| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Current Products and Practice |
Department of Orthodontics, University of Athens, Greece
Eastman Dental Institute for Oral Health Care Sciences, University College London, 256 Gray's Inn Road, London WC1X 8LD, U.K.
Centre for Postgraduate Dental Education, University of Edinburgh, U.K.
Specialist Practice, Erding, Germany
Department of Orthodontics, Faculty of Medicine, Medical University of Warsaw, Poland
Abstract
This paper reports on a survey of teaching contents and time allocation within the undergraduate orthodontic curriculum in European countries in 1997, and on whether or not these countries set a formal undergraduate examination in orthodontics. A questionnaire and an explanatory letter were mailed to all members of the EURO-QUAL BIOMED II project. Answers were validated during a meeting of project participants and by fax when necessary. Completed questionnaires, which were subsequently validated, were returned by orthodontists from 23 countries. They indicated that orthodontics was taught in all undergraduate curriculums of the countries surveyed. The number of hours in the undergraduate curriculum devoted to orthodontics was reported as varying from 135 to 500 hours with a mean of 245 hours. The time reported as allocated to theory, clinical practice, laboratory work, diagnosis, and treatment planning varied widely. In general, clinical practice and theory were reported as being allocated most curriculum hours, whilst diagnosis, laboratory work, and treatment planing were reported as receiving relatively less time. Removable appliances were reported to be taught in 22 of the 23 countries, functional appliances in 21 countries and fixed appliances in 17 countries. An undergraduate examination in orthodontics was reported by 20 countries. It was concluded that orthodontics occupies a small proportion of the undergraduate curriculum in dentistry in most countries, the emphasis is on theory and clinical work, and that removable appliances, functional appliances, and certain aspects of fixed appliances are taught in the majority of countries that responded to the questionnaire
Key words: European, Survey, Undergraduate Orthodontic Education
Introduction
As described in the general introduction, this survey was one of a series of five carried out by the Professional Development Group of the EURO-QUAL BIOMED II project (ter Heege, 1997
), in order to establish a baseline of up to date information, prior to the formulation of guidelines for all aspects of orthodontic education in Europe (Prahl-Andersen and ter Heege, 1995).
In the USA, the American Dental Association requires that dental students are taught clinical orthodontic procedures. The American Dental Association accreditation guidelines state that ‘graduates must be competent to recognize malocclusion in the primary, mixed, and permanent dentition and treat limited developmental and acquired abnormalities’ (Behrents and Keim, 1991).
In contrast, to date in Europe, there are no such guidelines for undergraduate orthodontic education and furthermore there is no common curriculum. Even though a substantial diversity exists in the length, intensity, and contents of existing undergraduate orthodontic curriculums, the relevant EC Training Directive (78/686/EEC) allows freedom for European Union (EU) qualified dentists to establish practice within any of the Member States of the EU, and considers the primary qualifications obtained from the 130 or so dental schools within the EU as fulfilling the same educational standards.
At present, orthodontics has become a highly sophisticated health care service, which can provide excellent treatment of malocclusion and facial deformity, based on the premise that this treatment is given by well educated, skilled, and experienced clinicians. A pan-European curriculum for the postgraduate training of specialists in orthodontics at postgraduate level has been set out in the final report of the Erasmus project (van der Linden, 1996). Although no similar guidelines as yet exist for general dentists, few will argue that, on graduation, a dentist should be able to recognize a malocclusion, know which patients to refer, to whom they should be sent, at what stage of dental development the referral is appropriate, and be able to handle orthodontic cases in a manner that improves the overall quality of dentistry offered (Moore and Erickson, 1988; Gorczyca et al., 1989). It therefore follows that an adequately qualified oral health workforce is the key to providing the best possible orthodontic and oral health service to the population. However, as far as orthodontics is concerned, such a workforce may not necessarily consist solely of specialist orthodontists. Indeed, article 5 of EC Training Directive (78/687/EEC) allows dentists who do not possess the title of orthodontic specialist to perform orthodontic procedures provided that they possess the necessary knowledge. This ruling raises the question ‘to what level should general dentists be trained in orthodontics?’
