Dental General Practice Residency Program

The Jennifer Moreno VA Medical Center, a part of the VA San Diego Health Care System, is an acute care medical and surgical hospital that offers a one-year Dental General Practice Residency Program following the Accreditation Standards established by the Commission on Dental Accreditation of the American Dental Association.

There are a total of four dental residents each year and the program is accredited by the ADA. The curriculum is designed to broaden the expertise of the general dentist in all the dental disciplines, manage medically compromised patients, and gain familiarity with hospital protocol and procedures, including the treatment of inpatient and same-day surgery patients.

Purpose of the Program

The purpose of this program is to provide the graduate dentist with the opportunity to advance his or her dental education and clinical experience to a level beyond that accomplished in pre-doctoral training. The program also provides the opportunity to experience general dentistry practice within the hospital environment, employing a greater level of physician-dentist interaction. Emphasis is upon dental treatment of the medically complex patient.

The major portion of the program is devoted to providing comprehensive dental care with an emphasis on diagnostic techniques and therapeutic skills. Emergency dental treatment is also provided. The program balance is subdivided into three internal blocks: 6 months of prosthodontic/restorative dentistry, 3 months of endodontic training, and 3 months of oral surgery training. During these rotations, the sole focus will be on that specific dentistry facet. Lectures, seminars, and clinic supervision are regularly provided by the medical center's attending staff. The program is under the direct supervision of the Director of the General Practice Residency Program.

Period of Training

The resident program begins on July 1 and continues for 52 weeks, with 14 days of paid annual leave and 10 paid federal holidays. The program emphasizes clinical training in endodontics, oral medicine, oral surgery, periodontics, prosthodontics, and restorative dentistry. In addition, there are off-service assignments in anesthesia, emergency medicine, and head & neck surgery.

Goals and Objectives for Service Rotations

Anesthesia (70 hours)

The resident will receive supervised practical experience in the following:

Preoperative evaluation
Assessment of the effects of behavioral and pharmacologic techniques
Venipuncture technique
Patient monitoring
Airway management
Understanding the use of pharmacologic agents
Recognition and treatment of anesthetic emergencies
Assessment of patient recovery from anesthesia

Emergency Medicine (70 hours)

The residents will be under the supervision of the attending physicians.

To promote the general dentist's awareness of their role in total patient healthcare.
To gain experience relating recognized signs/symptoms to a working diagnosis.
To understand how ED physicians obtain clinical information and how to interpret this information.
To understand the interpretation of laboratory data in the diagnosis and treatment.
To gain experience in performing a history and physical assessment.
To gain experience in treating medical emergencies.

Head and Neck Surgery (70 hours)

The residents will be under the supervision of the attending physicians.

Goals and objectives of this rotation are:
To gain a better understanding of head & neck anatomy.
To gain a better understanding of clinical and surgical protocol.
To gain knowledge in utilizing surgical pathology laboratory
To promote the general dentist's awareness of their role in identifying abnormal oral pathology and when to refer to ENT.
To gain experience in relating recognized signs/symptoms to a working diagnosis.
To understand how ENT physicians, obtain clinical information and how to interpret this information.
To understand the interpretation of laboratory data in the diagnosis and treatment.
To gain experience in performing a history and physical assessment.
To gain experience in biopsy procedures.

Didactic and/or Clinical Training

The didactic program comprises about 10% of the resident's time. The didactic program includes lectures, seminars, literature reviews, medical risk assessment, and case presentations; also, there is the opportunity to attend various local professional meetings.

The program will include:

Assignments in critical review of scientific literature
Involvement in quality improvement
BLS certification
Two Formal Research Presentations
3 Formal Treatment Planning Seminars

Specific Program Goals and Objectives

Upon completion of the program the resident will be able to act as a primary oral health care provider for:

Providing emergency and multidisciplinary comprehensive oral health care.
Obtaining informed consent.
Functioning effectively within interdisciplinary health care teams, including consultation and referral.
Providing patient-focused care that is coordinated by the general practitioner.
Directing health promotion and disease prevention activities.

Upon completion of the program, the resident will be able to assess, diagnose, and plan for the provision of multidisciplinary oral health care for a wide variety of patients with special needs. (Those patients whose medical, physical, psychological, cognitive, or social situations make it necessary to modify normal dental routines in order to provide dental treatment for that individual). These individuals include, but are not limited to, people with developmental disabilities, cognitive impairment, complex medical conditions, significant physical limitations, and/or other vulnerable populations.

Upon completion of the program, the resident will be able to manage the delivery of patient-focused oral health care relating to the patient's social, cultural, behavioral, economic, medical, and physical status.

Upon completion of the program the resident will be able to provide the following at an advanced level of skill and complexity beyond that accomplished in pre-doctoral training.

