Advanced Clinical Programs

BRANCH DENTAL CLINIC NORFOLK 

THE GOAL OF THE ACP (TRACK-1) PROGRAM IS TO ENHANCE EACH RESIDENT'S:

1. Competence and confidence in the various clinical disciplines that are integral components of general dentistry.
2. Ability to make judgments in diagnosis, disease control, treatment planning, and decision making during the course of treatment and assessing post-treatment outcomes.
3. Ability to interact with all health practitioners treating the patient by acting as the coordinator of the patient's total oral health care.
4. Understanding of the Navy Dental Corps' Dental Practice Model in staff, materials and program management to increase productivity and efficiency of quality of health care delivery.

OBJECTIVES OF TRAINING

Oral Pathology	Physical Evaluation & Oral Diagnosis & Treatment Planning
Orthodontics	Comprehensive Control of Pain & Anxiety in the Conscious Patient
Implants	Special Care Patients Including Medically Compromised
Geriatric Dentistry	Asepsis, Infection Control, Hazard Control
Periodontics	Restorative Dentistry (Operative Dentistry, Fixed & Removable Prosthodontics)
Endodontics	Oral & Maxillofacial Surgery
Pediatric Dentistry	Preventive Dentistry

Oral Pathology

Objectives of training:

• Be able to evaluate oral manifestations of systemic disease, to effectively utilize clinical and laboratory aids to diagnose, develop differential diagnoses of oral conditions, and develop treatment protocols for common oral lesions.
• Definitively diagnose oral conditions when histopathologic data are correlated with clinical findings.

Topics covered in formal instruction:

• Oral Lesions
• Oral Cancer/Biopsy
• Radiographic Interpretation

Physical Evaluation & Oral Diagnosis & Treatment Planning

Objectives of Training:

• Order and interpret the appropriate clinical and/or laboratory tests necessary for the accurate diagnosis of oral conditions.
• Properly request and evaluate consultations from other medical and dental services, as needed.
• Recognize the oral manifestations of systemic disease and understand their effects on the oral cavity.
• Devise a differential diagnosis for oral conditions using: clinical presentation, radiographic and laboratory findings, the historical record, physical examination data, and demographic information.
• Prescribe pharmacological agents properly and understand their mechanisms of action and the effects of drug interactions.

Topics covered in formal instruction:

• Medical History/Pregnancy - Physical Assessment
• Hepatitis/HIV - Endocrine Disorders
• Bleeding Disorders - Oral Cancer/Biopsy
• Cardiovascular Considerations
• Pulmonary Diseases - Anti-fungal drugs
• Xerostomia - Non-narcotic analgesics
• Antibiotics - Antimicrobial Prophylaxis
• Drug metabolism and Pharmacokinetics
• Anti-viral/Gastrointestinal
• Antianxiety/Muscle Relaxants

Preventive Dentistry

Objectives of training:

• Understand the various etiologic factors involved with caries.
• Understand the Specific Plaque Hypothesis and how to treat caries as a carbohydrate modified bacterial infection.
• Discuss and demonstrate the use of various preventive measures against caries : fluorides, Chlorhexadine, sealants, fluoride releasing restorative materials, diet modification, xylitol gum, etc.
• Understand, demonstrate and be able to utilize caries risk assessment in treatment planning patients.
  

Topics covered in formal instruction:

• Epidemiology of caries and periodontal disease
• Etiology, diagnostics, and preventive techniques
• Risk assessment model

Comprehensive Control of Pain and Anxiety in the Conscious Patient

Objectives of training:

• Understanding of etiology of and the contributing factors to dental anxiety
• Understand the use of nitrous oxide conscious sedation and proper monitoring equipment
• Develop an appropriate pharmacotherapeutic plan to support patients who require drug therapy
• Prescribe pharmacological agents properly and understand their mechanisms of action and the effects of drug interactions

Topics covered in formal instruction:

• Conscious Sedation
• Drug Metabolism / Pharmacokinetics
• Non-narcotic analgesics
• Anti-anxiety medications
• Stress physiology and behavioral therapy
• Pharmacology (Orofacial Pain / TMD lectures)

Implants

Objectives of training:

• Understand the indications and contra-indications for osseointegrated attachment is prosthodontic or periodontal reconstruction.
• Be familiar with implant systems.
• Understand the principles of osseointegrated and the associated bone biology.
• Evaluate, maintain and trouble-shoot osseointegrated attachments after placement.

