Dentistry throughout the world

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview

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Dentistry throughout the world is practiced differently, and training in dentistry varies as well.

## Dentistry in Australia

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Australian dentistry is overseen by the Australian Dental Association, while specialization is overseen by the Royal Australasian College of Dental Surgeons. Dentists trained in Australia must meet the entry requirements of one of the Australian institutions offering dental courses, and then complete the required full-time academic training leading to a dental degree. If dentists wish to specialize, they must complete extra study after having had clinical experience.

In order to practice dentistry in Australia, you must be registered in the particular State in which you intend to practice. Registration requirements vary from State to State. Generally, the only persons immediately entitled to apply to be registered as dentists are persons holding the qualifications of BDS, BDSc, BDent from the Australian, New Zealand universities. Usually registration will not be granted to a foreign graduate until he or she is a resident in the State, holds a visa approved for employment, and has passed the ADC examinations and/or completed a 2-year advance standing program in order to obtain a locally accredited dental qualification.[2]

The Universities of Adelaide, Melbourne, Queensland, Western Australia, LaTrobe, and Griffith University all offer undergraduate dental degree courses of 5 years in length. Sydney University offers a graduate entry program which is 4-years duration and requires a previous bachelors degree for admission (Melbourne University also will be transitioning to a 4-year graduate entry dental program by 2010). Charles Sturt University and James Cook University dental schools will commence in 2009. The qualifications awarded by these schools satisfy the formal academic requirements for registration of all Australian Dental Boards.

###  Australian dental schools

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* University of Adelaide
* Griffith University
* University of Melbourne
* University of Sydney
* University of Queensland
* University of Western Australia
* Latrobe University
* Charles Sturt University

## Dentistry in New Zealand

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New Zealand dentistry is overseen by the New Zealand Dental Association[3], while specialization is also overseen by the Royal Australasian College of Dental Surgeons.

University of Otago is New Zealand's only dental school that offers the required academic training. Entry into New Zealand's only dental school requires the student to compete into the second year dentistry course via the Health Sciences First Year course[4]. Once in the course, students will start their dental education in their second year of University study. The total time to complete the course, including the first year competitive course, is 5 years of full-time academic study.

## Dentistry in Canada

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Canadian dentistry is overseen by the Canadian Dental Association, while specialization is overseen by the Royal College of Dentists. Today, Canada has about 16,000 dentists. Canadian dentistry is not publicly run (see Medicare (Canada)); however, some provinces[5] provide for free dental care for children and the elderly. Other Canadians are mostly covered by workplace dental plans, but many have to pay out-of-pocket.

For most of the early colonial period dentistry was a rare and unusual practice in Canada. In severe situations, barbers or blacksmiths would pull a tooth, but for many years Canada lagged behind European advances. The first dentists in Canada were United Empire Loyalists who fled the American Revolution. The first recorded dentist in Canada was a Mr. Hume who advertised in a Halifax newspaper in 1814.

During the first half of the 19th century, dentistry expanded rapidly. In 1867 the Ontario Dental Association was formed and in 1868 they founded Canada's first dental school in Toronto, the Royal College of Dental Surgeons of Ontario. The University of Toronto agreed to be affiliated with the dental school. As time passed, other Canadian universities also created dentistry programmes. However, the University of Toronto still has the largest dental school in Canada that features the most postgraduate research opportunities as well as certifications for all the dental specialties.

Dental care is not covered by the Canadian health care system, as it is in many other countries with public health care.

### Canadian dental schools

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* University of Toronto (1868)
* McGill University (1905)
* Université de Montréal (1905)
* Dalhousie University (1908)
* University of Alberta (1923)
* University of Manitoba (1958)
* University of British Columbia (1964)
* University of Western Ontario (1966)
* University of Saskatchewan (1968)
* Université Laval (1971)

## Dentistry in Chile

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The first dental school was established at the Universidad de Concepción in the year 1919. Other institutions providing professional dental education in Chile are Universidad de Chile, Universidad de Valparaíso, Universidad de Talca, Universidad Nacional Andrés Bello, Universidad Mayor, Universidad de los Andes, Universidad Diego Portales and Universidad de Antofagasta.

## Dentistry in Costa Rica

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Dentistry is overseen by the Colegio de Cirujanos Dentistas de Costa Rica. Dentists complete 6 year courses from the University of Costa Rica in D.D.S. (Doctor of Dental Surgery), or similar courses from various private universities. Costa Rica is often cited as being one of the top ten countries in the world for medical tourism, including dentistry.

