1. The human oral microbiome.
Dewhirst FE1, Chen T, Izard J, Paster BJ, Tanner AC, Yu WH, Lakshmanan A, Wade WG.
J Bacteriol. 2010 Oct;192(19):5002-17. doi: 10.1128/JB.00542-10. Epub 2010 Jul 23.
The human oral cavity contains a number of different habitats, including the teeth, gingival sulcus, tongue, cheeks, hard and soft palates, and tonsils, which are colonized by bacteria. The oral microbiome is comprised of over 600 prevalent taxa at the species level, with distinct subsets predominating at different habitats. The oral microbiome has been extensively characterized by cultivation and culture-independent molecular methods such as 16S rRNA cloning. Unfortunately, the vast majority of unnamed oral taxa are referenced by clone numbers or 16S rRNA GenBank accession numbers, often without taxonomic anchors. The first aim of this research was to collect 16S rRNA gene sequences into a curated phylogeny-based database, the Human Oral Microbiome Database (HOMD), and make it web accessible (www.homd.org). The HOMD includes 619 taxa in 13 phyla, as follows: Actinobacteria, Bacteroidetes, Chlamydiae, Chloroflexi, Euryarchaeota, Firmicutes, Fusobacteria, Proteobacteria, Spirochaetes, SR1, Synergistetes, Tenericutes, and TM7. The second aim was to analyze 36,043 16S rRNA gene clones isolated from studies of the oral microbiota to determine the relative abundance of taxa and identify novel candidate taxa. The analysis identified 1,179 taxa, of which 24% were named, 8% were cultivated but unnamed, and 68% were uncultivated phylotypes. Upon validation, 434 novel, nonsingleton taxa will be added to the HOMD. The number of taxa needed to account for 90%, 95%, or 99% of the clones examined is 259, 413, and 875, respectively. The HOMD is the first curated description of a human-associated microbiome and provides tools for use in understanding the role of the microbiome in health and disease.
2. GUIDELINES FOR EFFECTIVE PREVENTION OF PERIODONTAL DISEASES
Guidance for Dental Hygienists
General Guidance Diseases
Guidance for Dental Surgeons
Guidance for Dental Hygienists
These guidelines are the product of the XI European Workshop in Periodontology (the ‘Prevention Workshop’), which took place in November 2014 in La Granja de San Ildefonso (Segovia), Spain. For further information, please see the Prevention Workshop website (prevention.efp.org). The full proceedings of the workshop were published in April 2015 in the Journal of Clinical Periodontology and can be downloaded (in pdf format) free of charge from: http://onlinelibrary.wiley.com/doi/10.1111/jcpe.2015.42.issue-S16/issuetoc. In addition,
a podcast is available for viewing (at http://efp.stream-congress.com) in which the four co-chairmen of the Prevention Workshop discuss its conclusions and guidelines.
This guidance is based upon systematic reviews of randomised clinical trials within the
available literature and, where indicated, meta-reviews of those systematic reviews. The
findings may appear contrary to the undergraduate teachings of many dental hygienists,
but they are the current evidence base. The dental hygienist plays a crucial role in the
successful prevention of gingivitis and periodontitis, educating patients and achieving
behaviour change. Therefore this guidance aims to provide the current evidence for
mechanical and chemical plaque control for implementation by dental hygienists.
• Daily mechanical plaque removal remains the foundation of primary (managing gingivitis) and secondary
(preventing recurrence of periodontitis) prevention and when correctly performed is effective in reducing
plaque and gingivitis.
• Professional oral-hygiene-instruction, personalised to individual patients, is vital to their ability to achieve the
required standard of plaque removal. This is best demonstrated in the patient’s own mouth and checking the
patient can achieve this prior to leaving the surgery is recommended. It also requires appropriate time within
your treatment plan.
• Patients need to understand that periodontal prevention is a life-long commitment and that reinforcement of
techniques to improve efficacy is vital at recall appointments.
• Both manual and power brushes are effective in reducing plaque and gingivitis.
• Re-chargeable power brushes are slightly more effective at reducing plaque levels and gingival inflammation than
manual brushes, but there is insufficient evidence at this time to recommend one brush design over another.
Recommendations should also take account of financial costs and also patient dexterity/needs.
Guidelines for Effective Prevention of Periodontal
Diseases Prevention of Periodontitis
Guidance for Dental Hygienists
General Guidance Diseases
Guidance for Dental Surgeons
Guidance for Dental Hygienists
• Daily interproximal cleaning is essential for maintaining interproximal gingival health, but there is no evidence
to support the use of dental floss for interdental cleaning in periodontitis patients. Interdental brushes are
the most effective method and the method of choice where spaces will accommodate their atraumatic use.
