Dental Residency Program

The Tibor Rubin VAMC/VA Long Beach Healthcare System includes a tertiary care teaching center affiliated with the University of California, College of Medicine at Irvine and several community-based outpatient clinics. While a full range of medical services are available, the Tibor Rubin VAMC is nationally recognized for its comprehensive Cancer, Blind Rehabilitation, and Spinal Cord Injury Centers.

The population treated within the VA hospital setting has significant medical and dental needs. The Dental Service receives over 20,000 patient visits per year. Concomitantly, patients typically have an array of debilitating physical, psychological, and/or medical conditions that complicate their dental treatment. Residents in the Advanced Education in General Dentistry (AEGD) Program are highly trained in the management of these complex patients. The spectrum of dental care ranges from emergency procedures to comprehensive evaluation and treatment of eligible inpatients and outpatients, encompassing virtually all dentistry specialty areas excluding pediatric and orthodontic treatment. Special emphasis is placed on providing treatment to patients with dental conditions associated with or exacerbating significant medical problems, such as head and neck cancer, spinal cord injury, diabetes, cardiac valve dysfunction, joint replacement, and organ transplantation. The AEGD Program is the only advanced dental training program at the Tibor Rubin VAMC.

The Dental Service receives support from other services within the Medical Center, such as Radiology and Laboratory. Additionally, it provides broad consultative services to ENT, Radiation Therapy, Orthopedics, Psychiatry, Medicine, Spinal Cord Injury, Community Living Center, and Pulmonary Sleep Clinic. Emergency services are provided for dental trauma and oral infections.

The Dental Service is staffed by several full-time and part-time dentists (including full-time specialists in periodontics, maxillofacial prosthodontics, and oral and maxillofacial surgery), 4 AEGD residents, 3 full-time hygienists, approximately 1.5 assistants per dentist, and 1 laboratory technician.

The Advanced Education in General Dentistry program is a one-year program designed to provide clinical and didactic training in general dentistry at the post-doctoral level. Four resident positions are available. The program is accredited by the Commission on Dental Accreditation of the American Dental Association. A certificate is awarded to the resident upon successful completion of the program.

This residency will prepare the resident to deliver total oral health care in the private practice setting by providing instruction and experience involving ambulatory and hospitalized patients with a wide spectrum of medical conditions. In addition, it will enable the resident to develop a level of understanding of oral health as an integral and interactive part of total health. It will also offer the opportunity to work with other health care professionals within the hospital and broaden clinical exposure to conditions not commonly seen in the clinic of a dental school.

The program is very clinically oriented and residents spend the majority of the program providing dental treatment on an outpatient basis. Residents obtain significant experience in endodontics, surgical and non-surgical periodontal treatment, surgical placement and restoration of implants, oral and maxillofacial surgery, and complex prosthodontic treatment – both fixed and removable.

AEGD residents work in conjunction with dental assistants, hygienists, lab technicians, and administrative staff. There is no on-call schedule. Treatment planning sessions and literature review discussions occur weekly. Evaluations of resident performance occur tri-annually during the program year. This program is competency-based, wherein residents are required to demonstrate competency in selected procedures.

Act as a Primary Oral Health Care Provider

1. Effectively evaluate, plan, and provide emergency and multidisciplinary comprehensive oral health care
2. Obtain proper informed consent
3. Function effectively within interdisciplinary health care teams and request consultation or referral as needed
4. Coordinate and provide patient-focused care
5. Direct health promotion and disease prevention activities
6. Use advanced dental treatment modalities as defined by the program

Assess, Diagnose and Plan for the Provision of Multidisciplinary Oral Health Care for a Wide Variety of Patients Including Patients With Special Needs

1. Obtain patient medical history and perform medical risk assessment
2. Perform comprehensive head and neck evaluation in conjunction with appropriate radiographic and laboratory studies
3. Enhance knowledge and experience in diagnosis of oral and systemic diseases
4. Increase knowledge and experience in comprehensive multidisciplinary treatment planning
5. Learn to plan and sequence treatment in a manner that takes into account the various needs of the patient
6. Determine the appropriateness of patient referrals to dental specialists
7. Perform appropriate follow-up care after specialty treatment has been completed

Manage the Delivery of Patient-Focused Oral Health Care

1. Increase knowledge and understanding of a patient's physical, psychiatric, and medical conditions in order to aid provider to be more sensitive and adaptable to the special needs and desires of patient
2. Become familiar with alternative options for restorative, fixed and removable treatment
3. Be able to modify treatment delivery in consideration of the patient’s special needs
4. Be able to formulate, sequence, and execute a treatment plan based on a patient's special needs
5. Practice evidence-based dentistry

