PROSTHODONTICS - American College of Prosthodontists

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The American College of Prosthodontists8. Review the summary information attached as Appendix 1 and 2. This information has beenprovided by the Commission on Dental Accreditation regarding general changes in the languagecommon to all advanced specialty education standards and changes in the specialty’sdiscipline-specific accreditation standards. Please provide an overview comment on futuretrends regarding this information. (Suggested response - up to one page)The ACP is committed to build on the accomplishments achieved over the past tenyears. The specialty of prosthodontics exists because of its strong definition and related CODAeducational standards. The changes in CODA standards reflect the organized effort, whichcontinues to date, to establish a reoccurring agenda through which the predoctoral educatorsand the postdoctoral-advanced program educators meet formally in support of prosthodonticseducational programs. Those committed have assumed a significant responsibility andownership for reviewing CODA accreditation standards and suggesting revisions and updatinginformation for model content and best practices in support of educational activities. These twogroups of educators have committed to monitor the specialty, practice education and treatmentmodalities that relate to our diagnostically focused definition – clinical conditions associatedwith missing or deficient teeth and/or maxillofacial tissues using biocompatible substitutes – inorder to maintain the relevance of our educational programs and accreditation standards.The momentum began as a result of the 2000 Strategic Planning Process in which theofficial definition of Prosthodontics to become a diagnostic-focused definition was approved byCDEL and the ADA House of Delegates in 2003. This definition mandated a careful review ofthe educational programs and accreditation standards and has evolved over the years.Changes made in July 2004-January 2005 were related to implant-supported patient care andassociated formal education in order to increase the level of knowledge and skills in all aspectsof implant-supported education as a core treatment modality for the treatment of partial andcomplete edentulism.The impetus resulted in the Reframing the Future of Prosthodontics Summit in 2005 andin conjunction with the CODA Validity and Reliability Study (2006) and surveys (2006-2007), thespecialty underwent a review of both the discipline predoctoral education and advancedspecialty education accreditation standards. Proposed comprehensive changes to theprosthodontics specialty standards were submitted in July 2007 to CODA and officially updatedin January 2009 (Appended Accreditation Standards, highlighted version). The new standardsmandate oral cancer screening and assessment, as well as include the application andknowledge related to emerging technologies in providing assessment and care for our patients,including evidence based decision making, risk assessment for oral diseases, wound healing aspart of the standards. The oral cancer screening and assessment has been promoted as achange in the predoctoral accreditation standards, likely to have final action at the Summer2010 CODA meeting. With the launch of the Prosthopedia®, the resources are available for allour educators – both predoctoral and advanced education program directors. This reflects thecurrent and projected future for the practice of prosthodontics.The specialty of prosthodontics has been supportive of the CODA “boilerplatechanges” that have occurred over the past ten years, to include changes in advancedstanding and policy on enrollment increases. There has been in-depth discussion on theproposals for changes in definitions related to the levels of knowledge and levels of skills withinthe accreditation standards for specialties since March 2009. In brief, the ACP advancededucation in prosthodontics program directors oppose the proposed changes. The ACPresponded to CODA with a cogent response directed to the CODA Task Force and emphasizedthe statements emphasized within the response. (Reference documents appended, F-CODAAccreditation Standards annotated, G - ACP Resolutions and Comments on CODA ProposedChanges in the Definitions).Prosthodontics - 162010 CDEL Re-recognition of the Specialty Report 16 of 279
Changes in Scope of PracticeThe American College of Prosthodontists9. Highlight recent epidemiological data or studies that establish the incidence and/orprevalence of major conditions routinely diagnosed and/or treated by practitioners in thespecialty. Please provide overview comments on how these changes have affected the practiceof the specialty and the future practice of the specialty. (suggested response - up to fivepages)The data presented will show there is greater need for prosthodontic services, includingcomplex prosthodontics over the next 25 years. The needs for these services will continue toincrease with the growth in the adult population which is the fastest growing segment of the U.S.population. With these factors, the demand for complex prosthodontic services to be providedat the specialty level will also grow dramatically.According to Oral Health–Healthy People 2010: Objectives for Improving Health, 26% ofthe US population between the ages of 65 and 74 are completely edentulous. Other data showsthe prevalence of persons who are edentulous increases with age from 0% of the 18 