However, caution is advised in their use at healthy sites where interdental spaces may be too narrow to safely
accommodate them. Here, there may be a role for dental floss.
• 2 minutes brushing twice daily may be effective for primary prevention of periodontitis in low-risk groups.
High-risk patients and secondary prevention require much longer.
• Chemical anti-plaque agents employed adjunctively to mechanical plaque removal in a mouth rinse or added to a
fluoridated dentifrice provide significant benefits in gingivitis management and preventing plaque accumulation.
However, financial cost, environmental issues, side-effects, and the need for additional patient actions for
mouth-rinse use should be borne in mind when making such recommendations.
GUIDELINES FOR EFFECTIVE PREVENTION
OF PERIODONTAL DISEASEs
Guidance for Dental Hygienists
3. EFP Guidelines for Seeking the Specialty in Periodontology
Dentistry as one of the health professions with clear educational standards has been reviewed in terms of its educational outcomes, the definition of the professional profiles and competences in the recent European Directives (2005). In this document, there is recognition to only two dental specialties – Orthodontics and Oral Surgery – and the established rights of specialist dentists. This directive, however, does not regulate the education and training of these specialties, nor the approval of further dental specialties. All these regulatory aspects are left to the discretion of the individual EU Member States.
This creates the potential for heterogeneity in all aspects of dental specialties training and practice and poses a great difficulty in obtaining convergence of education and training and practice standards.
A specialist dentist is by definition a dentist trained beyond the level of general dental practitioner and authorized to practice as a clinician with advanced expertise in a branch of dentistry. A dental specialty has been defined as a nationally or internationally recognized branch of dental specialization for which a structured postgraduate training program exists. In October 2005, the European Parliament adopted a new EC directive on the mutual recognition of professional qualifications. It replaced the previous sectoral directives, which were introduced in 1978, when the EU was far smaller. The new EC directive includes the educational requirements for the mutual recognition of diplomas, certificates and other evidence of the formal qualifications of dental (and various other health) practitioners.
As far as health specialties are concerned, the new EC directive states:
“To allow for the characteristics of the qualification system for doctors and dentists and the related acquis communautaire in the area of mutual recognition, the principle of automatic recognition of medical and dental specialties common to at least two Member States should continue to apply to all specialties recognized on the date of adoption of this Directive.
To simplify the system, however, automatic recognition should apply after the date of entry into force of this
Directive only to those new medical specialties common to at least two fifths of Member States. Moreover, the Directive does not prevent Member States from agreeing amongst them on automatic recognition for certain medical
and dental specialties common to them but not automatically recognized within the meaning of the Directive, according to their own rules. The automatic recognition will therefore, apply to those specialties formally recognized when the new directive comes into effect in the autumn of 2007”.
This automatic process (the two-fifths rule), however, applies only to medical and not to dental specialties. This means that it will not be easy to add other common dental specialties to the current list of two (Orthodontics and Oral Surgery), and in order to add additional dental specialties, it will be necessary to obtain agreements between individual countries. This places dentistry in a more difficult situation than medicine, where as soon as a specialty is officially recognized in two-fifths of Member States, it can become a pan–EU/European Economic Area (EEA) specialty.
Moreover, in spite of the fact that these two recognized dental specialties were formally recognized by the EC in the old sectorial directives regulating the mutual recognition of professional qualifications for dentists, there are Member States from the EU/EEA (Spain) that still have not recognized even these dental specialties.
The specialties of Periodontics and Children’s Dentistry, in spite of not being mentioned in the EC directive, are the next most commonly recognized by individual EU countries. According to the CECDO’s database and the survey of dental competent authorities, Periodontology is recognized in 15 EU/EEA countries, although some important EU/EEA countries, such as Austria, Germany, Denmark, France, Greece, Italy, the Netherlands and Spain, do not formally recognize it. Most of these countries, however, notwithstanding the fact that there is no formal recognition of dental specialties and specialists, allow dentists to undergo formal taught postgraduate courses in Universities for up to 3 years’ duration, allow dentists to limit their work to this specialty of dentistry and in some instances these dentists are allowed to claim to be specialists and treat patients referred by other dentists. Furthermore, they may even receive diplomas from their dental association or from specialist associations (National Societies of Periodontology).
