A European Core Curriculum in Cariology: the knowledge base

This paper is part of a series of papers towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a joint workshop of the European Organization for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE), which was held in Berlin from 27 to 30 June 2010. This paper presents a closer look at the knowledge base as presented in the European Core Curriculum in Cariology. It comprises not only traditional basic sciences, such as anatomy and histology, but also emerging sciences such as molecular biology and nanotechnology and also fields such as behavioural sciences and research methodology. The different supporting competences are elaborated and explained. The problems of implementing a curriculum that truly integrates this foundation knowledge into the clinical teaching are discussed.

European Core Curriculum in Cariology for undergraduate dental students

As dental caries prevalence is still high in many populations and groups of both children and adults worldwide, and as caries continues to be responsible for significant health, social and economic impacts, there is an urgent need for dental students to receive a systematic education in cariology based upon current best evidence. Although European curriculum guidelines for undergraduate students have been prepared in other dental fields over the last decade, none exist for cariology. Thus the European Organisation for Caries Research (ORCA) formed a task force to work with the Association of Dental Education in Europe (ADEE) on a European Core Curriculum in Cariology. In 2010, a workshop to develop such a curriculum was organised in Berlin, Germany, with 75 participants from 24 European and 3 North/South American countries. The Curriculum was debated by five pre-identified working groups: I The Knowledge Base; II Risk Assessment, Diagnosis and Synthesis; III Decision-Making and Preventive Non-surgical Therapy; IV Decision-making and Surgical Therapy; and V Evidence-based Cariology in Clinical and Public Health Practice and then finalised jointly by the group chairs. According to this Curriculum, on graduation, a dentist must be competent at applying knowledge and understanding of the biological, medical, basic and applied clinical sciences in order to recognise caries and make decisions about its prevention and management in individuals and populations. This document, which presents several major and numerous supporting competences, does not confine itself to dental caries alone, but refers also to dental erosion/non-erosive wear and other dental hard tissue disorders.

Evidence-based cariology in clinical and public health practice as part of the European Core Curriculum in Cariology

This paper is part of a series of papers contributing towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a process starting in 2006 and culminating in a joint workshop of the European Organization for Caries Research together with the Association for Dental Education in Europe, which was held in Berlin from 27 to 30 June 2010. The scope of this paper is to present the evidence-based cariology in clinical and public health section of the European Core Curriculum in Cariology. This section was developed on the basis of international consensus on the current and future educational needs in the fields of cariology and disorders of dental hard tissues. The paper will deal with the core skills of evidence-based dental practice within the undergraduate curriculum underpinning the dual facets of clinical cariology (relating particularly to individuals) and public health cariology (relating particularly to groups/societies). Core competencies in evidence-based dentistry, which are generic to the undergraduate curriculum as a whole and not only cariology, are integral to lifelong learning skills within dentistry. As the clinical cariology competencies in assessment and management of caries for the individual patient are dealt with within other sections of the European Core Curriculum in Cariology, only a few relevant examples will be presented here, but for Public Health Cariology, the competencies will be explored within this document and their relationship to the principles of evidence-based dentistry discussed.

Decision-making and treatment with respect to surgical intervention in the context of a European Core Curriculum in Cariology

This paper is part of a series of papers towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a process starting in 2006 and culminating in a joint workshop of the European Organisation for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE) which was held in Berlin from 27 to 30 June 2010. The present paper covers decision-making and treatment with respect to surgical intervention. In particular, it will provide some background information on this part of the European Core Curriculum. Undergraduate dental education should enable the student to become a competent, skilful and caring dentist who is able, upon graduation, to take professional responsibility for diagnosis, as well as effective safe, and long-lasting care in the best interests of the patient. With respect to decision-making around surgical intervention for dental caries, several factors have to be considered. These include, patient needs, preventive strategies, tooth preservation, caries management success and failure rates, as well as short-term and long-term treatment costs. With respect to surgical intervention, manual skills at a high level are required. This is of crucial importance for the graduating dentist allowed to practise dentistry in many EU countries.

A survey on education in cariology for undergraduate dental students in Europe

The aim of the survey was to collect relevant information about education in cariology for dental undergraduate students in Europe. The ORCA/ADEE cariology curriculum group prepared a questionnaire that was mailed in 2009 to 179 European dental schools. One hundred and twenty-three dental schools (72%) from 32 countries completed and returned the questionnaires. In most of these schools, education in cariology is delivered by at least two different units. The units mainly involved are Paediatric Dentistry, Conservative Dentistry, Restorative Dentistry or Operative Dentistry. Theoretical education in cariology is delivered by practically all responding dental schools, and in 96% of these schools, it starts within the first 3 years. Pre-clinical exercises are offered by 98% of the schools starting mainly in the third or fourth year. In 97% of the schools, clinical exercises are carried out, and this occurs mainly in the fourth and fifth year. In nearly all dental schools (88%), education in cariology comprises not only caries but also dental erosion and non-erosive wear. The vast majority of the responding dental schools (89%) supported the idea of developing a European Core Curriculum in Cariology.

