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General Practice Residency in Dentistry

The Massachusetts General Hospital General Practice Residency in Dentistry is a one-year program accredited by the Commission on Dental Accreditation (CODA). The residency is structured to provide experience in all phases of ambulatory and inpatient dental care.

Overview

The Massachusetts General Hospital General Practice Residency is a one-year program accredited by the Commission on Dental Accreditation (CODA) with a status of approval without reporting requirements. The residency is structured to provide experience in all phases of ambulatory and inpatient dental care.

To provide a broad educational experience, the training program combines the resources of several Harvard-affiliated institutions: Massachusetts General Hospital, Brigham and Women’s Hospital, and Brigham and Women’s Faulkner Hospital.  Residents complete rotations in oral and maxillofacial surgery, anesthesiology and internal medicine. Lectures, literature reviews and case presentations are scheduled throughout the year.

Our goal is to create an environment for learning that will enable each resident to develop not only clinical dental skills, but also the intellectual skills needed to face the challenges of the future. 


Goals and Objectives

The program will prepare graduates to:

  • Act as the primary care provider, by providing training experiences that refine and advance their knowledge and skills in clinical dentistry, with emphasis on diagnosis, treatment planning and comprehensive dental care
  • Treat a broad range of patients, by providing training experiences that refine residents’ skills in the management of medically-compromised patients, including physical evaluation, risk assessment and understanding of how various medical disorders affect dental treatment planning and care
  • Function effectively in a hospital setting, by providing training experiences in hospital protocol, management of patients in the hospital setting, inpatient rounds and interaction with other hospital professionals
  • Manage dental day surgery patients in the operating room
  • Manage a broad range of acute dental problems
  • Manage oral pathologic conditions including those associated with cancer therapy
  • Apply scientific principles to learning and health care by providing residents with experiences that refine and advance their skills in critical review of dental literature
  • Understand the dental professional’s role in community service by providing a variety of experiences on and off the hospital campus

Supervision and Evaluation

All resident activity is supervised by attending staff either directly with the attending physically present with the resident and patient or indirectly with the attending in the same clinic or hospital, available immediately to supervise directly.  Evaluation of residents occurs after each rotation.  In addition, the director of the program holds formal evaluation sessions with each resident four times per year.  Residents provide formal evaluations of the staff and program at the end of the year.  Based on resident feedback, the program will implement improvements and changes as needed.

 

Competencies

Patient Management

  • Function as a patient's primary and comprehensive oral health care provider
  • Explain and discuss with patients, parents or guardians of patients, findings, diagnoses, treatment options, realistic treatment expectations, patient responsibilities, time requirements, sequence of treatment, estimated fees and payment responsibilities in order to establish a therapeutic alliance between the patient and care provider
  • Treat patients efficiently in a dental practice setting
  • Act in a manner to maximize patient satisfaction in a dental practice
  • Provide dental care as a part of a multidisciplinary health care team such as that found in a hospital, institution, or community health care environment
  • Practice and promote ethical principles in the practice of dentistry and in relationships with patients, personnel, and colleagues
  • Integrate multiple disciplines into an individualized, comprehensive, sequenced treatment plan using diagnostic and prognostic information for patients with complex needs
  • Modify the treatment plan, if indicated, based on unexpected circumstances or patient's individual needs
  • Perform a limited history and physical evaluation and collect other data in order to establish a risk assessment for dental treatment and use that risk assessment in the development of a dental treatment plan.
  • Use accepted prevention strategies such as oral hygiene instruction, nutritional education, and pharmacologic intervention to help patients maintain and improve their oral and systemic health
  • Treat patients with a broad variety of acute and chronic systemic disorders and social difficulties including patients with special needs
  • Develop and carry out dental treatment plans for patients with special needs in a manner that considers and integrates those patients’ medical, psychological, and social needs

Practice Management 

  • Use scheduling systems and insurance and financial arrangements to maximize production in dental practice
  • Use and implement accepted sterilization, disinfection, universal precautions and occupational hazard prevention procedures in the practice of dentistry
  • Provide patient care by working effectively with allied dental personnel, including performing sit down, four-handed dentistry
  • Participate in organized dentistry
  • Evaluate scientific literature and other sources of information to determine the safety and effectiveness of medications and diagnostic, preventive, and treatment modalities, and to make appropriate decisions regarding the use of new and existing medications, procedures, materials, and concepts
  • Demonstrate the application of the principles of ethical reasoning, ethical decision making and professional responsibility as they pertain to patient care, practice management, academic environment, and research
  • Maintain a patient record system that facilitates the retrieval and analysis of the process and outcomes of patient treatment
  • Understand the role of a dentist in community service as a health care provider and educator