The European Federation of Periodontology (EFP http://www.efp.net/) as the European umbrella organization representing all National Scientific Societies in Periodontology has approved as part of its mission to foster the formal recognition of Periodontology as a European Dental Specialty. In light of the legal difficulties to attain this recognition status at European Level, the EFP encourages the National Periodontal Societies to seek this recognition at their own national level in those countries still lacking this legal status.
Here are the main guidelines to pursue this process:
1) The Educational Program
In order to comply with the EC directives entrants to dental specialist training must have an EC-approved primary dental qualification (degree) and must carry out a formal specialist education in a structured postgraduate training program. This specialist-training program must last a minimum of 3 years full time (or part-time equivalent), must contain academic and clinical elements and must take place at ‘institutions’ approved by the competent authority in the country concerned. This implies that the National Society must first assure the existence of such a training program in their country.
The EFP has developed a model of such a program and there are currently 11 accredited dental schools providing this EFPPostgraduate Program in Periodontology and this number increases every year. These accreditation systems, however, do not have a legal binding in most European countries and just provide a reference of peer-review quality assurance.
The EFP-Postgraduate Program in Periodontology is based on the EC directives’ requirement of 3 years’ full-time education comprising both academic and extensive clinical training. In spite of the fact that according to the Bologna Framework, Masters degree program normally carry 90–120 ECTS credits, the length and the content of a dental specialty training program needs to accommodate the provisions of specialty training as detailed in the EC directive (2005). As such, it should carry at least three full-time years or their part-time equivalent (180 ECTS credits), and therefore, the specialty status can only be obtained after completing both the academic component and the required clinical training. These provisions also comply with the recommendations by the Conference on Master-level Degrees organized by the European University Association under the auspices of the EU in Helsinki (Finland) in March 2003, which concluded that programs leading to a Masters degree may have ‘different orientations and various profiles’ in order to accommodate a diversity of academic and labor market needs.
This course, therefore, should be organized in three full- time years (6 semesters–40 weeks per year) comprising 180 ECTS.
The academic content leading to an Academic Master Degree can be 120 ECTS, including the research presentation. The
Specialty Certificate, however, can only be obtained after completing both the Academic Degree and the required clinical time (three years). Both the Academic Degree and the Specialty Certificate should be interlinked in such a manner that one cannot be obtained without the other.
The following is the list of currently approved EFP Graduate Programs in Periodontology:
1. Academic Centre for Dentistry Amsterdam, the Netherlands
2. University of Bern, Switzerland
3. University of Goteborg, Sweden
4. Jonkoping Institute for Post-graduate Dental Education, Sweden
5. Eastman Dental Institute London, UK
6. Catholic University of Leuven, Belgium.
7. University Complutense Madrid, Spain
8. Hadassah Faculty of Dental Medicine Jerusalem,
9. Yeditepe University of Istanbul, Turkey
10. Trinity College, Dublin, Ireland
11. Haifa Medical Center, Israel
The National Societies seeking recognition should discuss with their respective governments whether this existing EFP postgraduate model could serve as the reference educational framework of specialist training in Periodontology in that particular country and which are the accreditation criteria for existing postgraduate programs in Periodontology.
1) The Periodontal Practice
In light of the heterogeneity of dental services in Europe and the lack of provision of specialized periodontal services by the public health systems of most European countries, there is not a European Profile of a Specialist in Periodontology in terms of professional competences. In fact there are different models available in those countries where Periodontology is currently a legally recognized specialty. There are countries where periodontal practice is not regulated and general dentists and specialists have similar legal competences (there is not a patient profile or a periodontal procedure that a general dentist cannot do) and similarly periodontologists are not obliged to limit their practice to Periodontology. On the other extreme there are countries where periodontologists are obliged to limit their practice to Periodontology and on the other hand the patient profile and periodontal procedures that can be treated by general dentists is also regulated and limited. There are also countries where the provision of certain periodontal services in the public health system is limited to specialist, but periodontal practice
is not regulated in the private sector.
Those National Societies of Periodontology seeking for specialty recognition should discuss with their relevant government authorities which model of periodontal practice at specialty level adjusts better with the country legislation and the provision of oral health services.
Prof. Mariano Sanz
17 May 2010
4. Dental hygienist education
The EFP has previously published its recommendations concerning undergraduate and
specialist education in periodontology. The aim of this document is to give guidance to those
authorities responsible for providing dental hygienist education in an effort to achieve
uniformly high standards throughout those countries which are under the umbrella of the EFP.
