Internal medicine education in dentistry: knowledge required varies according to dental specialty

BACKGROUND

With recent increases in the number of elderly and medically compromised patients, dentists are required to have a more comprehensive understanding of medical problems. There is, however, little awareness of the importance of internal medicine at dental schools in Japan.

OBJECTIVE

The aims of the present study were to examine whether dentists need medical knowledge, to examine how often they experience difficulties regarding internal medicine in dental practice, and to determine whether their specialty or career influences their needs or difficulties.

DESIGN

A questionnaire based on the above objectives was designed and was sent to all the faculty members in the department of dentistry at Tsurumi University and all dentists who work at the university hospital.

RESULTS

Of 408 surveys, 307 (75%) responded. Ninety-nine per cent of respondents recognized the necessity of internal medicine. The dentists specializing in gerodontology, dental anesthesiology or oral and maxillofacial surgery (group S) felt the need of knowledge of internal medicine more frequently than those of other specialties (group O) (Odds ratio 17.5, 95% CI: 2.4 approximately 129.9; P = 0.000). Seventy-four per cent of the dentists experienced difficulties in day-to-day practice caused by a lack of medical knowledge. Those in group S, experienced difficulties more frequently than those in group O (Odds ratio 5.3, 95% CI: 2.1 approximately 12.9; P = 0.000). While the more experienced dentists in group S encountered difficulties more often, the more experienced dentists in group O encountered difficulties less often.

CONCLUSIONS

The need for instruction in internal medicine varies according to dental specialty. Even very experienced dentists might fail to find solutions because of a lack of knowledge of internal medicine.

The professions of dentistry and dental laboratory technology

BACKGROUND

Dentistry's mission to provide rehabilitation services to patients who experienced dental disease is being jeopardized through the continual reduction of critical to quality skills and knowledge in dental laboratory technology being offered in dental and dental laboratory technician education. These reductions are creating a shortage of knowledgeable dentists and dental laboratory technicians who will be needed to address the projected public demand for laboratory-fabricated tooth replacements and restorations.

METHODS

Demographic trend analysis supports a hypothesis that without immediate action by dentistry, substantial patient needs will not be met owing to inadequate levels of dental laboratory support for general dentists.

RESULTS

The sophistication of laboratory-based rehabilitative and elective therapies demand closer cooperation between dentists and dental laboratory technologists.

CONCLUSIONS

Dentistry must not abdicate its responsibilities in dental technology as it pursues a path away from rehabilitation services toward a projected future of prevention services. With decreasing educational exposure and training in dental laboratory procedures, dentists will have difficulty participating with dental laboratory technologists to fabricate laboratory-based rehabilitative and elective therapies. Without significant guidance from dental professionals in establishing laboratory standards in both education and practice, proprietary interests and commercial biases may set the laboratory and clinical standards of the future.

CLINICAL IMPLICATIONS

Dentists will have limited experience or background to evaluate the dental laboratory technology offered in the marketplace and will be subject to the marketing of the industry. A shortage of educationally trained dental laboratory technologists will create a clinical and an economic burden on both dentists and patients.

Esthetic techniques and restorative systems used in the second-year undergraduate dental curriculum

Metal-free tooth-colored restorative systems for fabricating indirect intracoronal and extracoronal restorations have been developed because of patients' demand for superior esthetics. During the past decade, long-term clinical studies have demonstrated the success of many of these types of restorations in terms of function and esthetics. Ceramic veneers, all-ceramic crowns, ceramic onlays, and composite-resin inlays are becoming an integral part of contemporary clinical practice. The constant evolution in bonding techniques, adhesive systems, and cements plays a major role in the success of these metal-free restorations. In addition, home-bleaching procedures have become an integral part of the esthetically oriented dental practice. This article discusses the rationale, scientific basis, and implementation of a new undergraduate preclinical esthetics course for second-year dental students at the Louisiana State University Health Sciences Center School of Dentistry.

Understanding prosthodontics — where did it all go wrong?

