Are Polish and Swedish dental graduates adequately prepared for dental practice in the UK? A discussion of the transferability of general dental practitioners in Europe

In the context of European Union harmonization, this article compares the systems of training for general dental practice in three European countries, the UK, Sweden and Poland. A UK perspective is adopted and the question as to whether dentists who have qualified in Poland or Sweden are adequately prepared for practice in the UK is explored. The paper is a result of discussion between providers of dental training in the three study countries. Key similarities, strengths and weaknesses are identified and issues pertinent to the transferability of general dental practitioners within Europe are raised.     

Is there a need for a common framework of dental specialties in Europe?

This paper aims to promote discussion about dental specialties and post-graduate dental education in the European Union (EU). Previously, dental educators have concentrated their efforts of seeking Pan–EU convergence in undergraduate dental education. However, the impact of the enlargement of the EU, the new European Commission (EC) Directive of professional training and the Bologna Process all impact on post-graduate (specialist) just as much as on undergraduate dental education. The provisions of the new EC directive mean that, unlike new medical specialties, new Pan–EU dental specialties cannot be created purely because they exist in two-fifths of EU Member States. At present, some EU Member States recognise eight or more dental specialties, whereas others recognise none. It is suggested that changing needs and demands of patients, which reflect a general improvement in oral health, increased wealth and an aging population will place increasing demands on dentistry to provide more complex care and treatment and that the current undergraduate curriculum cannot be expanded to provide suitable training to meet these needs and demands. There is thus a need to expand dental specialist training in all EU Member States, to agree common standards for specialist education and to officially recognise a wider range of Pan–EU dental specialties. The paper concludes that in order to achieve these goals, there is a need of a better collaboration between competent authorities, including governments, universities, dental associations and the various Pan–European Scientific Specialist Organizations.     

Periodontology as a recognized dental speciality in Europe

The impetus of the Bologna Process under the auspices of European Union governments has raised enormous expectations. It is the major educational change in Europe within the last 50 years and all the focus from university institutions, learned societies and thematic networks has shifted to this process, with the aim of developing consensus schemes in order to arrive at the expected European Convergence in Higher Education (to be completed by 2010). Dentistry as one of the health professions with clear Educational Standards, as defined by the European Dental Directives, is also reviewing its educational processes within this Bachelor-Master-Doctorate scheme and evaluating how the current and future dental specialities should be accommodated within this framework. Among these specialities, Periodontology is currently considered a formal dental speciality in 11 countries belonging to the EU however it lacks this legal status in the rest of the 14 EU countries. The purpose of this position paper is to provide evidence for the need for a recognized specialty in Periodontology at European level focusing on both the educational and professional perspective, with the hope of providing discussions that may contribute to facilitate its legal establishment as a new dental speciality in Europe.     

Developing Research in Graduate Programmes

The Berlin Communiqué (2003) on The Bologna Process mentions the importance of research as an integral part of Higher Education across Europe and calls for the inclusion of doctoral level qualifications as the Third Cycle (after the Bachelor-Master system). It is expected that incorporation of the PhD-training programme will reinforce the link between the European Research Area and the European Higher Education Area. To facilitate this process it is important to define common standards and to remove legal and other obstacles that might prohibit co-operation among EU countries.
Not all dental faculties in Europe are using a similar format for attaining the doctoral level. The varying format highlights the differences rather than the similarities among members of the EU. Based on the outcome of a trans-continental questionnaire, an attempt was made to outline the contours of a common PhD programme for dentistry that might serve as a template for European compliance.     