Operative Dentistry

Diagnosis and treatment plan: the need for restorations via oral exam, radiographic interpretation, and other diagnostic data.
Determine the appropriate restorative material and technique.
Perform comprehensive operative dentistry.
Diagnose and treat operative emergencies.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Restoration of the edentulous space

Diagnose and treatment plan the need for fixed and/or removable appliances.
Make and assess preparations for fixed and removable appliances.
Make and assess impressions for fixed and removable appliances.
Construct provisional/interim restorations.
Design, request and evaluate the fabrication of prosthetic work performed by lab technicians.
Evaluate and deliver the final prosthesis.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Periodontal Therapy

Diagnose, chart, classify, treatment plan, assess, and manage the treatment of periodontal disease.
Provide comprehensive periodontal care using chemical and non-surgical techniques.
Provide essential periodontal therapy and recognize the need for referral of complicated and advanced cases.
Manage surgical periodontics and advanced or complicated cases.
Assess and evaluate the prognosis and effectiveness of treatment.
Diagnose and treat periodontal emergencies.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Endodontic Therapy

Diagnose pulpal and periapical pathology and determine/treatment plan the need for endodontic therapy
Diagnose and provide initial treatment/referral of endodontic emergencies.
Recognize the need for consultation/referral of complicated or advanced cases.
Perform uncomplicated traditional or rotary endodontics.
Manage complicated or advanced endodontic cases.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Oral Surgery

Diagnose, treatment plan, and perform uncomplicated extractions and uncomplicated surgical extractions, including alveoloplasty.
Diagnose and treat/manage (based on complexity) the need for preprosthetic surgery.
Diagnose and treat/manage (based on complexity) the need for I & D of abscess.
Diagnose and treat/manage the need for biopsy (based on complexity).
Diagnose, treatment plan and manage the treatment of complicated or advanced surgical extractions.
Provide initial treatment and appropriate referral for oral surgery emergencies.
Recognize the need for consultation or referral.
Diagnose and treat/manage postoperative complications.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Evaluation and treatment of dental emergencies

Diagnose and provide treatment for uncomplicated dental emergencies.
Diagnose and provide initial treatment of complicated/advanced dental emergencies and then manage these emergencies through appropriate consultation and referral.
Recognize the need for consultation and/or referral of dental emergencies.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Pain and anxiety control utilizing behavioral and pharmacological techniques

Diagnose and evaluate the patient's level of pain and/or anxiety.
Treatment plan and provide control of pain and anxiety through local, behavioral, and pharmacological techniques.
Determine when to refer the patient for management of the appropriate level of pain and anxiety control.
Determine the ability of the patient to safely undergo the appropriate type of pain/anxiety control through appropriate medical risk assessment and/or consultation.
Anticipate, prevent, diagnose, and treat/manage complications and medical emergencies arising from pain and anxiety control.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Program Completion

Upon completion of the program, the resident will be able to manage (diagnose and treatment plan the need for care and coordinate the delivery of that care) the following:

Medical emergencies

Anticipate, prevent, diagnose, and manage potential medical emergencies through risk assessment.
Anticipate the impact of systemic disease on dental treatment and the effect of dental treatment on medical health.
Anticipate, diagnose, and provide initial treatment for medical emergencies, including BLS.
Manage medical emergencies after initial diagnosis and treatment have been performed.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Implants

Diagnose and treatment plan the need for evaluation of abnormal mucosa lesions and abnormal radiographic appearance.
Recognize the need for consultation/referral of lesions.
Diagnose and treatment plan the need for biopsy. Perform uncomplicated/simple biopsies and manage, complicated/difficult biopsies.
Diagnose and treat complications of oral mucosal disease treatment and biopsy.
Recognize the oral manifestation of systemic disease.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Oral mucosal diseases

Diagnose and treatment plan the need for evaluation of abnormal mucosa lesions and abnormal radiographic appearance.
Recognize the need for consultation/referral of lesions.
Diagnose and treatment plan the need for biopsy. Perform uncomplicated/simple biopsies and manage, complicated/difficult biopsies.
Diagnose and treat complications of oral mucosal disease treatment and biopsy.
Recognize the oral manifestation of systemic disease.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Temporomandibular disorder

Diagnose and manage temporomandibular disorder.
Diagnose and manage occlusal disorders.
Diagnose and provide minor occlusal adjustment.
Provide conservative therapy to include the construction of an occlusal appliance.
Recognize the need for consultation and referral for cases involving more than minor occlusal disorders, including complete mouth equilibration and orthodontic and orthognathic disorders.
Evaluate and assess the quality of care given by the provider to whom the referral was made.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.

Orofacial pain

Diagnose and manage orofacial pain.
Recognize the need for consultation and referral.
Evaluate and assess the quality of care given by the provider to whom the referral was made.
Demonstrate proficiency as evidenced by staff appraisals and self-appraisals.