General Practice Residency in Dentistry

• 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

• 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 

• 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

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 

Prosthodontics and Implants 

• Restore edentulous spaces with partial removable prostheses 
• Restore edentulous spaces with uncomplicated fixed restorations 
• Develop treatment plans that include implant restorations 

Periodontics 

• 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

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.

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

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.

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

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.

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

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.

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

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.

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 before, during, and after therapy

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.

Objectives

Residents will:

• 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.

Objectives

Residents will:

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

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:

• 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

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.