Scandinavian Fellowship for Oral Pathology and Oral Medicine: statement on oral pathology and oral medicine in the European Dental Curriculum

J Oral Pathol Med (2010) 39 : 800–e1 Background: For many years, dentists have migrated between the Scandinavian countries without an intentionally harmonized dental education. The free movement of the workforce in the European Union has clarified that a certain degree of standardization or harmonization of the European higher education acts, including the dental education, is required. As a result of the Bologna process, the Association for Dental Education in Europe and the thematic network DentEd have generated guidelines in the document ‘Profile and Competences for the European Dentist’ (PCD). This document is meant to act as the leading source in revisions of dental curricula throughout Europe converging towards a European Dental Curriculum. In order to render the best conditions for future curriculum revisions providing the best quality dentist we feel obliged to analyse and comment the outlines of oral pathology and oral medicine in the PCD. Methods: The representatives agreed upon definitions of oral pathology and oral medicine, and competences in oral pathology and oral medicine that a contemporary European dentist should master. The competences directly related to oral pathology and oral medicine were identified, within the PCD. Results: The subject representatives suggested eighteen additions and two rewordings of the PCD, which all were substantiated by thorough argumentation. Perspectives: Hopefully, this contribution will find support in future revisions of the PCD in order to secure the best quality dental education.     

Education for specialization in prosthodontics in Switzerland and the role of EPA

Advertisement for any dental treatment was rare in Switzerland. Then the use of digital media became popular, particularly in the field of implant- and esthetic-dentistry. In parallel to the dental schools of public universities, private universities and companies built up centers for continuing education that issue specialists diplomas and M.Sc. degrees.Prosthodontics itself is characterized by many sub-disciplines that incorporated their own associations. These also offer graduate training curricula which diminish the significance of specialization in prosthodontics.Specialized prosthodontists do not have a financial benefit in Switzerland where dentistry is not supported by any insurance. In other European countries funding of prosthodontic treatment depends on their healthcare systems.There are four specialties in Dentistry recognized by the European Union (EU). Specialization in prosthodontics was introduced in Sweden already in 1982 and today it is declared in about 20 European countries, while for others no recognized program exists. Thus there are great variations with more recognized specialists in former east European countries. In Switzerland the prosthodontic specialization curriculum was developed and guided by the Swiss Society for Reconstructive Dentistry, and only in 2001 it became fully acknowledged by the Federal Department of Health. The four Swiss Universities offer the 3-year program under the supervision of the society, while the government remains the executive body.In 2003 EPA tried to set up guidelines and quality standards for an EPA recognized specialization. In spite of these attempts and the Bologna Reform in Europe, it appears that the quality standards and the level of education still may differ significantly among European countries.     

Profile and competences for the European dentist

This paper presents the profile and competences for the European Dentist as approved by the General Assembly of the Association for Dental Education in Europe at its annual meeting held in Cardiff in September 2004. A task-force drafted the document, which was then sent to all European Dental Schools. Reactions received were used to amend the document. European dental schools are expected to adhere to the profile and the 17 major competences but the supporting competences may vary in detail between schools. The document will be reviewed in 5 years time. This paper will be disseminated to ministries of health, national dental associations and dental specialty associations or societies in Europe and these organisations will be asked to offer their comments. This information will be used in the reviewing process to be started in 2007. It is hoped that the availability of this document will assist dental schools in Europe to further harmonize and improve the quality of their curricula.     

Disparity in dental attendance among older adult populations: a comparative analysis across selected European countries and the USA

Background: The current study addresses the extent to which diversity in dental attendance across population subgroups exists within and between the USA and selected European countries. Method: The analyses relied on 2006/2007 data from the Survey of Health, Ageing and Retirement in Europe (SHARE) and 2004–2006 data from the Health and Retirement Study (HRS) in the USA for respondents ≥ 51 years of age. Logistic regression models were estimated to identify impacts of dental-care coverage, and of oral and general health status, on dental-care use. Results: We were unable to discern significant differences in dental attendance across population subgroups in countries with and without social health insurance, between the USA and European countries, and between European countries classified according to social welfare regime. Patterns of diverse dental use were found, but they did not appear predominately in countries classified according to welfare state regime or according to the presence or absence of social health insurance. Conclusions: The findings of this study suggest that income and education have a stronger, and more persistent, correlation with dental use than the correlation between dental insurance and dental use across European countries. We conclude that: (i) higher overall rates of coverage in most European countries, compared with relatively lower rates in the USA, contribute to this finding; and that (ii) policies targeted to improving the income of older persons and their awareness of the importance of oral health care in both Europe and the USA can contribute to improving the use of dental services.Key words: Dental attendance, dental insurance coverage, older populations, USA, Europe     