Topics covered in formal instruction:

• Overview of Implantology (osseointegration , periimplantitis, site evaluation &modification, clinical evaluation & trouble shooting, maintenance)
• Command policy pertaining to implants.
• Implant systems.
• Introduction to implant parts.

  Geriatric Dentistry

Objectives

• Understand gerontology, the demographics of the aging population, andimplications for the dental profession.
• Understand the physical and psychological changes that occur with aging and the impact on oral disease and treatment.
• Demonstrate pragmatic treatment planning for older patients, taking into account special needs and considerations involved in treating and maintaining the geriatric patient.
• Utilize materials and techniques of primary importance in treating the elderly.

Special Care Patients Including Medically Compromised

Objectives of training:

• Apply an understanding of the physiology, pathophysiology, and the principles of medical/pharmacological management of diseases of the endocrine, neurological, musculoskeletal, hematopoietic, cardiovascular, urogenital, respiratory and gastrointestinal systems to develop a treatment plan reflecting appropriate modification of dental therapy.

Topics covered in formal instruction:

• Pregnancy - Endocrine Disorders
• Bleeding Disorders - Oral Cancer
• Cardiovascular Disease - Pulmonary Disease
• Gastrointestinal Medications
• Differential Diagnosis of Head and Neck Pain
• Differential Diagnosis/treatment of the Medically Compromised Patient

Asepsis, Infection Control, Hazard Control

Objectives of Training:

• Understand and implement the OSHA Bloodborne Pathogen Standards and all related Navy and Naval Dental Center instructions.
• Demonstrate proper asepsis infection control and hazard control at all times in clinical and laboratory practice and supervise technicians in their adherence to instructions.

Endodontics

Objectives of training:

• Differentially diagnose the status of both pulpal and periradicular tissues associated with any tooth in the mouth.
• Employ proper endodontic therapeutic principles, treat dental emergencies of endodontic origin.
• Discuss the indications and contraindications for providing nonsurgical rndodontic treatment.
• Discuss the various methods and materials available for nonsurgical endodontic therapy.
• Treat with nonsurgical endodontic therapy, any tooth in the dentition emphasizing proficiency with the first molar forward.
• Retreat with nonsurgical endodontic therapy, any tooth in the dentition.
• Know the indications and contraindications for surgical endodontic therapy.
• Perform uncomplicated anterior surgical endodontic therapy.
• Discuss the etiology and pathogenesis of pulpal and periradicular pathoses.
• Discuss the principles of and reasons for endodontic treatment success.
• Provide reasoned and competent endodontic maintenance therapy for any tooth in the dentition.

Oral and Maxillofacial Surgery

Objectives of Training:

• Interview patients to obtain a complete and accurate health history.
• Demonstrate the techniques of head and neck examination as employed by the oral surgeon.
• Understand possible preoperative complications to surgery.
• Demonstrate the techniques of exodontia for all but the most complicated bony impacted teeth.
• Demonstrate an understanding of incisional and excisional biopsy techniques.
• Demonstrate an understanding of the management of patients with oral and perioral infections.
• Understand the management of head and neck trauma patients.
• Maintain a "chain of sterility" when performing surgery in the surgically prepared operatory.
• Monitor respiration and circulation, and properly manage a patient's airway during surgical, sedation and relative analgesia procedures.
• Perform reuscitative techniques and demonstrate proficiency in the management of medical emergencies in the dental office setting

Restorative Dentistry (Operative Dentistry, Fixed and Removal Prosthodontics)

Objectives of Training:

• Develop and implement phased treatment plans that integrate all disciplines of dentistry, ensuring coordinated, total patient care.
• Perform clinically successful operative dentistry procedures when restoring the carious, developmentally or environmentally defective, or the traumatically injured dentition.
• Integrate operative dentistry procedures into a comprehensive treatment plan with full consideration of caries risk assessment, appropriate caries control restorations, dietary assessment and design of final restorations to promote
  preservation of tooth structure, esthetics, occlusal stability and maintenance/ establishment of periodontal health.
• Evaluate tooth preparations and completed restorations from the standpoint of continual improvement of clinical technique.
• Evaluate and utilize new and established dental materials in order to determine appropriate clinical indications and their manipulation in various clinical situations.
• Establish a sound rationale for the indications and clinical manipulation of all operative dentistry materials used in your practice.
• Differentiate clinical situations in which fixed or removable prostheses are indicated.
• Perform prosthodontic therapy with full consideration of preventive dentistry principles.
• Appraise mouth preparations and completed prostheses from the standpoint of improving clinical technique.
• Perform minor reconstruction employing fixed and/or removable prostheses, using a semi-adjustable articulator.
• Construct complete denture(s) and overdenture(s).
• Use the art and science of color and illusion to enhance the visual effect of prosthodontic restorations.
• Evaluate complete laboratory work as a basis for improving personal skills and for improving communications skills with the laboratory technician.

Pediatric Dentistry

Objectives of Training:

• Understand the physiology and patterns of crtaniofacial growth and development.
• Diagnose and plan treatment for pediatric dental patients.
• Discuss all current behavioral management techniques and demonstrate appropriate use of the non-pharmacological techniques.
• Understand informed consent issues related to management of uncooperative behavior.
• Demonstrate skill in pediatric restorative dentistry including amalgams, composites and stainless steel crowns.
• Diagnose the need for and demonstrate use of pulp therapy for the primary and young permanent dentition.
• Diagnose the need for and construct and deliver fixed space maintainers.

Orthodontics

Objectives of Training:

• Identify developing malocclusions and know when to refer.
• Discuss the basic principles of orthodontic tooth movement and post-therapy orthodontic retention.
• Employ selected minor orthodontic procedures such as extrusion uprighting and crossbite correction to enhance restoration of the dention.

Questions about the ACP at Branch Dental Clinic Norfolk may be directed to:

The Program Co-Directors are CAPT George Woronko and CAPT Michael Lewis, graduates of the Navy Post-Graduate Dental School Comprehensive Dentistry Residency Program in Bethesda, MD.  They are members of the American Dental Association, Academy of General Dentistry and are board certified by the Federal Services Board of General Dentistry. They can be reached by phone at Com. 757-314-6561 or DSN 564-7011, Ext 46561 or by email at mtlewis@mar.med.navy.mil or gaworonko@mar.med.navy.mil.  

BRANCH DENTAL CLINIC SAN DIEGO

The Advanced Clinical Program (ACP) in General Dentistry located at Naval Station San Diego, CA provides an extensive post-doctoral clinical and didactic education for dental officers that desire additional training. Officers who choose ACP training are usually mid-grade officers that either are undecided on another specialty field and will use this year to "feel out" other specialty interest, or individuals that want to expand their scope of patient care but do not desire to go through the 2-year comprehensive program at the Naval Post Graduate School in Bethesda, Maryland. The Exodontia program are for those who desire to limit their treatment of patients to oral surgery without going to a four-year oral surgery program, or as a stepping off point for those that are contemplating applying for oral surgery training in the future.

The ACP Program in General Dentistry is 80% clinical and 20% didactic instruction with emphasis on a broad range of clinical exposure in all areas of general dentistry as outlined below. The focus of the one-year program is providing comprehensive multi-disciplinary care to patients. The didactic program is composed of seminars, lectures, and participation in the Nitrous Oxide Short Course. Learning is also augmented by literature abstracts for seminars, numerous presentations to staff and other residents, an Operative Short Course presentation and a table clinic. There are ongoing rotations in all specialties and the program has a superb staff including mostly board certified mentors. Currently we have 4 comprehensive dentists, one operative dentist, three endodontists, three oral and maxillofacial surgeons, four periodontists, four prosthodontists, one orthodontist, two oral medicine dentists and one orofacial pain specialist.

At the conclusion of the program, residents are awarded a certificate in recognition of the successful completion of an ADA accredited residency. In addition, residents who are members of the Academy of General Dentistry are eligible for 250 hours of CE credit towards achieving fellowship status. Residents accepted for ACP training are given one-year orders for the program and can usually expect an operation assignment as a follow-on tour. Also, starting in 2004, there is a two calendar year minimum Active Duty obligation (ADO) that applies to the one year Advanced Clinical Programs.