It is also intended to encourage the governments in those countries of the EFP where hygienist
practice is not legal (currently Austria, Belgium, France, Greece and Turkey) to make
legislation and set up training programmes for dental hygienists.
These guidelines have been subject to extensive consultation amongst all the constituent
national periodontal societies of the Federation, the International Dental Hygienist Federation,
national dental hygienist societies and many of the training schools for dental hygienists in
Europe. There has been a considerable uniformity of opinion which has enabled the EFP to
propose a core curriculum which is supported by virtually all of those bodies. It is also able to
include certain topics which are currently practised by hygienists in some European countries
and receive wide support but because they are more controversial, it is appropriate that
decisions on whether they be included should be made locally, according to national opinion.
It is not considered that the inclusion or exclusion of these items from the ‚Recommended
Curriculum‘ significantly dilutes the recommendations.
The original model for these recommendations was the one prepared by the General Dental
Council of the United Kingdom „Curriculum for Dental Hygienists – Requirements for the
Education and Training of Dental Hygienists“, May 1997.
2. Permitted Work
The EFP recommends that dental hygienists should, after appropriate education and training,
be permitted to undertake the following work, providing that a registered dentist has
previously examined the patient and indicated in writing, the nature of the work to be
performed under the dentist’s supervision and responsibility. Despite the fact that in some
European countries, dental hygienists are legally permitted to work independently of dentists,
the EFP considers it highly desirable that all members of the dental team work in cooperation
with each other to the benefit of the health of the patient.
a. Cleaning and polishing teeth.
b. Supra- and subgingival scaling of the teeth.
c. The application to the teeth of prophylactic materials, for example fluoride solutions,
and fissure sealants.
d. The insertion of temporary fillings and of crowns which become dislodged during the
course of the hygienist’s treatment.
e. Collection of data, for example, medical and dental histories, plaque and periodontal
f. Administer comprehensive advice on oral hygiene and the care of the mouth,
according to patients‘ needs.
g. Dental radiography.
h. Local analgesics (subject to local agreements and training).
i. Impressions (subject to local agreements and training) .
j. Certain orthodontic duties such as the fitting and/or removal or bands/brackets,
although not part of the work of a ‚dental hygienist‘ are currently incorporated into the
curriculum of dental hygienists in some European countries.
3. Entry Requirements
Applicants for places on training courses should have had a good general education and good
communication skills. The precise qualifications will vary from country to country but should
include a biological science and be sufficiently high to indicate an ability to benefit from
Higher Education. In most cases this will be equivalent to University entry standard. It is
appreciated that a substantial number of applicants may come from a dental nursing
background. Due consideration should be given to dental nursing qualifications and
experience in assessing eligibility for the course.
4. Education and Training
The aim of dental hygienist courses is to develop individuals capable of unsupervised practice
within dental teams, working to the prescription of dentists. The objectives of the course are:
a. To provide a sufficient body of knowledge and understanding to enable dental
hygienists to undertake their prescribed work with care, safety and responsibility and
to recognise the full scope of their remit.
b. To develop a professional attitude relating to the care of all types of patient and
relating to the role of the dental hygienist in the dental team and the whole health care
To this end, courses of education and training should be designed to take into account the
a. The development of an understanding of health in relation to disease.
b. The integration of teaching of basic science with clinical science and practice.
c. The association of training with other members of the dental team.
d. The need for continuing professional education and development.
e. The use of a broad range of educational methods.
A full-time course should extend over a minimum period of two academic years. Where the
course incorporates additional duties, such as those listed (h), (i) and (j) in Section 2, the
course is likely to require more than two years. At least fifty percent of the course should be
devoted to clinical dental practice. In drawing up a timetable provision should be made for
time for private study, revision, and continuous assessment. Ideally training should be
undertaken in institutions alongside the training of other members of the dental team and
should involve all environments relevant to the future work of the hygienist.
5. Course Content
The arrangement of the subjects in the course is left to the discretion of the training body. The
subject divisions shown below are not intended to prevent integration, where appropriate,
between the various subjects and phases in the course.
Trainees will be required to achieve certain minimum standards of knowledge and
competency. The length of training time necessary to achieve these standards will depend on
the teaching methods employed and the existing abilities and knowledge of individual
students. It is for this reason that this document attempts to describe levels of knowledge,
rather than specify minimum training hours to be employed for the various parts of the
Outline guidance in relation to courses is given below.
6. Foundation Course
A Foundation Course outlining the work to be undertaken by the dental hygienist and
including their professional, legal and ethical obligations, Health and Safety issues,
resuscitation and first aid. The precise content of this course will depend on the previous
educational background and experience of students.