## Dentistry in Hong Kong

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To become a dentist in Hong Kong, one must complete the 5-year B.D.S. course in The University of Hong Kong. Students learn basic health sciences, dental sciences under the Problem Based Learning policy. Besides, formal training and supervised practice are prescribed. It is accepted that only after 5 years of such training would the trainees achieve a superior level of professional competence.

Graduates can enter general practice or pursue a specialist M.D.S. degree after gaining one to two years of working experience.

Before the dental school was established in the University of Hong Kong(in 1980), most of the practicing dentists obtained their dental degree from the Philippines.

## Dentistry in India

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Modern Indian dentists must earn the Bachelor of Dental Surgery degree (B.D.S.), which requires four years of study and one year of internship. This degree is overseen by the Dental Council of India In most states, one has to appear for an entrance test conducted by the Directorate of Medical Education, whereas some autonomous universities conduct their own entrance tests. Post graduate courses (Master of Dental Surgery. MDS) are also available in different specialities. It requires 3 years of study after BDS.

The Master of Dental Surgery is available in the following specialities - Orthodontics, Oral and Maxillofacial Surgery, Conservative and endodontics, Periodontics, Prosthodontics, Pediatric Dentistry, Oral Pathology, Oral medicine and Radiology, Community Dentistry. Although many institutions are offering other short or long courses in Dental Implantology and Esthetic Dentistry, These are yet to be regularised by the Council.

Besides Certificate courses are also offered in Dental Mechanics and Dental Hygiene. These are two year certificate courses. Dental Mechanics offers knowledge about Prosthodontic appliances to be fabricated in a dental laboratory while a Dental Hygienist deals with clinical part, viz scaling, polishing, et.al.

The First Dental College of India was established in Calcutta presently Kolkata in the year 1924. It was then called Calcutta Dental College and Hospital and was constructed single handedly by Dr.Rafiuddin Ahmed without any government aid. Incidentally it was the first Dental College to be established in Asia.

After his death on 9 February 1965 the college was renamed after him. After that many Other Dental Colleges have come up in India.

## Dentistry in Iran

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In Iran dentists require six years of post secondary education. The whole program is one single degree of D.D.S. (Doctor of dental surgery). After this, those wishing to specialize in a particular field may pursue higher education. Upon graduation, a dentist may need to fulfill a two year military requirement (as a dentist in uniform) in order to start in private practice. There are many dental schools but two of the most notable are:

* University of Tehran (School of Dentistry .1939) [6]
* Dental School of Shahid Beheshti University

## Dentistry in Italy

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In Italy dentists complete 5 years of undergraduate study to earn a degree. Nevertheless it is possible to agree on certain basic clinical competences common to all member states of the European Union.

The following is an example of one such clinical competency (excision of a buried tooth root): If a clinician is deemed to be clinically competent in the surgical removal of a buried root, this implies much more than the technical and surgical ability required to excise a buried piece of root from alveolus. It embraces a broad range of pre-clinical and clinical knowledge and understanding on which surgical treatment is based.

## Dentistry in Malta

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The first course leading to a degree in Dental Surgery, at the University of Malta, commenced in 1933. The qualification was recognized by the Medical Council of the United Kingdom in 1936.

Dental Surgery was established as a separate Faculty in 1954, previous to which the course was under the direction of a Board of Studies within the Faculty of Medicine and Surgery. The Faculty caters for an undergraduate intake of 8 students annually. A B.Ch.D Degree is awarded at the completion of the 5 year course.

## Dentistry in Mexico

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Dental care in Mexico is considerably less expensive. Many travel yearly to Tijuana for quality care but one must research and exercise care. See Dentists in Tijuana.

## Dentistry in Norway

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The 5-year dental education is offered at three universities:

* University of Oslo
* University of Bergen
* University of Tromsø

All dentists in Norway are organized through "Tannlegeforeningen". Dental services are free for children.

## Dentistry in Pakistan

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History of dentistry in Pakistan starts even before its birth. Pakistan's premier and oldest dental institution 'de'Montmorency college of Dentistry' was established in 1934 at Lahore by then Governor of Punjab Sir Jeff Fitz Harway de' Montmorency. It was the only dental college at the time of partition of subcontinent that existed in this part of the world,today which we know as Pakistan. de'Montmorency College of Dentistry as a very rich heritage of academic and clinical excellence both before and after independence. History of dentistry in Pakistan is in fact story of progress of de'Montmorency College of Dentistry. At present there are upwards of 20 dental schools (public & private) throughout Pakistan, according to the Pakistan Medical & Dental Council the state regulatory body has upwards of 6200 registered dentists. The four year training culminates in achieving a Bachelor of Dental Surgery (BDS) degree, which also requires a one year compulsory internship to be a registered dentist in Pakistan.

