Giddon Donald B, Donoff R Bruce, Edwards Paul C, Goldblatt Lawrence I
Dr. Giddon is Professor of Developmental Biology Emeritus, Harvard School of Dental Medicine; Dr. Donoff is Dean, Harvard School of Dental Medicine; Dr. Edwards is Professor, Department of Oral Pathology, Medicine, and Radiology, Indiana University School of Dentistry; and Dr. Goldblatt is Dean Emeritus and Professor Emeritus, Department of Oral Pathology, Medicine, and Radiology, Indiana University School of Dentistry.
J Dent Educ. 2017 May;81(5):561-570. doi: 10.21815/JDE.016.023.
This Point/Counterpoint acknowledges the transformation of dental practice from a predominantly technically based profession with primary emphasis on restoration of the tooth and its supporting structures to that of a more medically based specialty focusing on the oral and maxillofacial complex. While both viewpoints accept the importance of this transformation, they differ on the ultimate desired outcome and how changes should be implemented during training of dentists as oral health professionals. Viewpoint 1 argues that, in response to a shortage of both primary care providers and access to affordable oral health care, dentists need to be able and willing to provide limited preventive primary care (LPPC), and dental educators should develop and implement training models to prepare them. Among changes proposed are consideration of three types of practitioners: oral physicians with sufficient training to provide LPPC; dentists with excellent technical proficiency but minimal medical and surgical training; and mid-level providers to provide simple restorative and uncomplicated surgical care. Viewpoint 2 argues that the objective of dentists' education in primary care medicine is to help them safely and effectively provide all aspects of oral health care, including appropriate preventive medical care, that already fall within their scope of knowledge and practice. Dental educators should encourage students to use this knowledge to take full ownership of non-tooth-related pathologic conditions of the oral and maxillofacial complex not currently managed in the dental setting, but encouraging graduates to expand into non-dental LPPC outside the recognized scope of practice will only further exacerbate fragmentation of care.
本“观点/反观点”承认牙科实践已从一个主要基于技术的职业（主要侧重于牙齿及其支持结构的修复）转变为一个更基于医学的专业领域，专注于口腔颌面复合体。虽然两种观点都认可这一转变的重要性，但它们在最终期望的结果以及在将牙医培养成口腔健康专业人员的培训过程中应如何实施变革方面存在分歧。观点1认为，鉴于初级保健提供者短缺以及获得负担得起的口腔保健服务困难，牙医需要有能力且愿意提供有限的预防性初级保健（LPPC），牙科教育工作者应制定并实施培训模式来培养他们。提议的变革包括考虑三种类型的从业者：经过充分培训以提供LPPC的口腔医师；技术熟练但医学和外科培训最少的牙医；以及提供简单修复和不复杂外科护理的中级提供者。观点2认为，牙医在初级保健医学方面的教育目标是帮助他们安全有效地提供口腔保健的各个方面，包括已经在其知识和实践范围内的适当预防性医疗护理。牙科教育工作者应鼓励学生利用这些知识，充分负责目前在牙科环境中未得到管理的口腔颌面复合体与牙齿无关的病理状况，但鼓励毕业生在公认的执业范围之外扩展到非牙科LPPC只会进一步加剧护理的碎片化。