CDR Paul G. O'Loughlin, DC, USN
Director, ACP/AEGD Program
Branch Dental Clinic
Naval Station
2310 Craven Street
San Diego, CA 92136-5596
(619) 556-8229 DSN 526-8229
Fax: (619) 556-8289
email - POloughlin@nmcsd.med.navy.mil

OBJECTIVES OF THE ONE-YEAR
ADVANCED CLINICAL PROGRAM IN
GENERAL DENTISTRY

INTRODUCTION:   These objectives cover the full-range of general dentistry.   The level of experience, competency and interest among general dentists is quite varied.  Therefore, it is doubtful that any resident will achieve all of these objectives.  However, this is in keeping with the goals of these programs as stated in the Standards for Advanced Education Programs in General Dentistry of the Commission on Dental Accreditation of the American Dental Association:  "The program must expand the scope and depth of the dentists' knowledge and skills in order to enable the general practitioner to provide comprehensive patient care to a wide range of population groups." More simply put, it is not necessary that all residents achieve all objectives but that they are challenged to expand and increase their knowledge and skills.

PROGRAM OBJECTIVES

Upon the completion of this program, each resident will be able to:

1. Devise an effective comprehensive treatment plan, based on sound criteria, for all patients encountered.
2. Manage more sophisticated clinical situations in each of the dental specialties.
3. Appreciate their clinical strengths and limitations and know when and how to consult with and refer patients to individuals for more specialized care.
4. Provide effective guidance for the less experienced dental practitioner in diagnosis, treatment planning and clinical care delivery for general dentistry patients.

OVERALL PROGRAM GOALS

  The goals of this program are to enhance each resident's:

1. Competence and confidence in the clinical disciplines that are integral components of general dentistry.
2. Ability to make judgments in diagnosis, disease control, treatment planning, and decision making during the course of treatment and assessing post-treatment outcomes.
3. Ability to interact with all health practitioners treating the patient by acting as the coordinator of the patients' total oral health care.
4. Understanding the Navy Dental Corps' Dental Practice Model in staff, materials and program management and provide experience in patient and practice management to increase productivity and efficiency of quality health care delivery.
5. Attitude toward learning and to encourage the ongoing pursuit of self-motivated professional knowledge.
6. Ability to share his/her professional knowledge and expertise through formal and informal teaching.

Goals will be achieved by the following methods:

1. By didactic instruction and by supervised, repetitive clinical exposure.
2. Formal and informal diagnosis and treatment planning seminars, and guided clinical treatment planning presentations.
3. By residents treating a significant number of comprehensive care patients performing all dental treatment and initiating all medical/dental consultation referrals.
4. Each resident to have supervisory responsibility to manage his/her own appointment schedule, order and maintain supplies and equipment, and instruct and manage his/her assistant's conduct in the operatory.  A formal course in dental administration is also offered.
5. By conducting, with faculty advice, literature reviews, seminars, table clinics and clinical case selection.  Guest lecturers and attendance at national meeting reinforce this self-directed atmosphere.
6. Achieved by scheduling resident presentations, through didactic instruction in scientific communication, by required delivery of a table clinic or other presentation at state and local meetings and by scheduling resident lectures during postgraduate short courses.

ONE-YEAR ADVANCED CLINICAL PROGRAM
IN GENERAL DENTISTRY CURRICULUM

The program consists of a 12-month comprehensive clinical and didactic curriculum. Formal presentation instruction, seminars, literature reviews, demonstrations, and first-hand clinical experience are provided in the following disciplines:

• Endodontics
• Oral Diagnosis / Oral Medicine
• Oral Surgery
• Orthodontics
• Pediatric Dentistry
• Periodontics
• Prosthodontics (Fixed And Removable)
• Operative (Restorative) Dentistry
• Temporomandibular Disorders/Orofacial Pain 

Additional instruction is provided in the following areas:

• Dental Administration
• Dental Materials
• Dental Pharmacology
• Implantology
• Dental Radiography
• Occlusion
• Oral Pathology
• Physical Diagnosis
  Preventive Dentistry/Cariology
• Communication Skills
• Treatment Planning

The program was fully re-accredited by the Council on Dental Education of the American Dental Association in 1999. This accreditation is good for seven years with the next site visit scheduled in 2006.