Dental schools in Pakistan

* Fatima Memorial Hospital College Of Medicine And Dentistry
* de'Montmorency College of Dentistry, Lahore
* Dental Section Nishter Medical College, Multan
* Dental Section Jamshoro Medical College, Hyderabad
* Dental Section Khyber Medical College, Peshawer
* Dental Section Ayub Medical College, Abbotabad
* Dental Section Bolan Medical College, Quetta
* Hamdard University
* Baqai University
* Fatima Jinnah Dental College
* Altamash Institute of Dental Medicine
* Lahore Medical and Dental College
* International Islamic University Islamabad

## Dentistry in the Philippines

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Most Filipino Dentists must earn a total of 6 years of dental school (2 years preparatory; 4 years proper) to obtain the degree Doctor of Dental Medicine (D.M.D.). Presently, the country has a total of 17 dental schools, in which the board licensing is administered and regulated by the Board of Dentistry of the Professional Regulation Commission. Centro Escolar University is noted to have the largest enrollment of Dentistry students every year in the country.

* Ago Medical and Educational Center
* Cebu Doctors University
* Centro Escolar University
* Davao, Medical School Foundation
* De Ocampo Memorial College
* Emilio Aguinaldo Colleges
* Our Lady of Fatima University
* Iloilo Doctors College
* Lyceum of Batangas
* Lyceum Northwestern
* Manila Central University
* Medina College
* Mindanao Medical Foundation
* Misamis University
* National University
* Pines City Educational Center
* Southwestern University
* Unciano Paramedical Colleges
* University of Baguio
* University of the East
* University of Perpetual Help
* University of the Philippines
* University of the Visayas
* Virgen Milagrosa University Foundation

## Dentistry in Slovakia

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In Slovakia, dentists complete 6 years of undergraduate study to earn a MUDr (lat. Medicinae Universae Doctor) degree. Dental education is offered at two universities: Comenius University in Bratislava and University of Pavol Jozef Safarik in Košice. Junior graduates work under a skilled doctor for at least 3 years to receive their license from The Slovak Chamber of Dentists. Part of dental service is paid from health insurance but mostly treatment (fillings, prosthodontics) is paid cash by patient.

## Dentistry in Sweden

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The 5-year dental education is offered at four universities:

* University of Malmö http://www.mah.se/templates/Page____13098.aspx
* University of Gothenburg http://www.odontology.gu.se/
* Karolinska Institutet, at Huddinge Hospital http://ki.se/ki/jsp/polopoly.jsp?d=1524&l=en
* University of Umeå http://www.odont.umu.se/index_eng.html

Most dentists in Sweden are organized through "Tandläkarförbundet" which also issues the scientific 'Swedish Dental Journal': http://www.tandlakarforbundet.se/swe/default.asp.

Dental care is provided at public and private dental offices. Dental services are free for everyone up to 20 years of age. From the age of 20 and upwards there is a fixed state refund which usually is, depending on the dentist's fee and what type of dentistry performed, around 10 % - 15 % of the total cost. For more expensive dental work above the age of 65 the patients only pay 7800 SEK (~ $1,000) plus the cost of the dental material that was used.

The English title given to dental graduates in Sweden is D.D.S (Doctor of Dental Surgery)

All dentists in the European Union/EES are elegible to work in Sweden. Dentists with an exam outside EES are required to take a one year course at Karolinska in Stockholm.

## Dentistry in Taiwan

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After graduating from high school, students are required to take a 6 year dental program to get their D.M.D. degree. The first dental school in Taiwan belonged to the College of Medicine at National Taiwan University. There are currently 7 dental schools in Taiwan:

* China Medical University (Taiwan)
* Chung Shan Medical University
* Fu Jen Catholic University
* Kaohsiung Medical University
* National Cheng Kung University
* National Defense Medical Center
* National Taiwan University
* National Yang Ming University
* Taipei Medical University

## Dentistry in the United Kingdom

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File:Dentistry.jpgAn NHS dentist performing an examination

In the United Kingdom, dentists complete 5 years of undergraduate study to earn a B.D.S. or BChD degree. After graduating most dentists will enter a V.T. (vocational training) scheme, of either 1 or 2 years length, to receive their full National Health Service registration. Dentists must register with the G.D.C. (General Dental Council), and meet their requirements as the governing body of the profession, before being allowed to practice.

