3.

6 PRACTICE MANAGEMENT

The curriculum states that its graduates must have the following

Skills:
A. Design treatment plans proposing an adequate multidisciplinary
approach.
B. Maintain clear and precise communication with patients and peers in the
health field.
C. Establish efficient administration of a private dental practice.
D. Deal with and apply sanitary regulations as well as those related with the
profession.

In addition, among the Attitudes and Values that they should possess, graduates
should be methodical and ordered in order to function effectively as professionals.

One of the policies that State University of Medicine and pharmacy “Nicolae
Testemitanu” pursues in all the courses it offers is to promote among graduates the
concept of self-employment, which is to say, a spirit of enterprise, so that on
graduation they may enter into business for themselves. The course as
Management of stomatological services and health economy in dentistry seek to
awaken in students, not only an awareness of how to manage and administrate
their future practices as successful businesses, but also a more profound
realization and sense of responsibility as generators of employment. The intention
is, furthermore, that graduates enjoy the highest level of competence, that they be
able to analyze the conditions prevailing in their environment and find and create
the best opportunities to set up a business, i.e. a clinic or private practice, using
strategic planning that will enable sustained growth and permanence in a highly
competitive market.

Equally, the courses Comprehensive Dental Care Clinic I to VII, all complement the
development of knowledge, skills and attitudes necessary for students to analyze
different care models and participate in group activities aimed at finding solutions
to people’s dental and oral problems. Clinical practice is where students are taught
time management and task and resource administration in order to implement
Treatment Plans, arrange appointments, supervise payments, etc. In these clinics
the intention is also to develop the leadership skills needed to have a successful
career once their time at university has ended.

During the development of clinical practice, students learn to work in teams

providing oral health care to patients. The intention is to create awareness of the
importance of setting goals, delimiting functions, coordinating work and developing
interdisciplinary work skills.
During the first years of clinical practice, students function as part of a team given
elementary responsibilities related to the development of patients’ Treatment
Plans. As their education progresses, each becomes leader of a work team, an
experience of great value for their future professional development. For the first
two semesters, students work in the Clinic as assistants to their classmates in
more advanced semesters (Four Hands Technique). From the 3rd semester, they
form part of a patient care team, led by a student from the 8th semester. Their
participation is limited to simple activities, such as taking X-rays, processing
models, arranging appointments, etc. By the 4th semester, when they take
Comprehensive Dental Care Clinic I, they are able to open and review patients
records and assist chair side. In the 5th semester they take Comprehensive Dental
Care Clinic II, where they carry out more complicated operating procedures in
Periodontics and surgery and begin with uncomplicated fixed prosthesis
rehabilitation. By the time they take Comprehensive Dental Care Clinic III, in the
6th semester, their rehabilitation skills have grown and they are carrying out pre-
prosthetic procedures, total and removable prosthesis, and some simple
endodontic treatments. In Comprehensive Dental Care Clinic IV (7th semester,
start of senior year) students work on tasks in Multidisciplinary Dentistry for specific
groups and begin to treat children and adolescents as well as older patients; work
that will develop in complexity as they move to Comprehensive Dental Care Clinic
V-VII
Students' Clinical Experience:

In the first 4 semesters, students receive information on the states of health and
sickness in the human body, as well as their most frequent oral, dental and
periodontal manifestations, with an emphasis on clinical diagnosis and treatment.
At the same time, preclinical diagnostic activities which relate to the teeth and the
periodontium are taught for later application in clinical practice. Students are given
information on the basic principles of radiation and the interpretation of X-ray
images in order to relate them to dento-maxillary pathologies for their use in dental
diagnosis. In addition, students identify the main systemic disorders relevant to
dental practice as well as the appropriate management of patients with medical
problems, designing treatment plans not only for otherwise healthy patients, but
also for the medically compromised.

Theoretical knowledge and preclinical courses instruct students in the methodology

and techniques for assessing patients in such a way that all areas of knowledge
are integrated and they are capable of performing diagnosis. In the Admissions
Department, fourth semester students apply the knowledge acquired over the three
previous semesters and develop the skills and behaviors necessary to assess and
diagnose patients. In doing so they begin the process of demonstrating
competence in the following areas:
1. Questioning.
 A health and clinical history questionnaire is administered to patients in
order to obtain information on their medical histories, this questionnaire has
to be filled out clearly and completed legibly by hand

2. Vital Signs
Measurement of arterial tension and pulse. The data obtained is recorded in
the patient’s file, the vital signs are taken and interpreted in order to classify
the patient accordingly.
When the medical history shows a patient with an uncontrolled disease, the
student classifies this patient as Type III and refers him or her to a
consultation with a physician in order to clarify the status of the patient with
regard to this illness or to request medical or laboratory tests that will
provide a basis on which to determine the extent to which the illness is
under control. The student duly notes this in the medical record. If patients
can demonstrate convincingly that their medical condition will have no
impact on, or impede the provision of dental care, the students proceed to
perform an intra- and extra-oral examination.
3. Perform the extra-oral evaluation of head and neck structure
This will describe any alterations observed in the general appearance of
patients’ head, neck and face, recording any data found in the clinical history
form provided.