Dental hygienists in Europe: trends towards harmonization of education and practice since 2003

Abstract: Aim: The aim of this study was to investigate the trends in dental hygienists’ education and regulation in the European Union (EU) and European Economic Area (EEA) to examine whether, since 2003, there has been harmonization in dental hygiene education. Methods: Information and data were obtained via piloted questionnaires and structured interviews with delegates from the International and European Dental Hygienists’ Federations and representatives of the Council of European Chief Dental Officers and by literature review. Results: In the EU/EEA, dental hygienists are legally recognized in 22 countries. Since 2003, there has been an increase in the number of Bachelor degree programmes and in autonomous practice. Entry to the profession is now exclusively via a Bachelor degree in five EU/EEA Member States and pending in two more. Ten Member States have adapted their degree programmes to the European Credit Transfer System. Two Member States combine education for dental hygienists and dental therapists. However, dental hygienists are not recognized by EU law and in five Members States, the introduction of the profession has been opposed by dental associations. Conclusions: For the reasons of wide variations in the standards of preventive care and periodontal therapies, the formal recognition of the dental hygiene profession by EU legislation and agreement on a pan‐European curriculum for dental hygiene education leading to defined professional competencies and learning outcomes is required. To achieve this, there is a need for a better collaboration between competent authorities including governments, universities and dental and dental hygienists’ associations.     

Computer literacy and attitudes among students in 16 European dental schools: current aspects, regional differences and future trends

A questionnaire survey was carried out to investigate the competence and attitude of dental students towards computers. The current study presents the findings deriving from 590 questionnaires collected from 16 European dental schools from 9 countries between October 1998 and October 1999. The results suggest that 60% of students use computers for their education, while 72% have access to the Internet. The overall figures, however, disguise major differences between the various universities. Students in Northern and Western Europe seem to rely mostly on university facilities to access the Internet. The same however, is not true for students in Greece and Spain, who appear to depend on home computers. Less than half the students have been exposed to some form of computer literacy education in their universities, with the great majority acquiring their competence in other ways. The Information and Communication Technology (ICT) skills of the average dental student, within this limited sample of dental schools, do not facilitate full use of new media available. In addition, if the observed regional differences are valid, there may be an educational and political problem that could intensify inequalities among professionals in the future. To minimize this potential problem, closer cooperation between academic institutions, with sharing of resources and expertise, is recommended.     

Towards higher standards in dental and stomatological education in Europe

In the creation of the European Union, attention was given to portability of licensure for professionals. Considerable differences exist among countries in culture, economic conditions, and educational resources and practices. In dentistry, these differences in professional training have been addressed through a peer consultative process rather than through political and legal means. The process of visits to dental schools throughout Europe and the organizational structure (DentEd) used to conduct the visits and summarize findings are described.     

Profile and competences for the graduating European dentist – update 2009

This paper presents the profile and competences for the European Dentist as approved by the General Assembly of the Association for Dental Education in Europe at its annual meeting held in Helsinki in August 2009. A new taskforce was convened to update the previous document published in 2005. The updated document was then sent to all European Dental Schools, ministries of health, national dental associations and dental specialty associations or societies in Europe. The feedback received was used to improve the document. European dental schools are expected to adhere to the profile and the 17 major competences but the supporting competences may vary in detail between schools. The document will be reviewed once again in 5 years time. Feedback to the newly published document is welcomed and all dental educators are encouraged to draw upon the content of the paper to assist them in harmonising the curriculum throughout Europe with the aim of improving the quality of the dental curriculum.     