An introduction to Teamwork in Health Care, dental auxiliaries and current national and
international trends in the delivery of dental care.
An introduction to patient care and management including the need to follow a written
treatment plan and the need to keep adequate records.
Instruction in information technology skills, including familiarity with computer assisted
7. Cell Biology and General Histology
An understanding of cell biology including the cellular structure and function of human
tissues and organs.
8. General Anatomy and Physiology
A general understanding of all the systems of the body, with a more detailed knowledge of the
structure and function of the following systems: Circulatory system, Respiratory system,
Digestive system, Nervous system, Skeletal system, Lymphatic system, Endocrine system.
9. Regional Anatomy
An overall understanding of the regional anatomy of the head and neck, with increasing
content in relation to the para-oral structures and fine detail of the oral cavity structure.
10. Dental Anatomy
An understanding of:
a. the anatomy and development of the human deciduous and permanent dentitions;
b. the anatomy and development of oral tissues and related structures;
c. the processes of eruption and resorption.
The identification of teeth and the use of current terminology and methods for nomenclature
A knowledge of the morphology of the permanent and deciduous teeth.
11. Oral and Dental Histology and Embryology
An understanding of the histology and embryology of human teeth, their supporting structures
and other oral tissues.
An understanding of the functions of these various tissues.
12. Oral Physiology
An understanding of:
a. the composition and functions of saliva;
b. the processes of mastication and deglutition;
c. the physiology of taste.
13. Diet and Nutrition
A knowledge of the principles of diet and nutrition and an understanding of their scientific
basis with particular reference to:
a. the composition of diet;
b. the relationship of diet to general health, dental and oral health;
c. the role of diet in the aetiology of dental caries;
d. the dietary requirement of groups with special needs and the influence on diet of age,
culture and occupation.
An ability to carry out diet analysis and provide advice and counselling for the prevention of
14. General Pathology
An ability to define the common terms and methods used in pathology.
An understanding of:
a. acute and chronic inflammation;
b. wound healing;
c. routes of spread of infection;
A knowledge of the common pathological conditions relevant to patients‘ medical histories.
A knowledge of the relevant diseases of childhood and their dental implications.
15. Microbiology and Infection Control
An understanding of:
a. the classifications and characteristics of micro-organisms;
b. the relationship between micro-organisms and disease.
A precise knowledge of the modes of transmission of disease.
A detailed knowledge of the principles of infection control and an ability to implement them.
A knowledge of:
a. the legal control of drugs and the principles of pharmacokinetics;
b. the therapeutic agents commonly used in medicine and dentistry with particular
reference to those of significance to the Dental Hygienist.
17. Local Analgesia
A detailed knowledge of the related oral anatomy and nerve supply.
A basic understanding of the physiology of nerve conduction.
A knowledge of the pharmacokinetics and use of local analgesic agents available in dentistry.
An ability to carry out the safe practice of local infiltration techniques.
18. Medical Emergencies and their Management
An ability to recognise potential and actual medical emergencies and to understand their
The ability to follow the necessary procedures to deal effectively with an emergency and to
carry out the technique of cardiopulmonary resuscitation (CPR).
19. Tooth Deposits and Stains
A comprehensive knowledge of dental plaque and its formation and development from a clean
tooth surface until its maturity with special reference to the micro-organisms involved.
A detailed knowledge of the role of plaque in the aetiology of caries and periodontal diseases.
The ability to recognise supragingival and subgingival calculus together with a knowledge of
formation and the various means of detection.
The ability to recognise the common types of intrinsic and extrinsic staining and a knowledge
of their origins and methods of removal.
20. Theory of Periodontal Instrumentation
An ability to describe:
a. the principles of scaling, root planing/debridement;
b. the design of scaling instruments and their use;
c. the action of mechanical scalers, their advantages and disadvantages;
d. the uses of polishing instruments and the different prophylactic pastes available.
21. Dental Caries
A detailed knowledge of the aetiology of dental caries.
A general knowledge of the clinical and histopathological changes that occur in dental caries.
A good understanding of the epidemiology of dental caries relating this to the relevant studies.
22. Periodontal Disease
A full understanding of the causes of all forms of periodontal diseases, including the
initiating, predisposing and systemic factors.
