a thorough knowledge of: The development of normal occlusion from birth to adulthood with variations in this development. Genetic and environmental factors relevant for the development of the dentition. Development of the different malocclusions, including its variations and ranges of severity. Effect of agenesis and supernumeraries and of (premature) loss of extraction of deciduous and permanent teeth on the development of the dentition. Be able to recognise and identify a given situation of the dentition as regards its: Normality or abnormality. Developmental stage attained. Future development. Possibilities for interceptive measures to improve the ultimate situation. JD/ORTHODONTICS.SpR NOV 2007 8
  9. 9. 2. FACIAL GROWTH (NORMAL AND ABNORMAL) Have a good insight in the growth of cartilage and bone and thorough knowledge of: Growth sites in the craniofacial skeleton. Postnatal growth changes in the craniofacial region, including those of soft tissues. Variations in functions in the craniofacial region that are relevant for facial growth. Different facial configurations and influences of environmental factors on facial growth. 3. PHYSIOLOGY AND PATHOPHYSIOLOGY OF THE STOMATOGNATHIC SYSTEM Have a thorough knowledge of: Normal and abnormal articulation of the dentition. Normal and abnormal behaviour of soft tissue structures. Normal and abnormal functioning of the temporomandibular joint. Diagnostic procedures regarding the temporomandibular joint and treatment procedures in temporomandibular joint disorders. 4. ASPECTS OF TOOTH MOVEMENTS AND FACIAL ORTHOPAEDICS Have a thorough knowledge of: Histological aspects of tooth eruption and spontaneous movements. Effects of different types of force application on cells and tissues. Influences of force systems and magnitude of post-treatment changes. Histological aspects of growth at cartilaginous structures, sutures and bone surfaces. Effects of facial orthopaedic systems on cells and tissues. Relations between adaptability of tissues and effects of facial orthopaedic measures. 5. RADIOLOGY AND OTHER IMAGING TECHNIQUES Have a good insight in: Techniques and risks involved in making radiographs for orthodontic purposes, a thorough knowledge of the abnormalities and pathologic conditions that can be diagnosed on radiographs and be familiar with digital radiographic and other imaging techniques. 6. CEPHALOMETRICS (INCLUDING TRACINGS) Be able to: Identify relevant anatomical structures on cephalograms. Describe the morphology of the head on basis of cephalograms. Make tracings of cephalograms that include essential contours. Perform several cephalometric diagnostic analyses on tracings and have a thorough knowledge of limitations of cephalograms and their analyses. JD/ORTHODONTICS.SpR NOV 2007 9
  10. 10. 7. ORTHODONTIC MATERIALS Have knowledge concerning: Properties and compositions of orthodontic materials and a thorough knowledge of parameters necessary for selection of correct material for various orthodontic procedures, the correct procedures for handling orthodontic materials and the proper application of orthodontic materials. 8. ORTHODONTIC BIOMECHANICS Understand basic principles of orthodontic biomechanics and how they relate to clinical and research problems. Solve problems related to force resultants and force equivalents. Estimate forces produced by different orthodontic appliances and estimate forces produced by dentofacial orthopaedic devices. C. GENERAL ORTHODONTIC SUBJECTS 1. AETIOLOGY Have a good insight into genetic and environmental factors that influence postnatal development of the dentition and facial growth and have a thorough knowledge of environmental factors that have an unfavourable influence and how they can be intercepted. 2. DIAGNOSTIC PROCEDURES Be able to: Take a relevant patient history. Perform a thorough clinical examination. Determine habitual occlusion, evaluate articulation and different jaw relations in patients. Evaluate influence of functional components of soft tissue structures on morphology. Take high quality impressions of dental arches with a maximum reproduction of adjacent structures. Make face bow registrations and mount casts in an articulator. Take good extra-oral and intra-oral photographs. 3. ORTHODONTIC DIAGNOSTIC ASSESSMENT, TREATMENT OBJECTIVES AND TREATMENT PLANNING. Be able to: Arrive at a tentative diagnostic assessment and classification on the basis of cursory examination of a patient, give advice after cursory examination concerning feasibility of treatment, need for a more detailed analysis-treatment plan or referring to other specialists for further evaluation and treatment to arrive at a proper diagnostic assessment on basis of anamnestic data, patient examination, dental casts, photographs, radiographs, cephalograms and other relevant data predict the likely development if no therapy is implemented. Define objective of a treatment plan and what alternatives should aim at. JD/ORTHODONTICS.SpR NOV 2007 10
