Postgraduate Training in Clinical Dentistry at Tromsø University – Where And When Has Periodontology Been Implemented?
Even before the first undergraduates had successfully completed their studies in 2009, the Norwegian Government had asked, in a letter dated December 21, 2007, the Norwegian Directorate for Social Affairs and Health, the Institute of Clinical Dentistry (IKO) at Tromsø University (UiT) and the Dental Health Service Center for Northern Norway (TkNN) to develop a new specialty, Clinical Dentistry. Due to the special circumstances in the far north of Norway, it was planned that the postgraduate program (similar as the program for undergraduates) should be organized in accordance with “the principles of a de-centralized educational model,” meaning implementation of distance clinical tutoring via web-based case presentations and lecturing.
A decentralized design requires access to local clinical facilities equipped with modern communication technology. This has been achieved by using the established network of external dental clinics linked to the undergraduate dental education.
The Mandate
It has to be emphasized that, originally, the idea was a three year special training in three major disciplines of Dentistry, i.e., restorative dentistry/masticatory function, periodontics, and endodontics.
The respective Study Plan, which can be found in its May 5, 2011 version here (last revised March 28, 2011) starts anyway with a 1994 quote of the Council of European Chief Dental Officers,
A specialist dentist is a dentist trained beyond the level of a general dental practitioner and authorized to practice as a specialist with advanced expertise in a branch of dentistry. Specialized practice may include clinical, teaching, administrative, research and advisory tasks. (My emphasis.)
Initial Modifications
It is obvious that the Study Plan Committee in Tromsø, consisting of the chief dental officer from Bodø, a representative from Turku University, Finland, and leaders of both IKO and the TkNN, had, in the beginning, conceived a rather comprehensive approach for the “specialty” of Clinical Dentistry (which, as will be seen below, quickly rather developed from a postgraduate training program to mere continuous education) and had suggested that it should include, besides the original topics endodontics, periodontology, and prosthetics/masticatory function, also “oral diagnostics and treatment planning, simple dento-alveolar surgery, and gerodontology.” (My emphasis.) The reason for this addition is not clear as oral diagnostics and treatment planning and “simple” dento-alveolar surgery (supposedly extractions) are part of any undergraduate curriculum and gerodontology as the study of dentistry in relation to aging, aged and elderly patients, ought be considered in the main disciplines restorative dentistry and periodontology anyway.
Furthermore, according to the Study Plan, “[t]he curriculum profile should be influenced by a community dentistry approach. A ‘holistic’ approach [sic!] should be emphasized qualifying the candidates for a balanced approach [sic!] to complex cases.”
Eventually, the Norwegian Directorate for Health and Social Affairs had approved the Study Plan. Its purpose and characteristics are listed as follows.
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’Clinical Dentistry’ should appear as a comprehensive clinical specialty with a ‘holistic’ profile placing the patients’ needs in the center. The specialty is aiming at adult patients’ needs, emphasizing a balanced, patient-centred approach to treatment.
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It should contain consultation and advisory duties in addition to clinical activities.
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It should have a competence-enhancing effect, particularly within the public dental health service.
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It should act as an ‘extension’ of regional competence center activities.
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The program is primarily aiming at dentists with a special interest in comprehensive clinical activities in a public dental health context.
The Study Plan emphasizes furthermore that, “[a]fter graduation, the candidates should be able to independently and proficiently master diagnosis, therapy planning and integrated treatment of advanced cases in a ‘holistic’ context” and “to establish collaboration with established specialties during the program.”
Evaluation methods will be according to guidelines in the „Bologna process‟, The Norwegian Quality Reform for Higher Education and the Guidelines for Specialty Education in Norway. Both clinical and theoretical aspects will be evaluated. In addition, a written research project is required. In addition to regular case discussions through the whole program, portfolio evaluations will be performed at the end of each year. A written exam in the Norwegian language covering all clinical topics will be performed at the end […].