An ability to:
a. classify the different types of periodontal diseases;
b. recognise a healthy periodontium and the clinical changes which occur in the presence
of periodontal diseases;
c. record and monitor various parameters associated with disease activity and its
aetiology, e.g. pocket charting and indices;
d. recognise and distinguish between acute and chronic periodontal disease;
e. recognise those periodontal conditions which necessitate the immediate attention of a
A thorough understanding of the role of bacteria in the pathogenesis of periodontal diseases
and the rationale for all forms of periodontal treatment including the indications for the use of
local delivery antimicrobial agents.
A basic understanding of the role of the immune system and other systemic factors in the
aetiology of periodontal disease.
An understanding of:
a. those factors which adversely affect the prognosis in periodontal disease;
b. the features and aetiologies of lateral periodontal abscesses, apical abscesses (both
acute and chronic) and perio-endo lesions.
An understanding of the basis for epidemiological studies in the provision of oral health care.
A knowledge of the indices used in oral epidemiological studies and an ability to use common
plaque, gingival and periodontal indices.
An understanding of the basic statistical methodology used in the planning and interpretation
of epidemiological studies.
A knowledge of the major epidemiological studies of oral disease, the changing pattern of oral
and dental diseases, and the cause and effect of the changes.
An ability to interpret the findings of epidemiological studies.
24. Dental Public Health
An understanding of:
a. public health measures in the control of disease and the promotion of health;
b. the principles of health promotion, including oral health promotion.
A knowledge of:
a. the structures of public health services;
b. community based oral health initiatives.
25. Oral Pathology and Oral Medicine
A basic knowledge of the aetiology and features of tooth anomalies.
The ability to recognise and ascribe causes for tooth wear (tooth surface loss).
A knowledge of the features and aetiology of oral lesions e.g. ulcers, white lesions etc. and
The ability to recognise the common oral infections.
An awareness of the differing features of benign and malignant lesions and their significance.
A knowledge of the causes, significance and local management of xerostomia.
A basic knowledge of the common causes of facial pain and the relevance of
temporomandibular joint (TMJ) disorders to patient care.
An ability to recognise changes from normal in the oral tissues and seek appropriate advice.
26. General Dentistry
A general understanding of restorative dentistry including prosthetics, implants, orthodontics,
paediatric dentistry and oral and maxillo-facial surgery.
A thorough understanding of the role of the dental hygienist in these areas and in the holistic
care of the patient.
A knowledge of the dental management of patients with special needs (mental, physical,
medical, social) and their care in different environments.
A knowledge of the physiology of ageing and the management problems associated with the
dental care of the elderly.
A knowledge of the principles and problems involved in providing domiciliary dental care.
27. Dental Radiography
A knowledge of legislation and regulations relating to dental radiography and ionising
A basic knowledge of ionising radiation and its effect on tissues.
A full understanding of the hazards involved in dental radiography and the measures to be
taken to protect patient and operator during the taking of dental radiographs.
A knowledge of the different types of radiographs and their uses in dentistry.
The ability to identify the anatomical features and common pathology visible on dental
The ability to interpret dental radiographs, as relevant to dental hygienists.
A knowledge of:
a. the techniques for taking dental radiographs;
b. the principles of processing dental radiographs and the faults which may occur;
c. the importance of quality assurance in dental radiography.
28. Preventive Dentistry
A thorough understanding of the principles of prevention of dental disease with an
appreciation of the dynamics involved including therapeutic, educational, social and
A comprehensive knowledge of:
a. mechanical and chemical plaque control methods, including modified methods for
patients with special needs;
b. the role of fluoride in preventive dentistry; topical and systemic delivery;
c. the principles and methods of dietary control of dental caries;
d. the composition, properties, techniques and uses of fissure sealants and other
preventive materials currently available.
e. the effects of tobacco on the oral tissues.
29. Behavioural Sciences
An understanding of human development with specific reference to:
a. child growth;
b. physical, mental and emotional development.
A sufficient knowledge of psychology and sociology in order to better understand human
behaviour and in particular health behaviour.
An awareness in general of the influence of social, psychological, cultural and environmental
factors on human behaviour and in particular the impact of these factors on oral health and the
delivery of dental care.
A knowledge and understanding of the theories and methodology relating to communication
and of the importance of developing inter-personal skills. An appreciation of the relevance of
listening, and of verbal and non verbal communication.
The ability to recognise potential barriers to effective communication and behaviour
modification, the ability to develop skills to minimise such barriers.
An understanding of techniques for management of the anxious patient.
An appreciation of the relationship between behavioural science and patient education, patient
management and successful teamwork including inter-professional collaboration and
30. Oral Health Education
A detailed knowledge of the principles of education and of the methodology of oral health
education with particular reference to planning, delivery and evaluation.