  11. 11. Describe a treatment plan for various types of orthodontic and dentofacial abnormalities including strategy of treatment and retention, therapeutic measures, timing and sequence of their application, prognosis and estimated treatment and retention time. 4. GROWTH AND TREATMENT ANALYSIS Be able to: Perform growth analyses based on serial cephalograms detecting treatment changes by means of tracings. Have a thorough knowledge of: Possibilities and limitations of different methods of superimposing. Restrictions in analyses of growth and treatment changes. Validity and limitations of growth predictions including computerised predictions. 5. LONG TERM EFFECT OF ORTHODONTIC TREATMENT Have a thorough knowledge of: Relapse associated with different anomalies and treatment procedures. Changes that can take place during retention period. Changes that can occur after retention has been terminated. Be able to predict the probable long-term effects of orthodontic treatment in individual patients. 6. IATROGENIC EFFECTS OF ORTHODONTIC TREATMENT Have a thorough knowledge of: Risks involved in different treatment and retention procedures. Influences of various conditions and age ranges on iatrogenic effects. Possible influences of treatment on temporomandibular joints. Effects of different types of treatment in periodontal structures in the long run. Factors involved in root resorption. Possible influences of treatment on facial expressitivity and the possible influences of treatment on dentofacial appearance and aesthetics. 7. EPIDEMIOLOGY IN ORTHODONTICS Have understanding of: Basic principles of epidemiological studies. Validity of indices. Prevalence and incidence of orthodontic anomalies. Aspects involved in subjective need for treatment. Factors involved in estimating objective need. Models to determine the demand for treatment. Roles played by orthodontists in demand for treatment and the influence of the society on demand for treatment. JD/ORTHODONTICS.SpR NOV 2007 11
  12. 12. 8. ORTHODONTIC LITERATURE Be familiar with various orthodontic journals and be able to: Critically analyse and detect essentials in current literature. Present concise literature reviews. D. ORTHODONTIC TECHNIQUES 1. REMOVABLE APPLIANCES Have a thorough knowledge of: Theory, indications, design and use of removable appliances. Possibilities and limitations of removable appliances and be able to fabricate and repair removable appliances. 2. FUNCTIONAL APPLIANCES Have a thorough knowledge of: Theory, indications, design and use of functional appliances. Possibilities and limitations of functional appliances and be familiar with different approaches and constructions used in functional appliances. 3. EXTRA-ORAL APPLIANCES Have a thorough knowledge of: Theory, indications, design and use of various types of headgears, facial masks, chin-caps and combined extra-oral/functional appliances. Possibilities and limitations of these appliances. 4. FIXED APPLIANCES Be familiar with: Theory, indications and applications of full fixed appliances. Different concepts and treatment approaches in full fixed appliance therapy. Possibilities and limitations of different techniques and have a thorough knowledge of at least one type of full fixed appliance. A pre-adjusted system is most frequently used. 5. RETENTION APPLIANCES Have a thorough knowledge of: Theory, indications and contra-indications, design and use of retention appliances. Possibilities and limitations of retention appliances and the most appropriate duration of retention. E. MULTIDICIPLINARY TREATMENT PROCEDURES F. JD/ORTHODONTICS.SpR NOV 2007 12
  13. 13. 1. CLEFT PALATE TREATMENT Have knowledge concerning the: Multidisciplinary approach in the treatment of cleft palate patients. Theory, indications and applications of multidisciplinary treatment of cleft palate patients and specific aspects involved in orthodontic treatment of cleft palate patients. 2. ORTHODONTIC/ORAL SURGICAL TREATMENT Have a thorough knowledge of: Theory, indications and applications of combined orthodontic/oral surgery treatments and specific aspects involved in orthodontic treatment of orthodontic/surgical cases. 3. ORTHODONTIC/PERIDONTAL TREATMENT Have a thorough knowledge of: Theory, indications and applications of combined orthodontic/periodontic and/or restorative treatments and specific aspects involved in orthodontic treatment of periodontally compromised dentitions. F. SPECIFIC TREATMENT PROCEDURES G. 1. GUIDING THE DEVELOPMENT OF OCCLUSION Have a thorough knowledge of indications and contra-indications of interceptive measures. 2. ADULT ORTHODONTICS Have a thorough knowledge of: Theory, indications and specific aspects involved in orthodontic treatment of adults. 3. CRANIOMANDIBULAR DYSFUNCTIONS Be familiar with: Aetiology of craniomandibular dysfunctions. General measures that can improve craniomandibular dysfunctions. Various therapeutic procedures in dentistry, and have a thorough knowledge of: Indications and contra-indications for orthodontic treatment in patients with craniomandibular dysfunctions. Possible implications of orthodontic treatment regarding craniomandibular dysfunctions and different appropriate orthodontic treatment procedures. JD/ORTHODONTICS.SpR NOV 2007 13
