[Reform efforts in dentistry - national and international approaches]. / Reformbemühungen in der Zahnmedizin ­ nationale und internationale Ansätze.

The Study of dentistry in Germany is in need of reform. The actual regulation on licensing dentists in Germany is from 1955, with the last changes made in 1993. Recently there have been different initiatives related to reform: a national catalogue of competency-based learning objectives in dental education (NKLZ), changes and stipulations in the respective rules relating to undergraduate curriculum in dental medicine, and an initiative of the Germany Ministry of Health to tackle and reorganize dental education in Germany.This article presents and reflects on these reform efforts in the context of actual teaching in Germany, Europe, and the United States.The reform process is an opportunity for dental education in German faculties of medicine. New dentistry programs are allowed at all faculties with model educational programs in medicine. Therefore, an example of actual reform efforts are presented based on the experiences of Hamburg. Research on dental educational programs revealed interesting approaches in dental education in other European faculties of medicine. Selected faculties were visited. These experiences led to the formulation of five main goals of reform: interdisciplinary study, problem- and symptom-based learning, early patient contact, science-based education, and communication training. The main goal is a dental education program designed along science-based, prevention-oriented, multidisciplinary, and individualized dental care that contributes to the life-long oral health of patients.

An Evaluation of Permit L Local Anesthesia within Dental Hygiene Practice in Massachusetts.

PURPOSE: The purpose of this descriptive study was to assess data pertinent to the Permit L local anesthesia license among practicing dental hygienists in Massachusetts, providing an overview of characteristics, practice behaviors, barriers for obtaining the permit and self-perceived competency. METHODS: A convenience sample of dental hygienists (n=6,167) identified through a publically available data base were invited to participate in a web-based survey. The survey consisted of demographic and Permit L specific questions. Items regarding opinions were rated using a 5-point Likert scale while frequencies and percentiles were used to evaluate demographics and practice-based information. Spearman's Rank correlation was performed to determine association between variables. RESULTS: A 10% (n=615) response rate was attained with (n=245) non-Permit L holders and (n=370) Permit L holders. Respondents reported significant differences in demographics and opinions between non-Permit L holders and Permit L holders (p<0.01) and between those certified through continuing education or curriculum based programs (p<0.01). Significant relationships were found in demographics (p<0.01) and practice (p<0.05) items in relation to the length of time the Permit L has been held. Themes from the data and comments indicate multiple factors influencing obtaining or not obtaining the Permit L. CONCLUSION: The results of this study provide an overview of Permit L local anesthesia administration that is generally comparable to previous studies and offers new insights into why some Massachusetts dental hygienists choose not to pursue certification. This study highlights the potential to increase the prevalence of the Permit L, address barriers to pursuing the Permit L, and further evaluate self-perceived barriers.

Perspectives of New York State Dental Residency Directors on Licensure by Residency.

In 2003, New York State enacted legislation that allowed graduating dentists to undertake a one-year postgraduate residency in place of a licensure exam. In 2007, it became mandated throughout the state. This was a paradigm shift for the dental community, and overall opinions varied widely on the topic. On one side, proponents of a board exam claim that the point of dental school is to produce competent practitioners and weed out those who would be dangerous to the practice of dentistry. Contrarily, proponents of residency see the need for further evaluation and assessment of practitioners in order to even understand their levels of competence. In the current residency model of licensure, it is up to attending dentists and residency directors to deem the dentists ready to practice. At this point, there is no standard way of assessing residents, nor are there any guidelines as to what should be used to assess prospective dentists. This puts a lot of responsibility on specific directors to decide what is appropriate in their own situation. The purpose of this survey was to collect and assess residency directors' perspectives on the current licensure model of a residency. The survey response rate was 57% of all residency directors in New York State. The results show how the biggest stakeholders view their role in licensure, what levels of assessment they use and what improvements they would choose to utilize if available.

How Will the U.S. Supreme Court's Decision in North Carolina Dental Affect the Regulation of the Professions?

The contract between the public and the professions is between two parties; so it is reasonable to expect that there might be at least two perspectives when a ruling is given regarding the interpretation of the contract. The Citizen Advocacy Center recently convened a conference to look at the U.S. Supreme Court decision in the functioning of the North Carolina Dental Board in balancing protection of the public with availability of oral health services. New questions are being asked.

A Closer Look at the North Carolina Board of Dental Examiners and Who Can Practice Dentistry.

On February 25, 2015, the U.S. Supreme Court rendered a six-to-three opinion in favor of the Federal Trade Commission in their dispute with the North Carolina State Board of Dental Examiners concerning teeth-whitening services provided by nondentists. That decision was the culmination of almost nine years of arguments and allegations that began with a disagreement regarding the definition of the practice of dentistry. The ethical aspect of this dispute resides in the one's perspective regarding the motivation behind the actions taken in the North Carolina State Board of Dental Examiners.

What Contract? With Whom? For What Purpose?

The central point in the U.S. Supreme Court upholding the Federal Trade Commission's action against the North Carolina State Board of Dental Examiners was that they acted without proper supervision from the State of North Carolina in curbing commercial activity: issuing cease and desist orders to teeth-whitening businesses, for example. It appears unlikely that the law of the land will allow professions to enforce and may substantially limit a profession's voice in defining nearby commercial activity. The line between professional services and commercial ones is not clear. Vending whitening agents, as drug stores do, is commercial but may not be professional. Providing such services in the dental office certainly should be professional, but is also certainly commercial. As dentistry becomes more overtly commercial in nature, it is likely that the profession will have less say over defining and enforcing oral healthcare practices.

State Dental Boards and Public Protection: Fulfilling the Contract.

Dental boards are agents of the state, sworn to protect the public. They combine the skills of professional training with responsibility to ensure that patients receive safe and effective care. They can play a vital role in ensuring that the profession does not invite more regulation by working to maintain the public's trust. Two cases are presented illustrating that one's perspective can cloud the sense of what is right and that it is wrong to pass ethical responsibilities on to others.