The General Practice Residency (GPR) in Dentistry is a one-year clinical and didactic program sponsored by Danbury Hospital. The overall objective of the hospital-based residency program at Danbury Hospital is to produce general dentists with a high level of clinical competency that will allow them to care for patients who require an increased reliance on total patient evaluation, alongside their medical colleagues in the health care community.

This broad objective has the following specific goals that each resident is expected to demonstrate upon successful completion of the residency program.

Clinic Schedule

General practice dental residents are assigned to regular clinical schedules from Monday through Friday, for the purpose of direct patient care activities under the supervision of attending staff.

Specialty Schedule

Dental specialty schedules in both clinic and didactics are scheduled during each week on a daily basis. Our Dental Specialty services include:

• Oral and Maxilla-Facial surgery
• Periodontics
• Prosthodontics
• Endodontics
• Pedodontics
• Invisalign Orthodontics

The current schedule is as follows:

Monday am – Prosthetics lecture and clinic Monday pm- General Dentistry
Tuesday am- Periodontics lecture and clinic
Tuesday pm- General Dentistry
Wednesday am- Prosthetics lecture and clinic; Pedodontics lecture and clinic, General Dentistry
Wednesday pm- Oral Surgery clinic
Thursday am- Peridontics lecture and clinic Thursday pm- Endodontics lecture and clinic.
Friday am/pm General Dentistry

Residents provide comprehensive dental services to a broad spectrum of the population, including the mentally, emotionally and physically challenged, and the elderly.

Our scheduled Operating Room experiences are scheduled on Wednesday mornings and encompass treatment for our special needs and medically compromised patients.

Supervision

Attending general practitioners and specialty staff supervise general practice dental residents during the regular hours of operation of the Dental Service.

When on call, residents are responsible to the:

• ED staff
• Oral and maxillo-facial surgeon on call
• The program director or designee

Clinical Environment

All regularly scheduled patients are treated at the Greater Danbury Health Center located at 70 Main St, Danbury, CT

The 5,000 square foot dental facility is fully equipped with:

• Eleven operatories
• Panorex
• Resident office
• Into-oral camera
• Dental laser
• Intra-oral microscope
• Internet access computers
• 3D-printer
• Cerec Scanner and Mill
• Resident Conference Room
• CBCT/Panorex

Rotations in anesthesiology and emergency medicine are completed a mile away at Danbury Hospital.

Educational Goals and Objectives

• Diagnosis and treatment planning relating to a diverse population with special emphasis on development of prognostic skills, risk/benefit and its effectiveness within a framework of informal consent.
• Perform effectively as a dental and interdisciplinary team member in caring for patients at the interface of medicine and dentistry in a hospital setting.
• Critical evaluation of professional literature including presentation to attending staff.
• To attain experience in the medical assessment of patients, which will allow the resident to make decisions on hospital admissions, patient management under general anesthesia in the hospital operating room, and the need for consultation.
• To provide additional responsibilities that broadens resident interest and experience in teaching, administration, research and continuing education.
• Provide the general practice of dentistry consistent with the general/specialty attending staff didactic presentations and clinical supervision.
• Function as an educational resource in the treatment or referral for patients as a community service.

Clinical Goals and Objectives

Rotations

Anesthesia

Residents undergo supervised teaching and performance of goals and objectives while on the Anesthesia rotation. These include:

• Preoperative evaluation
• Assessment of the effects of behavioral and pharmacological techniques
• Venipuncture technique
• Patient monitoring
• Airway management
• Administration of pharmacological agents
• Prevention and treatment of anesthetic emergencies
• Assessment of patient recovery from anesthesia

Emergency Medicine

The goals and objectives of the Emergency Medicine rotation are designed to evaluate the resident’s ability to:

• Attain a comprehensive medical assessment
• Perform physical examination
• Review data and laboratory studies
• Arrive at therapeutic decisions based on available evidence, sound judgment and patient preferences
• Demonstrate respect, compassion, integrity and honesty, always considering the needs of patients, families and colleagues

Medicine

The program provides formal instruction and supervised clinical experience in physical evaluation and medical risk assessment, including:

• Taking, recording and interpreting a complete medical history
• Understanding the indications of and interpretations of laboratory studies and other techniques used in the diagnosis of oral and systematic diseases
• Understanding the relationship between oral health care and system diseases
• Interpreting the physical evaluation performed by a physician with an understanding of the process, terms and techniques employed
• Using the techniques of physical examination (i.e., inspection, palpation, percussion, and auscultation)

Dental Specialties

Endodontics

Goals and Objectives

• Identify indications and contraindications for endodontic therapy
• Identify risk and benefits of treatment options
• Perform endodontic therapy for a wide-ranging population having multiple dental needs
• Become proficient in rotary endodontics
• Understand the needs for and rationale for pediatric pulpal therapy
• Referral to specialist when appropriate for assistance or treatment

