Competencies

General Dentistry Rotation
The objective of the general dentistry rotation is to gain clinical experiences that allow a resident to become competent in the following competency statements:

• Function as the patient's primary and comprehensive oral health care provider, particularly patients with medically complex and/or special needs. Apply “Best Care” principles to all patient care interactions.
• Practice all accepted sterilization, disinfection, universal precautions and occupational hazard prevention procedures.
• Consistently obtain a quality medical history that identifies and characterizes the patient’s chief complaint, history of present illness, past medical history, operations/hospitalizations, review of systems, medications, allergies, and any other pertinent information. Perform a proper physical examination appropriate to the needs of the patient. Understand the “classic” H&P examination.
• Order/obtain and interpret appropriate imaging (radiographs, CT), laboratory data, diagnostic tests, and any other additional information necessary to make appropriate treatment decisions.
• Look up supplemental information about “unknowns” (medications, syndromes, diseases, conditions, therapies, tests, etc.) sufficient for making educated decisions about patient care.
• Utilize the services of medical doctors and other healthcare professionals as appropriate to make quality patient care decisions.
• Establish an assessment of risk and differential / provisional / definitive diagnosis(es).
• Integrate collected data and demonstrate sufficient understanding of the patient’s condition to create an individually appropriate, comprehensive, phased and sequenced plan of care. Obtain informed consent as appropriate.
• Appropriately utilize a variety of pharmacologic agents commonly required in dentistry, including local anesthetics, analgesics, sedatives, antiemetics, steroids, fluorides, and antimicrobial medications. Use advanced theory/techniques where possible (For example: Gow-Gates, V2 division blocks, intraosseous delivery, scheduled dosing, trays, etc.).
• Provide control of acute pain through the proper use of psychological interventions, behavior management techniques, local anesthesia, sedatives and analgesics. Diagnose and manage patients with uncomplicated chronic pain complaints.
• Select an appropriate sedation modality for patients who would benefit from the use of sedation.
• Provide appropriate oral +/- N₂O minimal sedation and intravenous moderate sedation. Demonstrate appropriate record keeping. Understand how to prevent, recognize and manage complications related to the use of sedation
• Incorporate latest scientific knowledge/principles to prescribe which restorative material to use in a given situation.
• Restore single and multiple teeth (foundations and final restorations) utilizing amalgam, composite, gold, porcelain, or other accepted materials while demonstrating advanced skills (speed, efficiency, finesse, etc.), without sacrificing quality.
• Use accepted prevention strategies such as oral hygiene instruction, nutritional education, and pharmacologic intervention to help patients maintain or improve their oral health.
• Diagnose and treat early and moderate periodontal disease using nonsurgical, pharmacologic, and surgical procedures. Manage advanced disease where possible.
• Diagnose and treat pain of pulpal origin.
• Perform uncomplicated non-surgical anterior and posterior endodontic therapy utilizing conventional and rotary techniques.
• Understand how to manage mild-moderate endodontic complications.
• Understand the principles of, and indications for, surgical endodontic therapy. Perform an apicoectomy, if possible.
• Replace missing teeth/structures with properly designed and fitted removable (CD/RPD/implant-retained) dentures. Communicate case design with laboratory technicians and evaluate the resultant prostheses.
• Evaluate patients for implants; prescribe what type of implant(s) should be placed, and in what location(s).
• Appropriately place endosseous implants using proper principles and techniques, including simple bone grafting.
• Design and place proper final restorations (abutments/crowns, attachments) on implants.
• Evaluate complexity of exodontia based upon clinical and radiographic (conventional / CT) data.
• Perform nonsurgical and surgical extraction of erupted, soft-tissue and bony-impacted teeth. Perform uncomplicated pre- prosthetic surgery (tori/exostosis removal, frenectomy, alveoloplasty, etc.). Manage complications related to intraoral surgical procedures (i.e., infection, bleeding, dry socket).
• Perform biopsies of oral tissues.
• Understand basic TMD disorders. Manage conservatively using orthotics (nightguards, repositioning stents, etc.), physical therapy and medications where appropriate. Provide referral when appropriate.
• Recognize and manage oral mucosal diseases (i.e. autoimmune conditions, cancer, mucositis, drug reactions). Use palliative care, biopsy, pharmacologic intervention, and/or refer as appropriate.
• Evaluate patients for occlusal disorders including malocclusion, attrition, erosion, rumination, occlusal interferences, etc. Provide appropriate intervention (treat vs. refer) as appropriate.
• Perform preoperative History and Physical examinations, write orders, and provide general dental treatment for adults in the OR setting, including appropriate perioperative activities and paperwork.
• Perform dental consultations and request medical consultations for hospitalized and other “complex/special needs” patients.
• Appropriately evaluate and triage incoming emergent needs.
• Manage uncomplicated toothaches, mild to moderate infections using appropriate drains and medications, avulsed/luxated/subluxated/fractured teeth, and lacerated intraoral and extraoral tissues.
• Understand the diagnosis and treatment of common maxillofacial osseous fractures.
• Understand and apply eruption and exfoliation sequences, management of the developing dentition, infant oral health guidelines.
• Appropriately modify pharmacologic agents (local anesthesia, fluoride, antibiotics, analgesics) for the pediatric patient.
• Provide age-appropriate treatment plans.
• Manage oral habits such as thumbsucking, bruxism, etc.
• Use pharmacologic (oral/N2O) and non-pharmacologic behavior-management skills with the pediatric patient.
• Provide quality interaction and information for the parents of pediatric patients.
  Restore intra / extra-coronal defects in the primary dentition (amalgam, composite, SSC’s).
• Perform pediatric pulpal therapy.
• Perform uncomplicated surgical procedures on pediatric patients.
• Diagnose, prescribe and fit limited orthodontic and/or space maintenance appliances.
• Provide dental care under general anesthesia for pediatric patients.
• Provide emergency treatment (toothache, infections, trauma) for pediatric patients.