An appreciation of the fundamental role of communication skills.
A comprehensive knowledge of the scientific basis of oral health education.
An understanding of the relationship of oral health education to general health education.
31. Medical Conditions of Oral Significance
A thorough knowledge of the following:
a. the recording of a patient’s medical history;
b. patients‘ medical conditions which might affect the treatment given by a dental
hygienist or the health of members of the dental team.
An understanding of the oral manifestation of systemic disease.
32. Practical Training
Approximately half the time spent in training should be devoted to practical clinical
Facilities should be available for students to develop their practical skills using phantom head
and other appropriate laboratory aids, prior to working on patients.
The students should be able to identify and select the appropriate equipment, instruments and
materials for the task to be carried out, use instruments safely and effectively, and maintain
them to the required standard.
Students should be able to organise their working environment.
Adequate experience should be provided in the full range of practical procedures as permitted
by the Council’s Regulations including:
a. preventive procedures such as topical fluoride applications and fissure sealant
placement (including the fitting of rubber dam where appropriate);
b. periodontal therapies such as the polishing of the teeth (including teeth previously
filled or crowned), supra and sub gingival scaling, root surface debridement, pocket
irrigation, the placement of sub-gingival anti-microbial agents and the care of dental
c. local infiltration analgesia;
d. radiographic techniques of oral relevance including the taking of periapical, bitewing,
occlusal and panoramic radiographs and the processing of films;
e. measurements and assessments, including periodontal charting and the use of oral
hygiene, gingival and periodontal indices.
Types of Patients
During their training, Student Dental Hygienists should, in association with other members of
the dental team, treat the full range of adult and child patients, including medically
compromised children and adults and those with physical or mental disabilities.
Opportunity should be given for students to work or observe in a variety of working
conditions, such as community dental clinics, in-patient hospital facilities, general dental
practice and the domiciliary setting.
Practical Oral Health Education
Practical participation in the planning, provision and evaluation of oral health education
programmes and the practical demonstration of communication skills with individuals and
diversity of target groups.
33. Preparation for Employment
An understanding of the legal position of dental hygienists, including the type of work they
are allowed to carry out and the areas they are permitted to work in, under the direction and
written prescription of a registered dentist.
An understanding of the standard of conduct expected of dental hygienists and the kind of
behaviour which may be regarded as misconduct.
An understanding of, and the need to comply with, the legal requirement for annual
registration for dental hygienists in employment.
An understanding of the importance for dental hygienists in employment to have membership
with a relevant medical/dental protection agency.
An understanding of the importance of a contract of employment.
An understanding of the role of national and international dental hygienists‘ associations.
A full appreciation of the importance of continuing education, clinical audit and quality
assurance programmes throughout a dental hygienist’s professional working life.
A thorough knowledge of the Health and Safety regulations pertaining to dental practice.
An understanding of the role of the dental hygienist within the framework of a dental team.
There should be a properly integrated series of formative assessments throughout the course
in order to provide students and teachers with an indication of each student’s progress.
Provision should be available in the course to provide additional training for those students
who need it. The final summative assessment must be appropriate to ensure that not only are
the standards achieved sufficient to enable each student to practise legally in their own
country but also that the standards are equivalent to those of hygienists in other European
5. The effect of supragingival plaque control on the progression of advanced periodontal disease.
J Clin Periodontol. 1998 Jul;25(7):536-41.
The aim of the present trial was to study the effect of meticulous supragingival plaque control on (i) the subgingival microbiota, and (ii) the rate of progression of attachment loss in subjects with advanced periodontal disease. An intra-individual group of sites exposed to non-surgical periodontal therapy served as controls. 12 patients with advanced periodontal disease were subjected to a baseline examination (BL) including assessments of oral hygiene status, gingival condition (BoP), probing depth, clinical attachment level and subgingival microbiota from pooled samples from each quadrant. The assessments were repeated after 12, 24 and 36 months. Following BL, a split mouth study was initiated. The patients received oral hygiene instruction, supragingival scaling and case presentation. 2 quadrants in each patient were identified as „test“ and the remaining 2 as „control“ quadrants. Subgingival therapy was performed in all bleeding sites in the control quadrants. Oral hygiene instructions and plaque control exercises were repeated once every 2 weeks during the initial 3 months of the study. Thereafter the plaque control program was repeated once every 3 months for the duration of the 3 years. Sites demonstrating loss of clinical attachment > or =2 mm in the test quadrants were treated subgingivally. The results showed that in both test and control quadrants repeated oral hygiene instructions and supragingival plaque removal procedures resulted in low plaque scores throughout the study. The gingival bleeding scores and the frequency of periodontal pockets > or =4 mm was, however, significantly higher in the test quadrants than in the control quadrants. At the end of the 3 year study, the control quadrants showed significantly more reduced (> or =2 mm) pockets than the test quadrants, 265 versus 96. The number of sites in the test quadrants showing probing attachment loss > or =2 mm was more than 4x greater than in the control quadrants (59 versus 13). The microbiological findings indicate a more pronounced reduction only for P. gingivalis in the control quadrants. None of the other 4 marker bacteria consistently reflected or predicted the clinical parameters. The present study shows that only supragingival plaque control fails to prevent further periodontal tissue destruction in subjects with advanced periodontal disease.