to 24 yearolds; to 12% of the 50 to 54 year olds; 24% of the 60 to 64 year olds; and 43.9% of those 75and older (Marcus, et al., 1994). The rate of edentulism is estimated at 30% for African-Americans, American Indian, or Alaska Native for this age group, 26% for Caucasians, and 24%for Hispanics. Low-income adults aged 65 and older had the highest rate of edentulism (48% in1993), and there were dramatic differences between similar populations in the fifty states (13%in Hawaii to 47% in Kentucky are edentulous). Low education levels have been found to havethe highest and most consistent correlation with tooth loss. Early loss of teeth has shown to be asignificant factor leading to complete edentulism, with 7.4% of dentate Americans experiencingearly tooth loss becoming edentulous within the next decade. And, while reports indicate a 6%reduction in total edentulism between 1988 and 2002, significant growth in the US populationalong with possible declining access to dental care, shows a tendency for growth of edentulismin one or more dental arches over the next two decades. Based on the multiple factors,edentulous patients will need or demand an increase of approximately 230,000 units ofcomplete dentures per year.When considering complex prosthodontics in a partially dentate or dentate patient, acomplicating factor is the condition of the remaining dentition. The percent of treated anduntreated root caries increases markedly with age (Miller, et al., 1987). Approximately 7% ofdentate adults age 18 to 19 had at least one decayed or filled root surface, whereas, 54.4% of60 to 64 year olds had at least one decayed or filled root surface. Among seniors, 62.6% had atleast one decayed or filled root surface with 38% of these due to untreated decay (White, et al.,1995). Overall, 22.5% of dentate persons had root caries in 1988 -91. Mean root caries scoresincreased with age in every demographic group (Winn, et al., 1996).The data related to tooth loss and tooth retention will have a significant impact on thespecialty of prosthodontics. Based on the data related to edentulism, tooth loss and thecondition of remaining teeth, as well as other factors such as abrasion, attrition, erosion, and theneed for esthetic improvement (Douglass, 1992) coupled with the increase in the adultpopulation, there is an increased need for complex prosthodontics services.On review of three basic demographic trends occurring in the U.S.:(1) the population is getting larger,(2) the population is getting older,(3) the population is becoming more culturally diverse,The combination of these three trends, has a positive impact on the need for prosthodonticservices. Within 20 years the U.S. population is expected to exceed 325 million people. Thetotal U.S. population will therefore increase by 30% from 240 million in 1989 to more than 325million in 2020. Although there will be the same number of young people under age 20 years old(approximately 2 million at each level), they will represent a smaller proportion of the populationbecause of the increased number of older and senior adults. By the year 2020, it is projectedthat approximately 14% of the population will be less than 9 years old, 13% will be 10 to 19Prosthodontics - 172010 CDEL Re-recognition of the Specialty Report 17 of 279
Page 1: COUNCIL ON DENTAL EDUCATION AND LIC
Page 4 and 5: A. General InformationThe American
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30 Clmsjfication ofCom&e Edentulirm
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32 Clarszjicatwn ofcomplete Edeiitu
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Figure 14. Class Ipatient. (A) Pano
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Figure 16. Class KU patient. (A) Pa
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38 Clm$cation of Cumllete EdClass 1
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Figure 4. Class IV palienl. Edenlul
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ORALCANCERSCREENING,EXAMINATIONANDB
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THOSEATRISKFORORALCANCERWhoisatrisk
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ReferencesArbesSJ,OlshanAF.CaplanDJ
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THEPROCESSOFONCOGENESISIntroduction
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withalloftheotherhallmarksinplace,a
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MANAGEMENTOFSUSPICIOUSORALLESIONSIn
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CPE Course History From 2000-2010Da
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Accreditation Standards forAdvanced
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Document Revision History (continue
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Mission Statement of theCommission
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PrefaceMaintaining and improving th
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Definitions of Terms Used in Prosth
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Educationally Qualified: An individ
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Intent: Major changes have a direct
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STANDARD 2 - PROGRAM DIRECTOR AND T
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STANDARD 6 - RESEARCHAdvanced speci
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PROSTHODONTICS - American College of Prosthodontists

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