This paper addresses the anatomical and physiological effects of tooth loss on the patient and, further, audits the teaching of prosthodontics over the last 30 years. There is an abundance of evidence to outline changes that occur post-extraction related to morphological changes in the maxilla, the mandible and combined changes in inter-maxillary relations. In addition to the knowledge of patterns of bone loss, we are also now well aware that there is evidence to suggest that planned retention of roots and/or the placement of implants can help reduce post-extraction bone loss. Awareness by clinicians of the anatomical, physiological and psychological effects of edentulousness, is essential if empathy is to be struck with the patient. Equally, patients being rendered edentulous must be made aware of these factors if true informed consent is to be gained. New graduates are now less well equipped to practice complete denture prosthodontics than, say, 10 years ago and this is a consequence of three factors: crowded curricula, diminution in laboratory hours and the time a dental student spends in clinical prosthodontics.

Dental undergraduate expectations and opinions of Web-based courseware to supplement traditional teaching methods

The rapid growth of Internet for the delivery of information has enabled teaching materials to be placed on websites allowing student access to course material. It is the aim of this paper to evaluate a cohort of dental undergraduate students who have used Web-based courseware in prosthetic dentistry for a semester. A questionnaire was distributed to clinical undergraduate students prior to the use of the prosthetics course to determine their experience of using the World Wide Web (WWW) and their expectations of an online course. A second questionnaire was distributed at the end of 6 months which asked about their usage and opinions of the prosthetics Web-based courseware. The main concerns raised at the beginning of the course were related to computer access, the ability to use computers, the time involved and their conception that the e-course would be an additional burden. The main potential benefits were perceived to be convenience, availability of information and the ability to reinforce or catch up on aspects of the module they did not understand or had missed. Feedback at the end of the year showed that most students had accessed the Web-based courseware site at least once a month and, generally, their comments were favourable, dispelling some of the initial perceived fears. They felt that the website was a quick and convenient way to access information and was a good additional resource. Access to the site and printing information were the main problems raised by the students who had to use a shared cluster. In conclusion, Web-based courseware was felt to be a useful additional resource for students. However, this research showed that sufficient computers and printers must be available for such a resource to become an integrated part of the dental course.

Interdisciplinary, web-based, self-study, interactive programs in the dental undergraduate program: a pilot

The goal of this project was to encourage interdisciplinary, integrative health teaching and research in dental education through the development of web-accessible programs, collectively called the "StudyWeb." The specific objective of the project was the construction and integration of a series of prototypes of self-study modules. Four pilot modules were developed using existing teaching materials in histology, pharmacology, prosthodontics, and oral radiology and utilizing a variety of widely available software programs, including FrontPage and Photoshop. Low-end technological choices were made in order to facilitate compatibility with a wide range of hardware, software, and types of Internet access. Modules were tested for functionality, usability, and ease of navigation. The scope of the initial project was limited to development and functionality testing of the original modules. The next phase of this project will involve testing of the effectiveness of these web-based self-instruction tools.

Preclinical removable partial dentures curriculum survey

PURPOSE

In 2001, a survey of U.S. dental schools was conducted to determine the curricular structure, teaching philosophies, and techniques used in preclinical removable partial denture (RPD) courses and to also establish what newer educational techniques and materials are currently being used by U.S. dental schools.

MATERIALS AND METHODS

The questionnaire was mailed to the chairpersons of the prosthodontic/restorative departments of 54 U.S. dental schools. Of these, 43 schools returned the completed survey, resulting in a response rate of 80%. The mean, median, and range of responses were computed where applicable.

RESULTS

Results from this survey show that the mean student-to-faculty ratio in the preclinical RPD course was 12:1, with a median of 10:1 and a range of 6:1 to 27:1. The mean number of laboratory hours was 55, with a median of 50 and a range of 13.5 to 120. The mean number of lecture hours reported was 21, with a median of 20.5 and a range 10 to 60. The mean number of practical examinations was 2, with a median of 3 and a range of 0 to 8. The mean number of written examinations given was 2, with a median of 2 and a range of 1 to 6. Ninety-five percent of the schools have prosthodontists teaching this course. The mean number of months that this course is taught is 4.4 months, with a median of 4 and a range of 1.5 to 10. Fifty-five percent of the schools used the Hanau semiadjustable articulator. One hundred percent of the schools teach students to use a surveyor when designing an RPD, and 84% percent of the schools teach the Krol or the Kratochvil RPI design or a combination of the 2 designs.