Hospital Dentistry

  • Use proper hospital protocol when treating and managing patients in a hospital environment
  • Provide dental treatment in an operating room
  • Provide comprehensive management and care for individual inpatients or same day surgery patients from the beginning to the end of a patient’s hospital experience
  • Perform dental consultations and request medical consultations
  • Select and use assessment techniques to arrive at a differential, provisional and definitive diagnosis for patients with complex needs
  • Use the services of clinical, medical, and pathology laboratories or refer to other health professionals for the utilization of these services

Emergencies

  • Manage intraoral soft tissue lesions of non-traumatic origin
  • Treat patients with intra-oral dental emergencies and infections
  • Anticipate, diagnose and provide initial treatment and follow-up management for medical emergencies that may occur during dental treatment
  • Treat intraoral hard and soft tissue lesions of traumatic origin
  • Perform initial treatment and management of facial trauma

Pharmacology/Anesthesia

  • Use pharmacologic agents in the treatment of dental patients
  • Provide control of pain and anxiety in the conscious patient using techniques involving psychological interventions, behavior management, local anesthesia, oral sedation or nitrous oxide
  • Prevent, recognize, and manage complications related to the use or interaction of drugs, local anesthesia, or conscious sedation
  • Monitor and manage the airway of a semi- or fully unconscious patient

Oral Surgery/Oral Pathology

  • Diagnose and manage common oral pathological abnormalities
  • Diagnose and manage oral manifestations of systemic disease
  • Perform surgical and nonsurgical extraction of teeth
  • Recognize uncomplicated temporomandibular disorders and orofacial pain, making a differential diagnosis, and managing treatment

Clinical Dentistry - Restorative

  • Restore single teeth with a wide range of materials and methods
  • Place restorations and perform techniques to enhance patient's facial esthetics
  • Restore endodontically treated teeth
  • Diagnose and manage a patient's occlusion

Clinical Dentistry - Prosthodontics 

  • Treat patients with missing teeth requiring removable restorations
  • Treat patients with missing teeth requiring uncomplicated fixed restorations

Clinical Dentistry - Periodontics 

  • Diagnose and treat periodontal disease using surgical or nonsurgical procedures
  • Manage periodontal disease in medically complex patients

Clinical Dentistry - Endodontics

  • Diagnose and treat pain of pulpal origin
  • Perform uncomplicated non-surgical anterior endodontic therapy
  • Perform uncomplicated non-surgical posterior endodontic therapy
  • Treat uncomplicated endodontic complications

Quality Improvement

  • Understand the purpose, design, and implementation of quality improvement plans
  • Participate in a quality improvement plan

Curriculum

Massachusetts General Hospital Comprehensive Dental Care

The Massachusetts General Hospital Division of Dentistry is part of the Department of Oral and Maxillofacial Surgery

Dental residents rotate through the two practices of the Division of Dentistry - one in Boston on the main hospital campus and one in Danvers, which is a suburb 19 miles north of Boston.  For this reason, access to a car is advised for residents.

The Boston office is an 11-chair facility with digital radiographs and electronic medical records.  Specialists are available in endodontics, periodontics, prosthodontics, pedodontics, orthodontics, facial pain, and oral and maxillofacial surgery.  Dental residents spend most of the day for six months treating regularly scheduled outpatients for comprehensive care, and the rest of the day seeing inpatients on consultation.  These consultations may be requested by a wide variety of hospital services, including cardiac surgery, hematology/oncology, and neurology.  In addition, residents manage adult and pediatric dental rehabilitation cases in the operating room under direct supervision of an attending dentist.

The Danvers dental office is a 10-chair facility located in a Mass General satellite facility that also houses primary care medicine, pediatric surgery, cardiology, radiation oncology, urology, and obstetrics/gynecology.  The dental practice utilizes electronic medical records and digital radiographs, including CBCT.  Specialists are available in periodontics, endodontics, pedodontics, orthodontics, facial pain, and oral and maxillofacial surgery.  In addition, adult and pediatric dental rehabilitation is performed on a day surgery basis.  In this community setting, residents will spend most of their time, two days each week for five months, providing comprehensive dental care for regularly scheduled outpatients.