Operative Dentistry

1. Comprehensively examine, diagnose, and treatment plan varied and complex restorative needs
2. Improve understanding and clinical ability in the area of operative dentistry
3. Enhance knowledge and experience in indications, contraindications, and limitations of commonly used restorative materials
4. Improve understanding and experience in the techniques used to restore endodontically treated teeth

Replacement of Teeth Using Fixed and Removable Prosthodontics

1. Comprehensively examine, diagnose, and treatment plan the edentulous ridge using varied modalities, including fixed, removable, and/or implant prosthodontics
2. Determine when fixed versus removable appliances are indicated
3. Recognize and manage cases requiring a combination of fixed and removable prostheses
4. Improve understanding and experience using varied materials for either fixed or removable prostheses
5. Effectively design and deliver fixed and removable cases
6. Communicate and work effectively with the dental laboratory

Periodontal Therapy

1. Enhance knowledge and experience in the etiology, diagnosis, and treatment of periodontal disease
2. Enhance knowledge and experience in non-surgical and surgical periodontal techniques and procedures
3. Understand the rationale and use of topical and systemic antimicrobial agents
4. Assess when referral to a specialist is appropriate

Endodontic Therapy

1. Enhance knowledge and experience in the diagnosis and treatment of acute and chronic pathology of the pulp and periapical structures
2. Become familiar with different philosophies of instrumentation and obturation in the non-surgical treatment of single and multi-rooted teeth
3. Diagnose and treat endodontic emergencies and provide management of pain and anxiety
4. Understand the indications and techniques for surgical treatment
5. Assess when referral to a specialist is appropriate

Oral Surgery

1. Perform basic oral and maxillofacial surgical procedures including exodontia, pre prosthetic surgery, treatment of oral/facial trauma and infection, and biopsy
2. Diagnose and manage post-operative complications including pain, bleeding, dry socket, infection
3. Gain experience in the use of oral, inhalation, and intravenous sedation techniques
4. Diagnose and treat oral, facial, and temporomandibular joint pain and disorders
5. Enhance skills in medical risk assessment 6. Appropriately consult with medical physicians prior to surgical treatment

Evaluation and Treatment of Dental Emergencies

1. Assess and correlate the findings from medical/dental history and head/neck and dental examinations
2. Diagnose and treat typical and atypical facial pain
3. Diagnose and treat symptomatic pulpal and periapical pathology
4. Diagnose and treat acute gingival and periodontal pathology
5. Diagnose and treat acute and chronic lesions of the oral mucosa
6. Mange dental infections through the appropriate use of antibiotics and analgesics
7. Manage traumatic injuries to dental structures
8. Diagnose and treat routine or urgent complications of dental procedures -operative, fixed, and removable

Pain and Anxiety Control Using Behavioral and Pharmacological Techniques

1. Enhance patient management through the use of behavioral modalities, such as improved communication skills and psychological assessment
2. Perform preoperative risk assessment to determine appropriate methods of pain and anxiety control
3. Provide control of pain and anxiety through the use of pharmacological techniques beyond local anesthesia, such as oral, inhalation, and intravenous sedation and general anesthesia
4. Become familiar with pharmacological agents used in sedation, pain, and anxiety control
5. Understand the limitations for treatment and make appropriate referrals

Medical Emergencies

1. Assess patient through history, physical and appropriate laboratory tests
2. Recognize and manage common medical emergencies in the dental setting
3. Understand the pharmacology and use of therapeutic agents in the management of medical emergencies
4. Be proficient in Basic Life Support or Advanced Cardiac Life Support (optional)
5. Identify strategies to prevent medical emergencies

Implants

1. Enhance understanding of evaluation, diagnosis, and treatment planning in implant dentistry
2. Perform implant maintenance procedures; recognize and manage implant complications
3. Enhance experience in single-tooth and multiple-unit fixed implant restorations, implant overdentures, and implants involving removable partial dentures
4. Be familiar with surgical techniques, including hard and soft tissue grafting required to maximize implant success and enhance esthetic results
5. Understand the influence of medical conditions and medical contraindications on surgical implant placement

Oral Mucosal Diseases

1. Improve experience in evaluation and development of a differential diagnosis for hard and soft tissue lesions of the oral cavity
2. Obtain appropriate diagnostic studies
3. Correlate clinical features of disease with soft tissue and radiographic changes
4. Perform routine biopsies of oral lesions
5. Work in interdisciplinary and multidisciplinary health care teams to manage oral pathology

Temporomandibular Disorders and Orofacial Pain

1. Understand the epidemiology and etiology of temporomandibular disorders
2. Understand the basic anatomy and physiology of temporomandibular disorders
3. Evaluate and develop a differential diagnosis for orofacial pain and temporomandibular disorders
4. Conservatively manage orofacial pain and temporomandibular disorders
5. Understand the therapeutic rationale for fabrication of occlusal appliances