CONCLUSIONS

Preclinical RPD educational programs vary from school to school, yet a large percentage of schools agree on certain topics. Only 19% of dental schools are incorporating new technologies, such as the use of the internet, in their preclinical RPD curriculum.

The Carl O. Boucher Prosthodontic Conference spans four decades

Dr. Carl O. Boucher was a giant in prosthodontics in the middle of last century. To honor his quest for excellence, the Ohio State University School of Dentistry established an annual conference bearing his name in 1996. This article describes the inaugural conference, the structure of the annual conference, and expanding plans to promote continuous improvement in prosthetic dentistry.

Determining factors for implant referral rates

The research findings indicate that the field of implant dentistry will only grow at a moderately low level unless certain changes are made. Findings indicated that the effort by the implant companies has been nothing short of dramatic, and yet almost 60% of restorative doctors do not participate annually in any implant case. There was no clear indication that younger restorative doctors will significantly increase the number of implant referrals, as their overall implant education has not dramatically differed from those dentists who graduated in earlier years. Once the research was completed, it became obvious to Levin Group that the driving force behind implant referral growth will be implant surgeons, because of their one-to-one relationship with restorative doctors. The Levin Group Implant Management and Marketing Consulting Program is based on approaching restorative doctors in several different levels, starting with awareness all the way through to case facilitation and long-term tracking and communication. Finally, a continuing marketing/education effort needs to be consistently in place with effective materials, not only to create a high level of awareness, but also to motivate restorative doctors to refer cases and then work through the case with the implant surgeon to a satisfactory completion for the restorative doctor, implant surgeon, and patient. While the surgical insertion of implants may seem to carry a high-profit margin relative to the restoration of implants, the truth is that the restoration of implants usually provides a 40% higher profit margin for the restorative doctor than traditional dental services. One of the key issues is that referring doctors have not necessarily learned how to set fees and present cases with regard to implant dentistry. The key factor here is to ensure that the patient understands that implant services involve higher fees than traditional services, because of the necessarily higher levels of experience, education, and cost associated with implant dentistry. It is also important to emphasize to patients that the quality of life far outweighs the differential in fees.

Preclinical complete dentures curriculum survey

PURPOSE

A survey of U.S. dental schools was conducted in 2001 to determine the curricular structure, teaching philosophies, and techniques used in preclinical complete denture courses.

MATERIALS AND METHODS

The questionnaire was mailed to the chairperson of the prosthodontic/restorative departments of 54 U.S. dental schools. Of these, 43 schools returned the completed survey, a response rate of 80%. The mean, median, and range of responses were computed where applicable.

RESULTS

Results from this survey show that the mean student-to-faculty ratio in the preclinical course was 12:1, with a median of 12:1 and a range of 6:1 to 27:1. The mean number of laboratory hours was 74, with a median of 70.5 and a range of 31.5 to 160. The mean number of lecture hours reported was 28, with a median of 25 and a range 12 to 80. The mean number of practical examinations was 3, with a median of 3 and a range of 0 to 11. Eighty-four percent of the schools have prosthodontists teaching the course. The mean number of months that this course is taught is 5 months, with a median of 5 and a range of 2 to 13. Fifty-eight percent of the schools use the Hanau semiadjustable articulator. Sixty-five percent of the schools use protrusive records to set the articulator. The facebow preservation record is used by 84% of the schools.

CONCLUSIONS

Preclinical complete denture educational programs vary from school to school, yet a large percentage of schools agree on certain topics. Only 28% of dental schools are incorporating new technologies, such as the internet, in their preclinical complete denture curriculum. Nineteen percent of dental schools are using only the Portrait denture teeth, which are newer than the Bioblend and Bioform teeth.