6. Die deutsche Zahnmedizin ist nicht erstklassig, sondern durchschnittlich.
Die Prävalenz parodontaler Erkrankungen inDeutschland ist mit etwa 10 bis 12 Millionen fortgeschrittener
Fälle erschreckend hoch. Demgegenüber ist die Zahl der jährlich über die CKV abgerechneten systematischen Parodontalbehandlungenmit knapp einer Million Fälle lächerlich gering. Es wäre also im lnteresse der Mundgesundheit der Deutschen, dass die deutschen Zahnärzle mehr Parodontitisfälle behandeln.
Was erleben aber niedergelassene Kollegen, die als sogenannter,,Generalist“ oder „Fachzahnarzt“ beziehungsweise „DGP- Spezialistfür Parodontologie@“ parodontale Erkrankungen konsequent therapieren wollen?
Da sie mehr systematische Parodontalanträge stellen und abrechnen als der Durchschnitt, werden die örtlichen KZVen aufmerksam. Die Kollegen , die mehr parodontal therapieren als die Mehrheit der deutschen Zahnärzte, fallen den KZVen somit (negativ) auf. Die Mehrheit der deutschen Zahnärzle rechnet aber nur wenige und gemessen an der Häufigkeit der parodontalen Erkrankungen zu wenige systematische Parodontalfälleab 1,2. Durchschnittlichkeit beherrscht die deutsche,, Kassenzahnmedizin “ !
ln einem Beratungsgespräch der KZV beziehungsweise in einer Wirtschaftlichkeitsprüfung kann es dann schon mal sein, dass eine „DGP-Spezialistin für Parodontologie“ von einem KZVFunktionär den ,,guten“ Rat erhält, sie solle doch nicht so oft beziehungsweise bei so vielen Patienten Sondierungstiefen messen, dann hätte sieauch nicht so viele Parodontitisfälle.
So werden in Deutschland Cesundheitsprobleme von der verfassten Zahnärzteschaft gelöst!
Nicht so oft den Blutzuckerspiegel bestimmen, dann müssen sie auch nicht so viel Diabetes-Patienten behandeln.
So werden Arzthonorare gespart, aber wo bleibt die Cesundheit unserer Patienten? Kann ein krankes System die Gesundheit brewahren? Es bleibt festzuhalten, dass die deutsche Zahnmedizin hinsichtlich der parodontalen Gesundheit der Bundesbürger eine im europäischen Vergleich überdurchschnittlich schlechte Ergebnisqualität
liefert. Das heißt, die parodontale Cesundheit der Deutschen ist schlecht. Das über regionale Durchschnittswerte definierte System der KZVen zementiert den schlechten Status quo und ist völlig ungeeignet gesundheitspolitische Ziele wie zum Beispiel die Verbesserung der parodontalen Gesundheit der Bundesbevölkerung zu fördern.
Oder ist möglicherweise die Verbesserung der parodontalen Gesundheit der Versicherten gar
nicht das Ziel der Kostenträger, KZVen und Cesundheitspolitiker in Deutschland? Aber welche
Ziele haben sie dann …?
Prof. Dr. Peter Eickholz, Frankfurt am Main
1. Micheelis W, Schiffner U (Hrsg). Vierte Deutsche Mundgesundheitsstudie
(DMS lV). Materialienreihe Band 31
des lnstituts der Deutschen Zahnärzte. Deutscher ZahnärzteYerlag
(oAv), xöln, zoo0.
2. KZBV lahrbuch 2OO9. KZBV, Köln, 2O10.
Parodontologie 2O1 1 ;22 (1) :3