General Practice Residency in Dentistry
Sama Abdul-Aziz, DMD
Director, General Practice Residency in Dentistry
Department of Oral & Maxillofacial Surgery, Massachusetts General Hospital
Division of Dentistry, Massachusetts General Hospital
165 Cambridge Street, Suite 401
Boston, MA 02114
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The Massachusetts General Hospital General Practice Residency in Dentistry is a one-year program accredited by the Commission on Dental Accreditation (CODA) with a status of approval without reporting requirements. Every year, two residents are accepted into the program.
The General Practice Residency in Dentistry provides residents with clinical and educational experiences with an emphasis on comprehensive dental care and hospital dentistry. Residents provide longitudinal dental care to their patients throughout the year and become adept at treating patients with complex medical needs. In additional, residents rotate with internal medicine, anesthesia, oral medicine, oral and maxillofacial surgery, orofacial pain and temporomandibular disorders (TMD), and head and neck oncology. There are opportunities for elective rotations which are tailored to individual interests.
Residents work with inpatient medical services as dental consultants, performing consults for admitted patients at the hospital. Common reasons for dental consultation include clearance prior to valve surgery and oncology treatment, bacteremia of an oral source, and endocarditis.
Alongside faculty attendings, residents will see patients in the operating room to provide comprehensive dental treatment while the patient is under general anesthesia. Residents work with faculty who practice in the clinic, including those in general dentistry, prosthodontic, periodontics, and endodontics. Residents learn how to employ four-handed independent clinical practice with the support and guidance of faculty attendings.
Throughout the year, residents attend formal didactic lectures, hands-on learning sessions, and treatment planning conferences. Residents also gain experience reviewing literature and presenting cases to their peers and faculty attendings.
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. We hope to have residents that are interested in immersing themselves with the many learning opportunities this program and hospital has to offer, while also furthering advancing their skills to deliver high-quality comprehensive dental care to patients.
Goals and Objectives
The program will prepare graduates to:
- Act as the primary care provider by providing training that advances their knowledge and skills in clinical dentistry with emphasis on diagnosis, treatment planning, coordination of care, and comprehensive multidisciplinary dental care
- Treat a broad range of patients by providing training that refines their skills in the management of medically compromised patients, including physical evaluation, risk assessment, and understanding how various medical disorders affect dental treatment planning and care
- Function effectively in a hospital setting by providing training in hospital protocol, management of patients in the hospital setting, inpatient rounds and interactions with other hospital professionals as a part of the interdisciplinary team
- Manage dental day surgery patients in the operating room
- Manage a broad range of acute dental problems
- Identify and manage oral pathologic conditions including those associated with cancer therapy
- Manage the delivery of oral health care by applying concepts of patient and practice management
- Understand and utilize the values of professional ethics, patient’s rights, lifelong learning, patient-centered care, and acceptance of cultural diversity to deliver quality care and implement quality assurance practice
- Apply scientific principles to learning and health care by providing residents with experiences that further their skills in critical review of medical and dental literature
- Understand the dental professional’s role in oral health promotion and disease prevention for patients in the clinical setting as well as in the community
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.
- Function as a patient's primary and comprehensive oral health 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
- 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
- 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
- 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
- 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.
- Provide culturally competent care and accept cultural diversity in professional practice
- 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
Hospital Dentistry and Interdisciplinary Care
- Use proper hospital protocol when treating and managing patients in a hospital environment
- 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
- 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
Medical and Dental Emergencies
- Anticipate, diagnose, and provide initial treatment and follow-up management for medical emergencies that may occur during dental treatment
- Treat patients with intra-oral dental emergencies and infections
- Treat intraoral hard and soft tissue lesions of traumatic origin
- Perform initial treatment and management of facial trauma
- Manage intraoral soft tissue lesions of non-traumatic origin
- 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
- 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
Prosthodontics and Implants
- Restore edentulous spaces with partial removable prostheses
- Restore edentulous spaces with uncomplicated fixed restorations
- Develop treatment plans that include implant restorations
- Diagnose and treat periodontal disease using surgical or nonsurgical procedures
- Manage periodontal disease in medically complex patients
- Recognize and manage periodontal emergencies and complications of treatment
Oral Surgery/Oral Pathology
- Diagnose and manage common oral pathological abnormalities, including those related to cancer therapy
- Diagnose and manage oral manifestations of systemic disease
- Perform surgical and nonsurgical extraction of teeth
- Diagnose and manage post-surgical emergencies and complications
TMD, Occlusion, and Orofacial Pain
- Diagnose and manage a patient’s occlusion
- Recognize uncomplicated temporomandibular disorders and orofacial pain, making a differential diagnosis and managing treatment
- 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
- Implement accepted sterilization, disinfection, universal precautions, and occupational hazard prevention procedures in the practice of dentistry
- Maintain a patient record system that facilitates the retrieval and analysis of the process and outcomes of patient treatment
- Provide patient care by working effectively with allied dental personnel, including performing sit down, four-handed dentistry
- 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
- Participate in organized dentistry
- Understand the role of a dentist in community service as a health care provider and educator
- 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
- Understand the purpose, design and, implementation of quality improvement plans
- Participate in a quality improvement plan
Comprehensive Dental Care
Mass General is an 11-chair facility with digital radiographs and electronic medical records. Specialists are available, including those in endodontics, periodontics, prosthodontics, facial pain, and oral and maxillofacial surgery. For six months, dental residents spend most of the day 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.