Objectives

Residents are expected to:

  • Gain experience in four-handed dentistry
  • Learn the daily operations of a dental practice
  • Gain experience in advanced general dentistry
  • Learn the financial management aspect of patient care
  • Gain expertise in oral diagnosis, oral pathology, and the management of medically-compromised patients
  • Develop skills in communicating with physicians and other health care professionals
  • Become skillful in writing consultation notes and presenting clinical patients for discussion
  • Gain experience in OR dentistry, including review of history, prescribing and performing treatment, and documentation.

Oral and Maxillofacial Surgery Department Rotation

The Mass General Department of Oral and Maxillofacial Surgery has a combined six-year OMFS/MD program and very active outpatient and inpatient services. The oral surgery clinic is an 11-chair facility including 2 IV sedation rooms. The scope of patient care is very broad, including odontectomy, implant placement, biopsy and management of tumors, orthognathic surgery, and oral and maxillofacial reconstruction. 

There are resident-run outpatient clinics every day, attending private patient clinics and IV sedation clinics.  Patients who are referred by or seen in the ED present with a wide range of problems, from odontogenic infection to facial trauma.  OR cases, whether private or “house” cases are attended by OMFS residents and faculty, as well as GPR residents. GPR residents spend the greater part of two months on the oral surgery service as an active member of the surgical team.

Objectives

Residents will:

  • Gain experience in the oral and systemic evaluation and management of the routine and medically compromised surgery patient
  • Gain experience and develop confidence in simple and surgical exodontia
  • Learn operating room protocol
  • Gain experience in the management of intraoral infections, post operative complications, and other oral surgical emergencies

Brigham and Women's Hospital Oral Medicine Rotation

Brigham and Women's Hospital (BWH) is one of the largest tertiary care hospitals in New England and offers training programs in nearly all medical and surgical specialties and subspecialties. The Division of Oral Medicine and Dentistry at BWH is a regional center for oral medicine and mucosal diseases.

The rotation on this service is part-time over the course of a month and emphasizes oral medicine and oral pathology.

Objectives

Residents will:

  • Evaluate, diagnose and manage oral mucosal diseases, atypical facial pain and malignancy
  • Diagnose and treat oral manifestations of systemic disease and oral complications of cancer therapy

Anesthesia Rotation at BWH

Residents are assigned to the Department of Anesthesia at Brigham and Women's Hospital for two weeks. Residents receive instruction on the principles and techniques of general anesthesia from a pharmacological, theoretical and practical standpoint.  

Objectives

Residents will:

  • Become knowledgeable in the preoperative evaluation of the general anesthesia patient
  • Gain exposure to venipuncture
  • Gain exposure to intubation of an unconscious patient
  • Become knowledgeable in airway management and monitoring the unconscious patient
  • Become knowledgeable in the prevention of anesthetic emergencies
  • Assist in the supervising of patient recovery from anesthesia
  • Become knowledgeable in the use and effects of pharmacological agents

Internal Medicine Rotation

The Internal Medicine Rotation is a required two-week rotation on the inpatient Medicine service at Brigham and Women’s Faulkner Hospital in Jamaica Plain. There is a shuttle bus that runs between Brigham and Women’s Hospital and Brigham and Women’s Faulkner Hospital.  Dental residents participate as members of the medical team in the clinical management of patients under the supervision of medical residents and attending physicians. Dental residents also attend teaching sessions, inpatient rounds and conferences.

Objectives

Residents will:

  • Gain experience in history taking, physical diagnosis and appropriate laboratory testing
  • Learn to assess medical problems requiring an inpatient admission
  • Learn risk assessment and medical management of systemic illness

Head and Neck Cancer Rotation

Residents participate part-time for one month on the Head and Neck Oncology team at Mass General, which consists of an ear, nose and throat (ENT) specialist, a medical oncologist and a radiation oncologist. The team sees newly diagnosed patients, follow-up patients and patients actively undergoing cancer treatment.

Objectives

Residents will:

  • Learn the multi-disciplinary nature of head and neck cancer management
  • Learn the basic approach to medical workup, diagnosis, staging and treatment planning of head and neck cancer
  • Gain exposure to the medical and oral complications of head and neck cancer therapy and their management
  • Learn to be part of the multidisciplinary team in evaluating patients, educating patients on the oral complications of head and neck cancer therapy and advising patients on dental management pre- and post- therapy and during therapy

Facial Pain Rotation

Residents will work with attending staff in the Mass General Facial Pain Clinic  one afternoon a week for several weeks. The Facial Pain Clinic treats patients with TMD, MPDS, OSA, atypical facial pain, trigeminal neuralgia and burning mouth syndrome. Residents will assist in the work up and care of patients.