The Final Curriculum
While Part 2 of the Study Plan (p. 5f) briefly outlines the requirements for obtaining the degree of Specialist in Clinical Dentistry fairly consistent with the introductory information outlined above, in Part 3 (p. 7ff), one gets the impression that the original core disciplines prosthetics/masticatory function, periodontology and endodontics are no longer in the focus of the training. As an example, the first semester, in which students are introduced in Tromsø “to all topics included in the clinical specialty program,” students are supposed to attend 325 hours of an introductory module of didactic teaching in basic (100 h), paraclinical (125 h) and clinical topics (100 h). This seems to be a repetition of what general dental practitioners need to know.
In rare discussions with discipline heads in 2010 when raw draft versions of the Study Plan had been circulated by the TkNN study project leader (who is now head of TkNN) the problem of what has to be expected from trainees after completion of the program that goes beyond undergraduate teaching had never been solved. Of considerable concern was the suggested number of 60 hours (!) teaching in, for instance, periodontology just in the first semester and pertinent, then and so far unanswered, questions as regards further teaching (be it de-centralized or at IKO) in semesters 2-6. Learning goals for “Periodontology” are explicit (in Part 3 of the Study Plan),
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Perform periodontal diagnosis and treatment planning properly considering future use of the tooth/teeth
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Perform evidence-based treatment of advanced periodontal conditions including surgical procedures
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Perform referrals to and establish collaboration with relevant specialists if necessary
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Analyze the basic biological and technical aspects of osseointegrated implants.
Apart from awkward “advanced periodontal conditions” and, as fact of the matter, all should now be evidence-based in medicine, this hardly seems to be the minimum what every dentist has to be able to do in order to serve his/her patients. That is what has to be taught to undergraduate students (and, by the way, much more, what makes this “plan” really annoying). It may also reflect competencies and skills of the person(s) who have been charged with training.
Honestly, this program is not even continuing education, and that applies not only to periodontology.
Frequent mentioning of a “holistic” and “patient-centered approach” in the Study Plan may indicate that the planning committee had an allegedly novel idea in mind. Hence, treatment should differ from previous, mainly tooth-related, repair. But what the committee probably meant, comprehensive dental care, is not a new concept at all. However, when reading learning goals as formulated in the Study Plan for periodontology (see above), close connections between any clinical discipline, be it in Dentistry or even Medicine at large, which have to be considered in the overall treatment plan (inevitably having an influence on questions such as: When are periodontal measures, non-surgical or surgical, reasonably done and re-evaluated? When should then restorative measures be conducted?) are not even mentioned. These goals are, well, just misleading.
Periodontology as it is currently taught for undergraduates here at UiT is much more as may be seen here.
The discipline of Periodontology deals with the development, anatomy, structure, and function of the various soft and hard tissues of the periodontium in health and disease, i.e., gingiva, periodontal ligament, root cementum, and alveolar bone proper. It concerns diagnosis, prevention, and treatment of the various diseases and conditions affecting the periodontal tissues. There are close relationships to Oral Microbiology and Immunology, and Community Medicine. The impact of periodontal disease on non-oral diseases has to be considered as well. There are also close relationships to esthetic dentistry as well as implant dentistry.
Practical issues of Periodontology include treatment modalities for the different diseases and conditions of the periodontium, techniques, and instrumentation. Treatment of the periodontally diseased patient should be considered within the framework of Comprehensive Dental Care.
Although it was planned that didactic teaching is provided by academic staff at IKO, which is then supplemented with external dedicated professionals as clinical activities, up to now, postgraduate training in Clinical Dentistry (which, as had been explained above, must not be regarded a specialist training) is mainly run by the Dental Health Service Center for Northern Norway (TkNN) clinical staff.
Several months before the Study Plan had finally been revised (on March 28, 2011), the first four students had commenced the training program. They will complete the program in the end of 2013 when final exams are supposed to be held. The moment of truth.
A new batch of students has been taken in already in the autumn semester of 2012.
23 January 2013 @ 10.35 am.
Last modified January 24, 2013.
Periodontology 
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