Quality assurance and benchmarking: an approach for European dental schools

This document was written by Task Force 3 of DentEd III, which is a European Union funded Thematic Network working under the auspices of the Association for Dental Education in Europe (ADEE). It provides a guide to assist in the harmonisation of Dental Education Quality Assurance (QA) systems across the European Higher Education Area (EHEA). There is reference to the work, thus far, of DentEd, DentEd Evolves, DentEd III and the ADEE as they strive to assist the convergence of standards in dental education; obviously QA and benchmarking has an important part to play in the European HE response to the Bologna Process. Definitions of Quality, Quality Assurance, Quality Management and Quality Improvement are given and put into the context of dental education. The possible process and framework for Quality Assurance are outlined and some basic guidelines/recommendations suggested. It is recognised that Quality Assurance in Dental Schools has to co-exist as part of established Quality Assurance systems within faculties and universities, and that Schools also may have to comply with existing local or national systems. Perhaps of greatest importance are the 14 'requirements' for the Quality Assurance of Dental Education in Europe. These, together with the document and its appendices, were unanimously supported by the ADEE at its General Assembly in 2006. As there must be more than one road to achieve a convergence or harmonisation standard, a number of appendices are made available on the ADEE website. These provide a series of 'toolkits' from which schools can 'pick and choose' to assist them in developing QA systems appropriate to their own environment. Validated contributions and examples continue to be most welcome from all members of the European dental community for inclusion at this website. It is realised that not all schools will be able to achieve all of these requirements immediately, by definition, successful harmonisation is a process that will take time. At the end of the DentEd III project, ADEE will continue to support the progress of all schools in Europe towards these aims.     

Workforce requirements for a primary oral health care system

AIM: To present the case for a primary health care (PHC) approach for dental care in Vietnam, and thereby contribute to a better understanding of the oral health problems that exist in many developing countries. METHODS: Information was obtained in Vietnam through discussions with dental and medical authorities of provincial health offices, educational institutions, hospitals, health centres and schools and by collecting data from record books and reports. FINDINGS: Dentistry lacks a PHC strategy and consequently urgent oral care and oral disease prevention and control are not available for the majority of the population in Vietnam. The curriculum of dental students and dental auxiliaries is not adequately directed to the oral health needs of the population. The present number of dental personnel is too low. CONCLUSION: A basic oral health care package (BOHCP) advocated by the WHO which could be incorporated into primary health services at sub-district level and in the school dental service would be most suitable to meet the oral health needs of the population in Vietnam. The oral health education component of the BOHCP may have more impact when it is conducted in close collaboration with non-dental health personnel and lay persons. The curriculum of dental personnel should be adjusted to meet the requirements of their future tasks. Dental auxiliaries, provided they are well trained can carry out the BOHCP. Consequently, there is a large need for this type of dental personnel in Vietnam.     

Basic science teaching in dentistry in Central/Eastern Europe. Towards harmonisation?

The present study was carried out to examine basic science teaching in dentistry in Central/Eastern Europe, and compare the situation with the EU. In order to collect the necessary data, a questionnaire has been sent to 25 dental schools of the region and 14 schools from 8 countries responded. According to the data obtained, the number of hours devoted to basic sciences and medical clinical sciences together are 2206 in Central/Eastern Europe, and 1416 in the EU. In the case of dental clinical subjects, the difference in the number of hours is just the opposite, much higher in the EU. Thus, for the Central-European region there are two real alternative ways of convergence to western Europe. One option is to decrease the level of basic science and medical science teaching and use the free capacity to increase the weight of dental clinical subjects in the curriculum. The other option is to leave the subjects that are at high levels as they are, and increase significantly the number of hours of the whole curriculum. It seems important to promote the convergence between Central/Eastern Europe and the EU. The EU has to define the trends of the next few decades and the Central/Eastern European countries should converge in this direction.     

The effects of gender disparities on dental hygiene education and practice in Europe

Abstract: In Europe, over 96.5% of dental hygienists are women. The objective of this report was to examine the impact of gender role stereotyping on the image of the dental hygiene profession and on disparities in educational attainment and work regulations within Europe. Data pertaining to regulated or non-regulated dental hygiene practice in 22 European countries were analysed according to possible gender impact on access to education and on the structure of the delivery of care. It was examined whether there is a correlation between national differences found in the dental hygiene profession and gender related disparities found in other work-related areas. Results show that the gender bias in the dental hygiene profession has an effect on equal access to education, and on equal occupational opportunities for dental hygienists within the European Union (EU) and beyond. In northern Europe, higher educational attainment in the field of dental hygiene, more extensive professional responsibilities and greater opportunities for self-employment in autonomous practice tend to correlate with greater equality in the work force. In eastern Europe, lower educational and professional opportunities in dental hygiene correlate with greater gender disparities found in other work-related areas. In some western European countries, the profession has not been implemented because of the political impact of organised dentistry, which expects financial loss from autonomous dental hygiene practice. In order to fulfil mandates of the EU, initiatives must be taken to remove the gender bias in the delivery of preventive care and to promote equal access to educational attainment and to professional development in the whole of Europe for those who choose to do so.     

