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Hospital Dentistry  

Hospital Dentistry is that segment of the dental delivery system located within a hospital or in close association with a hospital. The hospital dental practice represents a special setting that is integrated within regular medical care, rather than existing as an area of specialty practice recognized by the profession. Like other divisions, the hospital dental practice is a clinical service division responsible to the Chief of Staff, Board of Directors, and other governing bodies of the hospital.

Odontologia Hospitalar

Segmento odontológico incluído  e associados aos serviços hospitalares.  A prática da odontologia hospitalar representa uma especial integração com os cudaos médicos regulares, embora não  seja uma área reconhecida como especialidade da profissão.

Como outros setores a clínica de odontologia hospitalar está sob  a responsabilidade e supervisão da diretoria administrativa e diretrizes do corpo clínico do hospital.

Job Description

The hospital dentist focuses on serving those who cannot receive dental care through the traditional delivery systems. Patients who are medically and/or mentally compromised (e.g., with cancer, heart disease, HIV/AIDS, Alzheimer's Disease), suffer from a debilitating anxiety toward dental treatment, or have schedules which preclude numerous extended appointments may seek care in a hospital setting. In addition, the service provides care for victims of emergency and trauma to the head and neck regions, offers consultation services for other hospital services, and furnishes dental care to patients residing in the facility. Hospital dentistry renders the full range of surgical, restorative, consultative, maintenance and preventive outpatient procedures offered through other practice settings. The hospital practice also offers services for restorative and surgical procedures completed under general anesthesia.

The hospital dentist is frequently involved with administrative duties. The hospital dental professional often serves on hospital boards and committees, attends regular medical staff meetings and team staff conferences, and meets with the Chief of Medical Services and other chairs. The hospital dentist also supervises other members of the dental team.

Most clinical facilities contain general treatment operatories and at least one surgical suite where oral and periodontal surgical procedures can be performed. Operating room and out-patient facilities are used as needed. The hospital dentist may render treatment in the emergency department, ambulatory care areas, or in-patient rooms. The dentist may admit or co-admit patients with other services to complete in-patient procedures.

Hospital dental services are staffed with dentists who have received training in hospital dentistry either through dental specialty programs or hospital-based General Practice Residency programs. Oral and maxillofacial surgeons, pediatric dentists, prosthodontists (especially maxillofacial prosthodontists), and oral pathologists are the specialists most frequently found in the hospital setting.

Advantages

Patients who might otherwise be denied treatment are able to have their dental needs met. Medically and/or mentally compromised patients can be treated on either an outpatient or inpatient basis depending upon their individual needs.
This is a challenging patient population due to the complex treatment needs and medical fragility of these patients.
Both medical and dental continuing education seminars are available to the hospital dentist.
The dentist engaged in private practice may render care in a hospital dental service on a part-time basis. For those wishing to make a career of hospital dentistry, a limited number of full-time positions are available.

Disadvantages

Additional educational requirements are needed for practice in the hospital environment. Formal training in anesthesia, oral surgery, and oral medicine is required due to the complex medical and dental needs of this patient population. Specialty or General Practice Residency training is a pre-requisite for many full and part-time positions.
Salaries and programs may vary with institutional and governmental support.
On-call duty is an essential component of the hospital practice.
Many dentists may be uncomfortable with the high degree of patient responsibility placed on the hospital dentist. They must be able to handle medical emergencies competently as such situations occur quite commonly in this setting.

Preparation/ Requirements

A DDS/DMD degree and state licensure are required for employment in state hospital dentistry programs. Formal training or significant experience must be acquired in either a dental specialty or hospital-based General Practice Residency program. Applicants must also exhibit substantial medical knowledge of the diseases and conditions they may likely encounter in this patient population.

Those dentists not directly employed by the hospital (e.g., dentists in private practice or academics) must petition the hospital advisory board for hospital privileges through the credentials committee. Such privileges allow the dental professional access to the hospital facilities for patient care. Privileges are restricted to the dentist's training area and may be further limited by co-admission with a staff physician. Contact the local hospital for specific instructions regarding that hospital's application procedure for privileges and relevant privilege restrictions.

Job Opportunities

Part-time positions are the most common type of hospital practice and should be available at most medical centers and large hospitals. The number and type of part-time positions vary with the size of the institution, type of institution, and financial base. Full-time positions are primarily limited to academic medical centers or large facilities. Institutions dealing primarily with trauma/malignancies involving the head and neck regions usually employ dentists.

Salary

Starting salary is dictated by the amount and type of experience and training brought to the position, the size of the program, and the payment method for services rendered. Full-time dental clinicians may be salaried from $50,000 to $150,000 depending upon location of practice, and specialty degree. Part-time dentists may not be salaried but other practice opportunities usually provide the major source of income. Government programs, third party plans, and hospital policy all must be considered in determining the earning potential for hospital dentistry.

Feture Trends

A significant increase in the number of hospital-based dental practices does not seem likely in the future, although a few more hospitals may acquire programs.

Individual programs vary with the stated objectives and ownership of the hospital. The three basic categories of hospitals and their relationship with the dental practice are as follows:

Private proprietary hospitals usually base their decisions on consideration of profit. Therefore, a hospital dental program must demonstrate economic feasibility and gain before one will be developed. Due to the current financial state of most health care institutions, the future development of programs in these hospitals seem unlikely.

Private non-profit hospitals possibly present the most diverse opportunities, but all are heavily dependent upon hospital management. After careful selection of a financially healthy institution, these hospitals should be very conducive to effective dental programs.
Public hospitals contain numerous dental programs but may be seriously affected by government budget restraints. Prospects for the development of new programs are poor.

References

Application Information

Contact the credentials committee of the hospital in which you are interested in seeking employment. This committee should be able to guide an applicant seeking to develop a new program at that hospital or employment/associateship opportunities within an existing program.

All dentists are eligible for consideration as hospital medical/dental staff members. However, hospitals have the prerogative to establish specific requirements and limit staff members. For hospital staff privileges, contact the Chief of the Dental Services at the local hospital or Chair of the Department of Dentistry at the academic medical center. General requirements for medical staff privileges (established by the Joint Commission on Accreditation of Health Care Organizations) include evidence of current licensure, relevant training and/or experience, current competency, standing in the profession/community, and health status.

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