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
The anesthesia rotation is a required two-week rotation at Mass General. Residents receive instruction on the principles and techniques of general anesthesia from a pharmacological, theoretical, and practical standpoint.
- 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
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, MA. There is a shuttle bus that runs between Brigham and Women’s Hospital in Boston, MA, 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.
- 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
Oral and Maxillofacial Surgery
The Department of Oral and Maxillofacial Surgery at Massachusetts General Hospital has a six-year, combined oral and maxillofacial surgery/MD program. The group is also actively involved in research and teaching oral and maxillofacial surgery to pre- and postdoctoral students from the Harvard School of Dental Medicine. The oral surgery clinic is an 11-chair facility, including two IV sedation rooms. The scope of patient care is very broad, including complete/partial odontectomy, implant placement, biopsy and management of tumors, orthognathic surgery, and oral and maxillofacial reconstruction. Patients who are referred by or seen in the emergency department present with a wide range of problems, from odontogenic infection to facial trauma. OR cases are attended by OMFS residents and faculty, as well as dental residents and student externs/interns. The resident spends one month with OMFS during this rotation.
- 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
The oral medicine rotation is a two-month, part-time rotation with the Brigham and Women’s Division of Oral Medicine and Dentistry that emphasizes oral medicine and oral pathology. Brigham and Women’s is a regional center for oral medicine and mucosal diseases.
- 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
Head and Neck Cancer
Residents will rotate for two months (part-time) with the head and neck oncology team at Mass General, which consists of otolaryngology specialists, medical oncologists, radiation oncologist, and auxiliary providers such as speech language pathologists. The team sees newly diagnosed patients, follow-up patients, and patients actively undergoing cancer treatment. If the patient is newly diagnosed, the medical oncologist presents the case to the team to then examine the patient together. After the team examination, the team discusses the proposed cancer treatment which may include a surgery, chemotherapy, and/or radiation therapy.
- 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 before, during, and after therapy
Orofacial Pain and TMD
Residents will work with orofacial pain specialists and the facial pain fellows. Residents will interview patients with facial pain, perform diagnostic tests, consider anatomic, physiologic, psychological, and neurologic factors when determining a diagnosis, and manage and follow-up with patients. The vast array of patients includes those with TMDs, myofascial pain syndrome (MPDS), obstructive sleep apnea (OSA), atypical facial pain, trigeminal neuralgia, and burning mouth syndrome.
- Learn the work-up, diagnosis, and treatment of various facial pain entities, including the distinction between TMD versus neuropathic pain, and the distinction between the TMD pathologies of MPDS versus 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
Short elective rotations based on the resident’s professional interests 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.
Dental residents are on-call for emergencies for patients of the practice and for inpatients admitted to Mass General. Emergency calls are taken from home and therefore, it is recommended that residents live within a 30-minute commute to the hospital. 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.
- Learn emergency diagnosis and management of acute dental problems
- Learn emergency workup, diagnosis, and management of facial infection and trauma
The following resources and benefits are available to residents:
- Full house-staff privileges at Mass General
- Assistance with housing search and finances
- Access to Harvard University academic and athletic facilities, including Countway Library, one of the largest medical libraries in the world
- Information regarding Mass General resident salary and benefits
The program is affiliated with Harvard University. Mass General provides resident salaries at a competitive rate. The university charges residents mandatory annual fees of approximately $1,620 for facilities usage and $1,088 for health coverage.
How to Apply
The residency program is highly competitive and continues to attract applicants who have performed well in dental school and have passed the Integrated National Board of Dental Examination (INDBE). 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.
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 15 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:
- 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 – 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.
Our general dentists and dental specialists each hold staff appointments at Mass General and faculty appointments at either Harvard School of Dental Medicine or Tufts School of Dental Medicine.
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The 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.