Objectives

Residents will:

  • Learn the work up, diagnosis and treatment of various facial pain entities, including the distinction between TMD vs. neuropathic pain, and the distinction between the TMD pathologies of MPDS vs. arthralgia
  • Learn the medical and psychological disorders that may complicate diagnosis or be a concomitant diagnosis
  • Learn how ancillary services may be helpful in treatment, such as physical therapy and mind-body medicine
  • Learn when to refer to or work with other specialties such as neurology, psychiatry, sleep medicine and pain medicine
  • Gain exposure to the outcomes of treatment, possible complications of treatment and management of those complications

Elective

If scheduling allows, a short elective rotation based on the resident’s professional interest can be arranged. Some examples of elective rotations include: shadowing dental specialists, working with oral public health organizations and shadowing other medical professionals such as ENT surgeons, radiation oncologists and speech pathologists.

Emergency On-Call

Dental residents are on-call for emergencies for patients at the Mass General Division of Dentistry’s two practices. Emergency calls are taken from home and therefore, it is recommended that residents live within a 30-minute commute to Mass General. There is always an assigned attending on back-up call in the event that residents need consultation. Emergency call coverage by dental residents for the Mass General Division of Dentistry is every other week throughout the entire year.

In addition, general practice residents will assist oral surgery residents on emergency call during the oral surgery rotation.  This emergency call duty is done in-house and not taken from home. There are call rooms available for resident use in the hospital.  The range of experience will include odontogenic infection, facial infection, and facial trauma.

Objectives

Residents will:

  • Learn emergency diagnosis and management of acute dental problems
  • Learn emergency workup, diagnosis, and management of facial infection and trauma

Resident Resources

The following resources and benefits are available to residents:

Cost

The Mass General GPR program is affiliated with Harvard University. The University charges residents mandatory annual fees of approximately $1,620 for facilities usage and $1,088 for health coverage.

How to Apply

Application Information

The residency program is highly competitive and continues to attract applicants who have performed well in dental school and have passed Part I of the National Board of Dental Examinations. In addition, we consider letters of recommendation, extracurricular activities and undergraduate performance, and accept results of the Advanced Dental Admission Test.

The program encourages all interested individuals to apply early. We do not discriminate with regard to age, color, gender, national origin, race, religion, sexual orientation, disability or veteran status. 

Application Process

A limited number of applicants are offered interviews and desirable candidates are rank listed in the Postdoctoral Dental Matching Program. Applicants will be notified of their status if they are offered interviews and if they are matched to the program. You are welcome to contact the office for interim status checks.

Please note: This program only accepts graduates of U.S. or Canadian dental schools.

STEP 1 – PASS

The program participates in the ADEA Postdoctoral Application Support Service (PASS), an information clearinghouse. Applicants must submit a completed application by October 19 of the year before the residency is to begin. See the PASS website for information.

Important: Our program requires applicants to submit the following in the PASS application:

  • Essay
  • Dental school transcript
  • Curriculum vitae (CV)
  • Institution Evaluation Form (IEF), which includes NBDE results
  • Four Professional Evaluation Forms (PEFs)
  • Advanced Dental Admission Test (ADAT) score, if taken

STEP 2 – Additional Application Materials Required

In addition to submitting the PASS application, applicants are required to forward the following directly to our program:

  • Undergraduate transcript sent directly from the college or university to the program
  • A 2”x2” photo (digital or hard copy accepted)

These materials should be sent to:

Agnes Lau, DMD
Director, General Practice Residency in Dentistry
Mass General Division of Dentistry
165 Cambridge Street, Suite 401
Boston, MA 02114

STEP 3 – The Match Program

The residency program participates in the Postdoctoral Dental Matching Program. In order to be considered for the residency program, candidates must register with the Match via the PASS website during the application process.

Faculty

View the general dentists and dental specialists at the Mass General Department of Dentistry.

Contact

Agnes Lau, DMD
Director, General Practice Residency in Dentistry
Mass General Division of Dentistry
165 Cambridge Street, Suite 401
Boston, MA 02114

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