Occlusal Disorders

1. Understand the factors of occlusion
2. Understand the requirements for total masticatory system health and stability
3. Perform a thorough occlusal examination to properly diagnose an occlusal disorder
4. Correct an occlusal disorder with proper equilibration or restoration(s)

Orientation

At the beginning of the residency year, an orientation period will expose the resident to the administration and functions of the Medical Center and Dental Service. The following subjects are included in this period of instruction:

1. Tour and introduction of the medical center and other services and departments for general familiarization.
2. Overview of hospital organization, functioning, application for privileges, and election of benefits.
3. Standard procedures in the medical center related to resident responsibilities, patient care, and the use of computerized medical records and digital radiography.
4. General policies and procedures of the Dental Service, such as patient eligibility
5. Dental rotation assignments, procedures, records and policies.
6. Hospital Dentistry Course for medical risk assessment and dental management of the medically compromised patient.

Dental Rotations

Clinical experience is provided primarily during block rotations in which the patient case mix is designed to maximize exposure to a specific discipline, thereby concentrating and enhancing learning during this focused period of time. The use of rotations, however, does not preclude comprehensive multidisciplinary oral health care, as residents are expected to comprehensively address total oral health care needs.

1. Restorative Dentistry (6 months) In this rotation, the resident will focus on operative dentistry, fixed and removable prosthodontics. Experience will be gained in the use of various types of restorative techniques and dental materials, as well as the indications for their use in clinical practice. Restoration of osseointegrated implants will also be accomplished. Formulation of treatment plans and presentation of cases before staff will be required. This rotation will also include experience in the fabrication of special prostheses used in oral and maxillofacial surgery such as stents for pre-prosthodontic, orthognathic, and implant surgery.
2. Endodontics/Periodontics (3 months) In this rotation, the resident performs both endodontic and periodontal treatment, as well as restorative treatment on patients in need of dental clearance for various medical procedures. During the Endodontic portion of this rotation, residents perform diagnosis of endodontic emergencies and complete a variety of canal preparation and obturation techniques, including use of rotary instrumentation and warm vertical obturation. During the Periodontics Rotation, the resident will perform phase I and II periodontal procedures. The clinical content will include the diagnosis and prognosis of periodontal disease, treatment planning, instrumentation, and periodontal surgical procedures and techniques, including flap design, suture technique, and osseous surgery including pocket reduction and crown lengthening procedures. The resident will also complete examinations, formulate plans, and perform restorative treatment in order to clear patients for specific medical procedures.
3. Oral and Maxillofacial Surgery (3 months) Experience will include performing surgical procedures in the dental clinic. Practical experience in CBCT scan interpretation, IV sedation, and major and minor oral surgery procedures, including exodontia, surgical placement of implants, and the treatment of pathology of the oral cavity will be provided.

Medical Rotations

Each off-service rotation is one-week in length and takes place within the medical facility.

1. Internal Medicine Assignment to this rotation should develop the resident's capacity for recognition of symptoms of systemic diseases. Observing and assisting a staff physician in the work-up of patients will help correlate physical diagnosis, laboratory findings, and imaging and other studies with history and symptoms.
2. Same-Day Surgery This area of training will teach the resident to obtain, record, and interpret comprehensive medical histories and to observe and perform complete physical examinations on patients anticipating outpatient surgical procedures. The resident will also assist in the preoperative insertion of intravenous lines.

General Dentistry Literature Review

A general dentistry literature review will be held once weekly. Each resident will participate by reading and alternately presenting current and historical dental literature. This literature will cover a variety of medical and dental topics as determined by the program director.

Multidisciplinary Treatment Planning

Each resident will work-up and present cases to the program director and other attending staff on a weekly basis or as need dictates. This includes multi-unit fixed prosthodontic and complex restorative cases, as well as treatment plans for medically compromised patients with difficult or unusual medical and/or dental issues.

Clinical Dental Education Webinar Series

The dental resident is encouraged to attend webinars sponsored by The Office of Dentistry’s Dental Education Program and the Veterans Health Administration Employee Education System whenever relevant topics are presented.

• Graduation from a United States or Canadian dental school, which has been approved by the American Dental Association Council on Dental Education
• Participation in Postdoctoral Application Support Service (PASS)
• Personal interview upon invitation
• Interviews are offered on a rolling basis as applications are received. This program does not participate in the Dental Matching Program.
• United States citizens are given first consideration.
• The program complies with the Equal Employment Opportunity policy of the Department of Veterans Affairs which provides equal opportunity to all regardless of race, color, creed, national origin, ancestry, sex, marital status, disability, religious or political affiliation, age, or sexual orientation.

Please refer to this program’s ADEA PASS website.

Program Number: AEGD1509

Application materials will not be returned to the applicant.