4. Perform an intra-oral exploration.

Observing and palpating tissues: oral mucosa, lips, tongue, palate, floor of
mouth, oropharynx. Students observe the state of dental hygiene and
examine the dental organs, taking note of its number, absences,
pigmentation, lesions, irregularities, occlusion, etc. Findings are recorded
on the clinical history form, in the section of clinical exploration, while any
problems encountered are shown on the tooth diagram.
5. Request panoramic and intra oral X rays.
With prior authorization from the clinic professor, the student takes 2
interproximal X-rays and then sends the patient to have an
orthopantomogram. If the X rays are clear, sharp, have good contrast, are
well processed and from the correct angle, they should be placed in the X
ray frame. The student interprets the X-rays, assessing the degree of
normality or abnormality of the bone and dental structures as well as the
general level of alveolar bone, included or impacted teeth, canal treatment,
tooth decay and bone lesions; radiographic findings are recorded on the
form of the same name.

6. Request lab tests, cabinet tests and specialist consultations.

These requests should be filled out correctly for those cases when the
patient may have a systemic condition that could compromise treatment.
The results are analyzed by the student responsible for the case, the
student is in contact with the specialist treating the patient and in this way
the current condition of the patient can be defined.
 7. Identify and make a preliminary diagnosis of the systemic and dental
condition of the patient.
The student records the preliminary diagnosis based on the information
given by the patient, the extra- and intraoral explorations, X rays, laboratory
and cabinet tests, and interdisciplinary specialist consultations.

8. Identify the Risk and Status of Tooth Decay, Periodontal Disease and Oral
Cancer.
Administer the questionnaire on Risk of Tooth Decay, Periodontal Disease
and Oral Cancer, which will determine the level of risk for each of these.

With the information thus obtained, students must then draw up an extensive list of
specific or differential systemic and oral diagnoses, subsequently making a
proposal for Medical and Dental Classification of the patient. If relevant, the student
outlines Phases I and II of the Oral Treatment Plan and requests the clinical
supervisor to check the procedures and records completed so far and authorize the
clinical file.

Students continue their progress towards competence in assessment and

diagnosis in Comprehensive Dentistry. In the Comprehensive Dentistry Clinics the
clinical supervisor assesses the activity of students. In all clinical activities students
receive feedback from the clinical supervisor. Tutors then provide feedback to
students’ weekly, monthly and at the end of every semester on their progress in
meeting the clinical requirements while treating their patients. The tutors also
review with students their patients’ pending treatment, their grades, their unique
individual achievements, and their teamwork. To accomplish this, tutors review the
student’s patients’ files and each student’s case history.
In our institution students are deemed to be competent in Patient assessment
and diagnosis when they demonstrate the ability to assess and diagnose a patient
without assistance from their clinical supervisor.   This experience is acquired and
is evidenced through the observation of multiple clinical activities satisfactorily
resolved. At the beginning of their clinical training students are closely supervised
by clinical supervisors and, over time, they give the student greater freedom in
carrying out procedures.

Added to this, the experiences of University Social Service, Community Brigades

and Professional Social Service give students the opportunity to work in different
care and administrative models, ranging from purely educational services, through
emergency or immediate dental care, to models of mass attention and social
security services, and including clinical services noted for the excellence of their
care quality. The Community Brigades are work teams that perform voluntary off-
campus field work, generally providing services in education and preventive and
emergency care to people in low-income groups.
University Social Service is obligatory in order to move through the semesters and
is independent of grades in other subjects. It consists in the promotion of health-
related activities in throughout the wider population by publicizing Risk Factors with
respect to oral health, signs and symptoms of the most frequent oral-dental
pathologies, preventive methods and Educational-Preventive techniques in the
Educational Sector (inner-city and rural schools), including the promotion of daily
care at home. The Department of Social Services assigns specific activities to the
students of the State University of Medicine and Pharmacy according to their
academic level and which must be fully completed. Students also have the
obligation to perform Professional Social Service at public health facilities
(Department of Health, State Policlinics, hospitals etc.) for one year following
completion of the academic program and only when it has been concluded may
students receive their professional license and begin work as dentists.
After participating in these dental care models, graduates are in a position to
analyze them, reproduce them, improve them and adapt them to their own
professional practice.