Caries in the preschool child international trends

Most studies on the prevalence and incidence of dental caries are carried out on schoolchildren and data on preschool children are comparably few. In most of the developing countries in South East Asia, children have a high prevalence of dental caries in the primary dentition, often in contrast to the situation in the permanent dentition. The reasons for this difference are not obvious, but may be linked to differences in diet. In Africa, dental caries prevalence in the preschool child seems to be increasing somewhat in countries or parts of countries where there is an increase in sugar intake, while it stays low in countries where a poor economy restricts sugar intake. The prevalence does not seem to be as high as in South East Asia. In most industrialized countries in northern Europe, in North America, in Australia and New Zealand, dental caries is decreasing, often linked to an increasing use of fluorides, to various types of dental health education programmes, etc. In many European countries, the prevalence in preschool children is, however, still high and caries in primary teeth is often left untreated. In Scandinavia, where all preschool children are included in an organized dental care programme, dental caries has been decreasing markedly during the 1970s and at the beginning of the 1980s. While the mean values for d.m.f.t. at present appear to be largely unchanged, there seems to be a change in the distribution of the disease. More and more children are totally free of the disease, while the group with high d.m.f. values has a tendency to increase.     

Progress and challenges in the harmonisation of European undergraduate dental education: A systematic literature review with narrative synthesis

Introduction

Harmonising education to support workforce mobility has been a policy objective for the European Union. However, alignment across varied national contexts presents challenges in dental education.

Methods

A systematic literature review with narrative synthesis. Searches of the electronic databases Embase [Ovid]; MEDLINE [Ovid]; Scopus; CINAHL; AMED and PsycINFO were conducted for relevant material published between 2000 and 2019 on undergraduate curricula, quality standards and learning outcomes in dentistry.

Results

Seventy-six papers met the inclusion criteria. Fifty-three papers were commentaries or editorials, twenty-one were research studies, and two were literature reviews on specific dental subfields. Eighteen of the research studies reported surveys. The literature contains extensive proposals for undergraduate curricula or learning outcomes, either broadly or for subfields of dentistry. Included papers demonstrated the importance of EU policy and educator-led initiatives as drivers for harmonisation. There is limited evidence on the extent to which proposed pan-European curricula or learning outcomes have been implemented. The nature and extent of dental students' clinical experience with patients is an area of variance across European Union member states. Arrangements for the quality assurance of dental education differ between countries.

Discussion

Harmonisation of European dental education has engaged educators, as seen in the publication of proposed curricula and learning outcomes. However, differences remain in key areas such as clinical experience with patients, which has serious implications if graduate dentists migrate to countries where different expectations exist. Mutual recognition of professional qualifications between countries relies on education which meets certain standards, but institutional autonomy makes drawing national comparisons problematic.     

Exploring changes in dental workforce,dental care utilisation and dental caries levels in Europe, 1990–2004

Objectives : To provide a conceptual framework of the relationships between dental health and dental care utilisation with socio‐economic factors, human resources and the finance and organisation of dental healthcare systems in European countries from 1990 to 2004. Methods : Bivariate relations and longitudinal analysis using time series cross‐sectional regression models. Data were obtained from published papers and official publications. Results : We found no evidence that greater access to dental healthcare professionals has contributed to improving dental health among 12‐year‐old children. The main parameters influencing oral health and its evolution are income and educational levels within countries. The greater number of dentists and a relatively young adult population have a positive effect on the utilisation of dental services. Conclusions : The improvement in dental health obtained among European children over the last 15 years does not seem to be attributable to policies aimed at improving access to oral health services. What has been achieved is a higher rate of utilisation by adults, due in part to the greater relative numbers of dental healthcare personnel in European countries between 1990 and 2004.