Outcomes

• Identify indications and contraindications for endodontic therapy
• Identify risk and benefits of treatment options
• Perform endodontic therapy for a wide-ranging population having multiple dental needs
• Demonstrate rotary endodontics
• Understand the need for and rationale for pediatric pulpal therapy
• Referral to specialist when appropriate for assistance or treatment

Oral Surgery

Goals and Objectives

• Obtain useful medical history, access vital signs, perform routine examination, order tests and lab work, and interpret those portions of the medical record necessary to satisfactorily comprehend the patient’s medical status and provide safe, appropriate dental management
• Provide appropriate treatment for dental care, taking into consideration medical, dental and psychosocial components of a diverse patient population
• The resident will be competent in: medical history taking, history and physicals, orders and dictation, admission planning, scheduling procedures and interacting with outside agencies
• Become proficient in prescribing medications at appropriate therapeutic levels for a broad-based patient population
• Resident will be able to visually see and demonstrate implant prosthetics on models; choose fixture types and find restorations
• Discern the rationale for implant placement
• Medical history review for implant placement
• Types of fixtures
• Fixed and removable implant uses
• Order and understand and assess lab values
• Perform routine exodontias
• Demonstrate proficiency in third molar extraction
• Identification of oral pathology
• Recognize need for referral
• Assist and place implants

Outcomes

• Place/assist Bone grafts & membrane/Perform sinus lift with surgeon.
• Assess patient status (medical, dental, psychosocial)
• Treat the anxious patient via oral or inhalation therapy in combination with local anesthetics

Invisalign

Goals and Objectives

• Residents with their attending(s) will diagnose, scan and treat simple invisalign cases.

Outcomes

• Residents will be able to recognize orthodontic needs in a variety of patient populations
• Clinical assessment, diagnosis classification, referral, and simple removable appliances

Pedodontics

Goals and Objectives

• Identify emergency treatment, dental anatomy
• Use of pediatric antibiotics and analgesic therapy
• Identify and treat nursing bottle syndrome
• Proficiency in pedodontic medical risk assessment
• Interpret the need and use of sedative agents

Outcomes

• Pediatric patient diagnoses encompassing operative treatment are taught throughout the year
• Residents will be able to demonstrate management techniques, restorative care and indicate patient referrals
• Utilize behavior management techniques

Periodontics

Goals and Objectives

• Understand and recognize healthy and diseased periodontium
• Formulate a treatment plan to treat simple to advanced cases

Outcomes

• Accurately describe the histological, anatomical, and physiological characteristics of periodontal disease
• Diagnose the extent of the disease process, develop a treatment plan, implement treatment and evaluate outcomes at a satisfactory level
• Demonstrate satisfactory proficiency in the following procedures:
  • Debridement: scaling and curettage, management of infections
  • Periodontal surgery:
    • Full and partial thickness mucogingival flaps
    • Free gingival grafts
    • Sliding flaps
    • Tissue contouring (soft, osseous)
    • Root amputations/hemisections
    • Stabilization of teeth
    • Suturing and packs
  • Occlusal adjustments
• Preventive services personally and via the use of auxiliary personnel

Prosthetics

• Define the interrelationships between Periodontics, Oral Surgery, Endodontics, and Prosthodontics
• Develop ideal treatment plans, including fixed/removable prosthetics and implant restorations
•  Understand the interrelationships between the periodontium and prosthetics
• Identify options and risks
• Successfully examine, diagnose, treatment plan and implement steps which will result in effective and
  satisfying prosthetic appliances and restorations
• Utilize and become proficient in Cerec scanning and designing fixed restorations
• Become proficient in designing and milling of Cerec
  restorations including EMAX, Ceresmart, and Zirconium crowns

Dental Implants

• Discuss the rational for implant placement
• Medical history review for implant placement
• Ideal placement of implant via models, xrays, and СВСТ
• Assist/place implant with the direction surgeon
• Restore implants with Prosthetic and General attendings
• Utilize models and scanner/CBCT to directly fabricate surgical guides with the 3 D Printer

This one-year program is accredited by the Commission on Dental Accreditation of the American Dental Association and is designed to meet their standards. A diploma certificate is awarded upon completion of the program. Currently, the program accepts four residents per year.

The clinical and didactic component of the program is located at the Greater Danbury Health Center in downtown Danbury, Connecticut. Residents have extensive opportunity to provide comprehensive dental services to a broad spectrum of the population, including the mentally, emotionally and physically challenged and elderly. The variety of dental cases treated include preventive services, emergency service, oral surgery, routine operative, endodontic, periodontic, pediatric, limited orthodontics and operating room dentistry and services for those with disabilities. Rotations in Anesthesiology and Emergency Medicine are completed at Danbury Hospital, one mile away from the Greater Danbury Health Center. The rotation in Medicine is completed at the Center.