Aims of the Study
To establish the following facts for undergraduate orthodontic education in Europe:
Materials and Methods
These have been described in the general introduction to this series. The questionnaire used in this survey is shown in Figure 1.
|
It was possible to validate the responses from 23 countries (Albania, Austria, Belgium, Bulgaria, Czech Republic, Denmark, Finland, France, Germany, Greece, Hungary, Ireland, Italy, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, and the U.K.). It appeared that orthodontics was taught in the undergraduate curriculums of all 23 countries. A response to the question on the total hours devoted to orthodontics was received from 22 out of 23 countries (no response was forthcoming from Austria for this question or to the other questions relating to curriculum hours). The reported hours ranged from 145 hours in the Czech Republic to 500 hours in the Netherlands, with a mean of 245 hours (Figure 2). Twelve of the 22 who responded to this question reported that their countries devoted between 200 and 280 hours in the undergraduate curriculum to orthodontic education, six between 135 and 199 hours, and four between 300 and 500 hours (Figure 2).
|
). However, the range of hours reported as devoted to theory was very wide, from 15 in the Czech Republic to 300 in the Netherlands.
|
). The range of reported hours was from 30 in Italy to 160 in the U.K.
|
), with the respondent from Germany reporting 168 hours, and those from the Czech Republic and Slovakia no hours at all for laboratory work.
|
), and a range of from 75 hours in Belgium to 10 hours in Albania and the U.K.
|
), and a range of from 70 hours in Denmark to 10 hours in Albania, Hungary and the U.K.
|
It was reported that a great diversity of fixed, removable and functional appliance systems were taught to undergraduates (Figure 8). Unfortunately, the responses to this question do not indicate how frequently they are used by the undergraduates, or orthodontists, or even if undergraduates actually use many of the systems as opposed to observing their use.
|
Discussion
Although there was a 100 per cent response rate to the questionnaire, which was probably achieved because of the relatively brief questionnaire, the small numbers of respondents involved and the fact that most met annually and were keen to contribute to the EURO-QUAL project, as explained in the introduction to this series of papers. It was not possible to validate the responses from Croatia, Estonia, Latvia, Lithuania, and Romania, and they have not been included in the results to this paper or the others in the series. As mentioned in the general introduction to this series, it should be borne in mind that, although respondents were asked to verify their answers at a meeting some weeks after they had submitted them, there is always the possibility that they are answering not on behalf of their country, but of their university, department of province/ region. This factor may be particularly relevant for larger countries with a number of autonomous regions or provinces, which may follow different practices as far as undergraduate education is concerned.
It appears that undergraduate orthodontic education is currently taking place in all European countries surveyed. The questionnaire did not seek to identify the quality of the undergraduate orthodontic curriculum. It did not differentiate an excellent curriculum from a good curriculum from an acceptable curriculum. However, it is reassuring to note that it appears that orthodontics is part of every undergraduate curriculum.
The responses to the questionnaire indicate that in 1997, with the caveat that some respondents may have been answering for their own university rather than for their country as a whole, the teaching of orthodontics took up a mean of 245 hours of the dental undergraduate curriculum in the 22 European counties that responded to this question. It is interesting to note that a recent survey of undergraduate dental training in the EU (Shanley et al., 1997), to which 30 dental schools responded, the mean figure for hours of orthodontic training was 253, suggesting that in spite of the caveat, the figure of 245 hours may well be reasonably accurate.
It is also difficult to collect reliable data for the mean total length of the undergraduate dental curriculum in all European dental schools. However, a recent study (Widström et al., 1996) suggests that the mean figure for 10 of the countries of the EU/EEA (Belgium, Denmark, France, Finland, Germany, Greece, Ireland, Norway, Portugal and the U.K.) was 181 weeks (with a range of 140–200 weeks). If the study of orthodontics takes place during the second half of the undergraduate curriculum, when students may be working a 7-hour day (35 hours per week), then it is possible that on average orthodontic education may take up about 7 of the 181 weeks, or approximately 5 per cent of the total undergraduate curriculum hours in many EU/EEA countries. It is interesting to note that the curriculum for orthodontic specialist training recommended by the Erasmus project (Van der Linden, 1996) is 4800 hours.
