In the past 30 to 50 years, the amount of information in dentistry has expanded so much that it is impossible for dental students to be prepared for even a fraction of dental practice after the conventional three or four years of professional education. Additionally, mature practitioners have a difficult time keeping up with the ever-expanding amount of information in the profession.
The initiation and expansion of private continuing education (CE) centers throughout the United States is evidence of the need and demand for additional postgraduate education for both new dentists and experienced practitioners. CE needs vary throughout a dental career.
This article discusses several dental career periods relative to the need for CE, the types of CE available, and the changes observable in the respective areas of dentistry that relate to the necessity of need for CE.
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CAREER PERIODS AND NEED FOR CONTINUING EDUCATION
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My experience in providing tens of thousands of hours of CE throughout the world has shown me that there are identifiable career periods when most dentists need more education.
Immediately after graduation.
This is the period of the greatest need for CE, contrary to the beliefs of some new graduates. There is far too much to teach a dental student in the few years he or she spends in dental school. I suggest that new graduates consult with practicing dentists in their communities to determine which elective dental services are requested by patients and in which areas the new graduates might be deficient. The most obvious needs are in practice management, practical occlusion concepts, all areas of esthetic dentistry, implant prosthodontics and implant surgery, because they are not taught in depth in most dental schools.
Ten years after graduation.
By this time, most new practitioners have identified their areas of interest and have become relatively proficient in their clinical skills. However, in the event they have not been involved in CE on a constant basis, they are significantly behind the state of the art in their knowledge. Dentistry is changing so fast that 10 years see many changes in concepts, materials, devices and techniques. Each person needs to identify his or her specific areas of CE need.
Fifteen to 20 years after graduation.
Most practitioners are stable financially by this point in their careers, and many are looking for new concepts to stimulate their interest in the profession. They can afford CE, and they are experienced enough in the profession to find it. Their clinical skills are sufficient to allow them to make decisions about the relative complexity of new procedures and their ability to make use of these procedures. This is a great time in a career. Dentists are able to determine which areas of the profession most interest them; in addition, they have observed failures and successes in their patient care, and these learning experiences allow better judgment regarding the areas in which they need education to upgrade their skills and knowledge.
More than 20 years after graduation.
These practitioners either have involved themselves with significant CE over the years since dental school or are woefully behind in clinical skills and knowledge. State-mandated CE requirements have assisted somewhat in updating those who have been negligent in obtaining CE, but many do not take these required courses seriously. Because of such carelessness, required periodic examinations to test competency and knowledge would be desirable. However, most practitioners have adequately updated themselves through the years and know their areas of interest and CE need.
Thirty or more years after graduation.
At this point in a career, a dentist’s clinical skills and knowledge can be excellent or pathetic, depending on the level of CE in which he or she has been involved. Unfortunately, those who are behind the times often continue to get worse, while those who have kept up are in the prime of their careers. The practitioners who are behind or are becoming physically compromised because of age often elect to retire, making the clinical challenges a moot point. Most of those who still are active enjoy dentistry and continue in their educational development.
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TYPES OF CONTINUING EDUCATION
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CE falls into several categories, which I list here in my opinion of their educational value, beginning with the highest:
- – hands-on patient treatment;
- – hands-on simulated treatment involving models;
- – viewing videos of live hands-on activity;
- – viewing videos of still images accompanied with the narrative of the presenter;
- – small seminar courses with significant participant interaction with the instructor;
- – large lecture courses with little interaction with the instructor.
The important challenge is for dentists to determine when they are behind in their clinical skills and knowledge in specific areas.
The type of CE need varies with each practitioner. Some need the highest level, while others can integrate new concepts into practice by just hearing about or seeing images of it. Each dentist must decide which type of CE he or she needs.
In my opinion, every dentist needs CE, starting from the day of dental school graduation until retirement. The important challenge is for dentists to determine when they are behind in their clinical skills and knowledge in specific areas.
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ASPECTS OF DENTISTRY REQUIRING CONTINUING EDUCATION
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The more change that is taking place in dentistry, the more need there is for CE. Here, I list the areas of dentistry in alphabetical order and rate the need for CE in each.
Diagnosis and treatment planning (high need).
Diagnosis and treatment planning is an area more important than ever before because of the myriad techniques, concepts, devices, materials and practice modes that are present today. Dental implants alone have nearly completely changed the oral treatment types possible. It is impossible for dentists of all ages to be knowledgeable about all of the changes and advancements in diagnosis and treatment planning without frequent CE.
Endodontics (low to moderate need).
Just a few decades ago, endodontic therapy was in a stage of rudimentary development. That has changed. Crown-down techniques, rotary root canal therapy and new obturation techniques have made endodontics a completely different entity from what it was even a few years ago. Most dental schools are teaching up-to-date endodontic therapy. Well-done endodontic therapy is successful and appreciated by patients, but techniques need to be painless, fast and predictable. It is essential that CE in endodontics be updated, but change in this area is relatively slow.
Esthetic dentistry (extremely high need).