## Dentistry in the United States

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In the United States dentistry is generally practiced by dentists who have completed a post-graduate course of professional education. With exception of rural Alaska, Dental therapists, technicians without medical training, are not permitted to practice in the United States. Use of dental therapists or dental hygienists to independently perform routine fillings or cleaning is strongly opposed by the American Dental Association, (the A.D.A.), the dentists' professional association. This has resulted in excellent but high-priced treatment which, however, fails to delivers services at a reasonable price to the lower social classes. With only a few exceptions, neither government-sponsored health care programs such as Medicare nor Medicaid cover routine dental treatment. As a result large sections of the population do without.[1][2] The worst conditions are in Kentucky and West Virginia.[3]

Rates for dental services have been rising rapidly, out pacing the rate of inflation. After falling for many years, the percentage of both adults and children with unfilled cavities began to rise in 2000 as did the percentage of adults with no teeth. Increasingly, people with adequate income to pay the fees are forgoing treatment.[1][2]

### Dental technicians

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Outside the United States, more than 50 countries allow technicians called dental therapists to drill and fill cavities, usually in children. In the U.S., state boards of dentistry have blocked dental therapists from working, arguing that only dentists should be allowed to drill teeth, because it is an “irreversible surgical procedure” and "can lead to serious complications like infections or nerve damage".[1]

### Dental education in the United States

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There are limited opportunities for dental education in the United States with only 4,440 graduating in 2003, down from 5,750 in 1982. There is little or no movement on the part of the American Dental Association, the ADA, or the states to expand dental education. Due to the hands-on training required, dental education is expensive and is not subsidized by the federal government.[1][2]

In the United States, dentists earn either a D.D.S. (Doctor of Dental Surgery) or D.M.D.(Doctor of Dental Medicine) degree. There is no difference in the training for either degree. The degrees are equivalent, and recognized equally by all state boards of dentistry. There are 56 Accredited Dental schools in the United States requiring 4 years of post graduate study (except for one unique 3 year program at the University of the Pacific)[7]. Most applicants to dental school have attained at least a B.S. or B.A. degree, however, a small percentage are admitted after only fulfilling specific prerequisite courses. So unlike many other countries (other than US, Canada, and Australia), it usually takes more than 8 years to become a dentist. (List of dental schools in the United States) The difference relates to the history involved in the division of medicine and surgery in medical practice. There has been a recent movement to include a 5th year of education that focuses on purely practical training in the clinical setting. In at least one state, New York, a state dental license can be received without taking the licensing exam (State Board Exam) upon completing this additional year of training (usually in the form of a GPR or AEGD).

Licensure is organized on three levels in most areas. All dentists must pass National Boards, Regional Boards, and then take a jurisprudence exam accepted by their state to fulfill their requirements to get a state license. Although a state license is only valid in the issuing state, because of the regional boards a dentist may be able to apply for licensure in any other state within the jurisdiction of their regional board. There are many cooperative agreements between states that allow recognition of another state's license so as to procure a license either via "licensure by credentials" or "licensure by reciprocity." Although a national licensure exam has yet to be made, the American Dental Association (ADA) has worked with education and examining groups to form such an exam.[8]

A dentist may go on for further training in a dental specialty which require an additional 1 to 7 years of post-doctoral training. There are 9 recognized dental specialties. They are Endodontics (root canal treatment), Oral and Maxillofacial Pathology, Oral and Maxillofacial Radiology, Pediatric Dentistry, Periodontics (gums), Prosthodontics (complicated dental reconstruction), Orthodontics (moving teeth), Oral and Maxillofacial Surgery (tooth removal and surgery of the oral and facial structures), and Dental Public Health. There is no specialty in esthetic dentistry or implantology, and no additional training is required for a dentist to make the claim of being an esthetic or cosmetic dentist. Dentists are forbidden to claim that they are specialists in areas of practice in which there is no recognized specialty. They may limit their practices to a single area of dentistry, and claim that their practice is limited to that area.

Any general dentist may perform those procedures designated within the enumerated specialties if they deem themselves competent. Many general dentists train in certain aspects of the above specialties such as the placement and restoration of dental implants, advanced prosthodontics and endodontics, and have limited or heavily focused their practices to these areas. When a general dentist performs any procedure that falls within the realm of a specialty, they are expected to perform with the same level of expertise as a certified specialist and are legally held to such standards with respect to any issues of malpractice.

## Notes

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1. ↑ 1.0 1.1 1.2 1.3 Alex Berenson, "Boom Times for Dentists, but Not for Teeth", New York Times, October 11, 2007
2. ↑ 2.0 2.1 2.2 Wikinfo article "Dentistry in the United States"
3. ↑ "In Kentucky’s Teeth, Toll of Poverty and Neglect" article by Ian Urbina in The New York Times December 24, 2007

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