  14. 14. G. USE OF COMPUTERS The student should be familiar with: Applications of computers in clinical orthodontics and patient management. H. MANAGEMENT OF ORAL HEALTH Have a good insight into: Specific aetiological features encountered in orthodontic practice regarding development of dental decay, periodontal problems and soft tissue lesions and have a thorough knowledge of: Procedures to detect orthodontic patients with a huge risk of developing periodontal problems and be able to institute a proper oral hygiene and preventive programme designed for the needs of orthodontic patients. I. HEALTH AND SAFETY CONDITIONS IN AN ORTHODONTIC PRACTICE Have a thorough knowledge of: Prevention of cross infection. The management of high-risk patients and control of substances hazardous to health for patients and personnel. JD/ORTHODONTICS.SpR NOV 2007 14
  15. 15. OUTCOME GRID FOR THE SPECIALIST IN ORTHODONTICS This grid is a summary of “Learning Outcomes for the Specialist Registrar in Orthodontics” 2003 ( What the Specialist is able to do How the Specialist approaches clinical Practice The Specialist as a professional Clinical Treatment Treatment Application Clinical Communication Health Attitudes, Ethical Information The role of Personal information Planning Procedures of basic reasoning and Promotion Stance and Legal handling the dentist development gathering clinical judgement Responsibilities within the sciences Health Service • Take a history • General • Guiding the • General • General • Demonstrate active • Take into • Demonstrate an • General • General • Self-awareness Principles developing Principles Principles listening skills consideration the understanding of Principles • Undertake an occlusion impact of social, patient psychology in • Health and • Continuing intra and extra- • Integrated • Cell and • Growth and • Demonstrate cultural and relation to health • Computer based safety professional oral examination Restorative Care • Adult molecular biology treatment appropriate behavioural education technology development of the head and orthodontics analysis communication skills factors on dental • Legislation and neck • Malocclusion • Genetics with a range of health • Demonstrate an • Critical ethics • Personal growth and medical •Craniomandibular • Long term patients ethical and moral evaluation of • Examine the problems dysfunctions • Craniofacial effects of • Keep up to date approach (to patients, literature • Surgery • Self-care occlusion embryology orthodontic • Demonstrate with strategies their relatives, Management • Appliances: • Interface with treatment appropriate for prevention of colleagues and staff, • Career • Obtain and Removable Oral & • Somatic and communication skills disease in and research • Personnel development interpret relevant Functional Maxillofacial craniofacial • Iatrogenic (verbal and written) different settings undertaken) Management clinical, Extra-oral Fixed Surgery growth effects of with other e.g. primary • Development of radiological and Retention orthodontic professional prevention, • Demonstrate • Finance additional laboratory • Interface with • Physiology of treatment colleagues screening, public confidentiality, experience in investigations Restorative breathing, awareness integrity, truthfulness • Audit areas of Dentistry swallowing, • Demonstrate campaigns and respect, without efficiency or including mastication and appropriate discrimination towards • Health service special interest Implantology speech communication skills • Collaborate with patients and structures with others in the other colleagues • Interface with • Psychology dental team in order professionals in Paediatric to ensure efficient health promotion • Demonstrate an Dentistry • Dental and effective working and disease appropriate approach materials prevention and response to • Demonstrate complaints about appropriate case • Apply the performance presentation skills, knowledge give appropriate principles and • Recognise and advice and methods of respond to legal information to health promotion responsibilities promote learning in so as to include an others appropriate • Recognise and health promotion respond appropriately dimension to most to colleagues whose clinical contacts professional conduct gives cause for D/ORTHODONTICS.SpR November 2007
  16. 16. concern This grid is a summary of “Learning Outcomes for the Specialist Registrar in Orthodontics” 2003 Page 11 (