Because of curriculum time limitations, esthetic dentistry is woefully undertaught in many dental schools. Since elective procedures are a major part of dentistry, dentists of all ages need CE in every area of esthetic dentistry, including bleaching, veneers, tooth-colored inlays and onlays, computer-aided design/computer-aided manufacturing, zirconia-based crowns and fixed partial dentures. Dentists should obtain CE in esthetic dentistry on an annual basis, because most dentists have not had formal education or experience in the esthetic areas of dentistry and the concepts are changing rapidly.
Implant dentistry (extremely high need).
Implant dentistry changes from day to day, and it is taught at only a meager level in dental schools. I advise dentists to seek and find courses in implant surgery and implant prosthodontics, decide which concepts and techniques they want to use, and constantly update their education and abilities in them. This area has caused the most change of any discipline in dentistry during my career. Dentists need CE in this area on an annual basis.
Occlusion (moderate need).
Some principles of occlusion are identifiable and pragmatic, and others are mysterious. Most schools teach conservative occlusal concepts, but inexperienced students may have a difficult time determining which of the concepts is useful and can be implemented in practice. As a result, too many dentists lack competence in even simple techniques. Practitioners should obtain CE to update themselves to the level at which they can integrate occlusion concepts into practice. However, change in this area is not occurring fast, and, therefore, practitioners should seek CE in and practice the currently accepted techniques.
Operative dentistry (low-to-moderate need).
The basics of operative (restorative) dentistry are taught relatively well in dental school. The most significant challenge to practicing dentists is to make the procedures in this low–revenue-producing area predictable and efficient. Dentists need CE on how to effectively use staff members in operative procedures. Four-handed and six-handed dentistry techniques have fallen out of vogue. Almost all dentists could benefit from CE in optimum staff utilization for operative dentistry.
Oral and maxillofacial radiology (high need).
Changes abound in this area. Digital radiography, though expensive and constantly improving, is a must for dental practices. Cone technology is emerging rapidly. Every dentist needs further CE in radiology, and it is likely that the coming changes in this area will require frequent updates on techniques and concepts.
Oral and maxillofacial surgery (moderate-to-high need).
Few dentists obtain enough education in dental school to be competent in simple oral surgical procedures. However, it is well-known that most general dentists routinely accomplish simple oral surgical procedures. Obtaining pragmatic, general practice–oriented CE in oral surgery topics such as routine tooth extractions, surgical tooth extractions, simple grafting, apicoectomies and other commonly needed procedures should be one of the first priorities for surgically oriented general dentists. However, changes in oral and maxillofacial surgery are not occurring rapidly.
Orthodontics (extremely high need).
Allegedly because of lack of curriculum time, and also because of various political impediments, the topic of orthodontics for general dentists has remained outside of most dental school curricula. Most general practitioners involved with simple to moderately complex orthodontic procedures agree that some orthodontic procedures should be undertaken by educated general dentists. The choice to do so is yours, after you obtain acceptable CE.
Pediatric dentistry (low-to moderate need).
The rudiments of this area usually are taught relatively well in dental school, but interested practitioners need years of experience in dealing with children to become clinically competent. For practitioners interested in pediatric dentistry, appropriate CE courses can reduce the time necessary to become competent in dealing with the oral and behavioral challenges posed by children.
Periodontics (low need).
In my observation, periodontics is one of the best-taught areas in dental schools. However, to increase the quantity of periodontal therapy delivered to the U.S. public and to put periodontal therapy into mainstream general practice, I see the need for dentists to become involved with other aspects of periodontal therapy including prevention, conservative periodontal procedures, reducing the pain of conventional periodontal surgery, laser therapy and other less invasive, innovative procedures that still produce enough revenue to motivate their incorporation into practice.
Practice management (extremely high need).
Effective practice management skills can produce better dentistry for patients and well-deserved adequate income for practitioners. Infrequently, one finds a dental school curriculum containing enough practice management information for students. CE in this topic is essential immediately on graduation and constantly during a dental career.
Preventive dentistry (moderate need).
I suggest taking CE courses that emphasize the aspects of prevention that benefit the patient and bring revenue into the dental practice. Such techniques are tooth remineralization; fluoride therapy in trays; and preventive therapy for caries, periodontal disease and occlusal problems. Although minimal revenue producers, most of these preventive procedures can be accomplished legally by staff members—and because of this delegation potential, dentists should consider incorporating them into practice. Preventive therapy can be a win-win proposition.
Prosthodontics (moderate need).
Ranging from simple single crowns to complex tooth-and implant-supported prostheses, prosthodontics has become of great service to patients. It is well-known that the combination of fixed, removable and implant prosthodontics is the most revenue-producing area of general dental practice. However, many of the procedures are complicated, laboratory-dependent, expensive and unpredictable. The simple procedures should be made more efficient and predictable, and the complex procedures should be made simpler and less expensive. Because of the constant change in materials and techniques in this area, practitioners should obtain CE in it annually.
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SUMMARY
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It has become apparent that the large quantity of information present in dentistry and the constant change in materials, techniques, devices and concepts do not allow any dental school to prepare graduates adequately for all areas of practice. Additionally, dentistry is changing so fast that mature practitioners constantly must upgrade their knowledge. CE is a necessity of life for all dentists. This article points out the periods in a dental career when continuing education is most needed, the types of continuing education available and the areas of dentistry that appear to be in most need of continuing education.
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CAREER PERIODS AND NEED...
TYPES OF CONTINUING EDUCATION