Hospital/Medicine Rotations
The objective of the hospital/medicine rotation is to gain clinical experiences that allow a resident to become competent in the following competency statements:

• Witness how our medical colleagues approach the management of illness, including medications, surgery, and non-surgical therapies. Link our didactic training about medical conditions with real-life clinical presentations.
• Refine skills in obtaining an H&P.
• Learn about hospital protocols/procedures, including orders, notes and reports in the electronic medical record (EPIC).
• Gain advanced knowledge of cardiac anatomy, physiology, pathophysiology and medical/surgical therapeutics.
• Experience how patients are worked up, diagnosed, and treated in the outpatient clinical setting.
• Witness cardiac surgery to gain a better understanding of cardiac disease, surgical capabilities, operating room protocols, and perfusion therapy.
• Understand current trends of oral healthcare delivery as they apply at the community, state and national levels.
• Understand how cultural and social factors influence disease prevention, prevalence, and delivery of oral care.
• Participate in the dental care of underserved populations.
• Work with attendings to refine and enhance oral surgical skills.
• Evaluate the patient’s physical status, relate it to the planned surgical procedure, and help determine choice of anesthesia.
• Understand basic pharmacology, pharmacokinetics, and interaction of commonly used anesthetic and sedative medications as well as secondary medications utilized during general anesthesia (e.g., muscle relaxants, analgesics, etc.).
• Understand the basic principles of fluid and electrolyte balance.
• Manage routine / non-complex airways using bag-valve-mask, LMA, nasal and oral intubation techniques.
• Perform routine / non-complex venipuncture and insertion of intravenous catheters for the infusion of fluid.
• Participate in the management of patients during recovery from anesthesia.
• Demonstrate self-directed learning and accountability of assigned reading topics. Actively participate in discussion sessions with the Anesthesia Faculty on various topics of their choosing.