CODA standard 2-24h-"replacement of teeth" dilemma: Unintended consequences and proposed solutions.

Abstract

The Commission on Dental Accreditation (CODA) was established in 1975 with the goal of serving the public and the dental profession by developing and implementing standards that guide and maintain the quality of dental educational programs. These standards are defined broadly around competencies reflective of an evidence-based definition of general dentistry and that should be met by the new graduates to function as an entry level provider. Consequently, CODA "expects each school to develop specific competency definitions and assessment methods in the context of the broad scope of general dental practice". CODA Standard 2-24h was implemented a decade ago to address concerns that dental schools are not sufficiently proactive in incorporating implant-related curricula and clinical competencies. When the standard was implemented, most patients already preferred dental implants over FPDs. This market trend, together with the prescriptive format of the standard, had the unintended consequence of creating pressure on programs that struggled to find enough patients who will chose FPDs as a treatment option. As a short term solution, we suggest a tooth replacement competency construct that has the potential to alleviate this burden. This solution incorporates principles of ethical decision making, patient-centered care, and evidence-based dentistry, without compromising educational aspects and competency development. For the longer term, we suggested to revise and rephrase the standard so that it will be clinically-centered rather than focused on technical tools that may evolve, change, or disappear as a result of technological progress and other market trends. This, in turn, will be conducive to fulfill the intent of Standard 2-24 to allow the schools to identify "competencies that will be included in the curriculum based on the school's goals, resources, accepted general practitioner responsibilities and other influencing factors."