As a clinical specialty it was not surprising that respondents reported that clinical practice and theory together took up a major part of the hours allocated to the undergraduate orthodontic curriculum. However, the very wide range was perhaps surprising. This observation also applies to the hours dedicated to laboratory work, diagnosis and treatment planning. It was most surprising that in two countries, it appears that dentists can enter clinical practice with no experience of orthodontic laboratory work whatsoever.As undergraduate orthodontic training frequently concentrates on teaching students to recognize malocclusions, rather than to enable them to provide a wide range of treatment, it was not surprising that the fewest curriculum hours in the undergraduate orthodontic curriculum were devoted to treatment planning. Even though the use of removable appliances and functional appliances was taught in almost all undergraduate curriculums of the countries surveyed, it was perhaps surprising that respondents reported the use of fixed appliances as being taught in many countries.
Conclusions
Acknowledgments
The authors would like to thank members of the EURO-QUAL BIOMED II project and colleagues in the countries who took part in the survey for their help and advice, and Mr David Gort for his help in producing many of the figures.
References
Behrents, R. G. and Keim, R. G. (1991) Education, Research and Personnel Needs in Orthodontics, Current Opinions in Dentistry, 1, 652–656.
European Council Directive Number 78/686/EEC (1978)Official Journal of the European Communities 1978; 21, L233, ISSN 0378-6978.
European Council Directive Number 78/687/EEC (1978)Official Journal of the European Communities 1978; 21, L233, ISSN 0378-6978.
Gorezyca, A. M., Jones, J. E. and Douglass, C. W. (1989) Orthodontic Treatment Provided by General Dental Practitioners and Pedodontists in Massachusetts, Journal of Clinical Orthodontics, 23, 346–352.
Moore, R. N. and Erickson, L. C. (1988) Predoctoral and Continuing Education in Orthodontics: Opinions of Nebraska Alumni, Journal of Clinical Orthodontics, 22, 152–156.
Prahl-Andersen, B. and ter Heege, G. J. (1995) The EURO-QUAL Programme: Guidelines for Quality in Orthodontics. Studieweek 1995, Nederlandse, Verenigingvoor Orthodontische Studie, 216–228, ISBN 90 8006 472 6.
Shanley, D. B., Barna, S., Gannon, P., Kelly, A., Teljeur, C., Munck, C. and Ray, K. (1997) Undergraduate Training in the European Union—Convergence or divergence? European Journal of Dental Education, 1, 35–43.
ter Heege, G. J. (1997)EURO-QUAL, Towards a Quality System for European Orthodontic Professionals,European Commission, Biomedical Health Research, Directorate General XII, Science, Research and Development. Press, Amsterdam, The Netherlands, ISBN 90 5199 330 7. Ohmsha, Tokyo, Japan, ISBN 4 274 90152 1 C3047.
Van der Linden, F. P. G. M. (1996)Three Year Postgraduate Programme in Orthodontics: the final report of the Erasmus Project, American Journal of Orthodontics. Dental Orthopaedics, 110, 101–107.
Widström, E., Eaton, K. A. and van den Heuvel, J. (1996)Dentistry in the EU and EEA—a Council of European Chief Dental Officers' Survey, STAKES, Helsinki Finland, ISBN 951 33 0231 8.
This article has been cited by other articles:
|
|
 |
|
  M. J. Lipp An "Objectified" Competency-Based Course in the Management of Malocclusion and Skeletal Problems J Dent Educ., May 1, 2008; 72(5): 543 - 552. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. D. Stephens and J. Cook Attitudes of UK consultants to teledentistry as a means of providing orthodontic advice to dental practitioners and their patients J. Orthod., June 1, 2002; 29(2): 137 - 142. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