Faculty impressions of dental students' performance with and without virtual reality simulation

This study compared faculty perceptions and expectations of dental students' abilities using virtual reality simulation (VRS) to those who did not use virtual reality simulation (non-VRS) in an operative dentistry preclinical course. A sixteen-item survey with a ten-point rating scale and three open-ended questions asked about students' abilities in ergonomics, confidence level, performance, preparation, and self-assessment. The surveys were administered three times to a small group of preclinical faculty members. First, faculty members (n=12, 92 percent response rate) gave their perceptions of non-VRS students' abilities at the end of their traditional course. Secondly, faculty members (n=13, 100 percent response rate) gave their expectations of the next incoming class's abilities (VRS students) prior to the start of the course with traditional and VRS components. Finally, faculty members (n=13, 100 percent response rate) gave their perceptions of VRS students' abilities after completion of the course. A Tukey's test for multiple comparisons measured significance among survey items. Faculty perceptions of VRS students' abilities were higher than for non-VRS students for most abilities examined. However, the faculty members' expectations of VRS training were higher than their perceptions of the students' abilities after VRS training for most abilities examined. Since ergonomic development and technical performance were positively impacted by VRS training, these results support the use of VRS in a preclinical dental curriculum.

Caries risk assessment, diagnosis and synthesis in the context of a European Core Curriculum in Cariology

This paper is part of a series outlining a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a process starting in 2006 and culminating in a joint workshop of the European Organization for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE), held in Berlin from 27 to 30 June 2010. For the areas of risk assessment, diagnosis, detection, activity, monitoring and synthesis Cariology, the present paper outlines the key competencies required and the related areas in which knowledge of and familiarity with are needed for dentists graduating at the beginning of 21st century. Three major competencies were identified: Risk Assessment- competent at identifying and estimating the probability for a patient of developing new caries lesions or progression of existing lesions during a specified period of time; Diagnosis- competent through collecting, analysing and integrating data on signs and symptoms of dental caries and assess activity status of a lesion on a tooth surface to arrive at an identification of past or present occurrence of the disease caries; and Synthesis- competent at synthesising all relevant information by combining and interpreting findings from: risk assessment and diagnostic processes; from patients' needs, preferences and best interests; and from monitoring, review and re-assessment findings, when available. Similar competencies were identified for erosion and non-erosive wear. Issues that were felt by the working group panel to be important in this field are discussed, as are approaches to aid curriculum implementation.

Decision-making and preventive non-surgical therapy in the context of a European Core Curriculum in Cariology

This paper is part of a series of papers towards a European Core Curriculum in Cariology for undergraduate dental students. The European Core Curriculum in Cariology is the outcome of a joint workshop of the European Organisation for Caries Research (ORCA) together with the Association for Dental Education in Europe (ADEE), which was held in Berlin from 27 to 30 June 2010. The present paper covers decision-making and non-surgical treatment. In particular, it will provide some background information on this part of the European core curriculum. The dentist, on graduation, must be competent at applying the principles of prevention of dental hard tissue disease processes (primary prevention) and progression when it has manifested itself (secondary prevention). The competences should apply in differing ways to patients of all ages. Goals of prevention should be clearly defined in order for outcomes to be evaluated, and a dentist should be competent at determining these outcomes. Although this concept is recognised by many academics and experts, clinical teaching, practice and health insurance coverage frequently emphasise surgical treatment. There are many reasons and obstacles that might account for this, and this paper suggests some reasons why this might be and makes suggestions for how these can be addressed in the future. One factor that is essential in the provision of a preventive, non-surgical approach is that of communication with the patient. However, this unfortunately takes less space in the dental curricula compared with technical skills aimed at restorative procedures; this weighting needs to be more equally balanced.

Clinical educators' views on the quality of undergraduate clinical restorative dentistry in the UK and ROI

INTRODUCTION

Following concerns expressed regarding recently expanded dental education, a survey was conducted on United Kingdom and Republic of Ireland clinical educators' perceptions of their work and the educational experiences they provide in clinical restorative dentistry. Many of the challenges facing dental education are common to all countries, and it would be of interest to note if the views reported are representative of the greater European perspective. The results of this survey represent a European regional picture.

METHODS AND MATERIALS

This is a survey of clinical staff in restorative dentistry departments across all of the fully established UK and ROI dental schools. The survey covered factors affecting the quality of undergraduate learning in restorative dentistry and the implications of these for programme delivery. Thematic analysis was applied to qualitative responses.

RESULTS

One hundred and eighty-eight responses were received across the gamut of clinical educators' roles and across 15 of the 16 schools. Themes identified were personal workload, teaching effectiveness, students' clinical experiences, provision of teaching, departmental organisation and job satisfaction.

DISCUSSION

The survey findings had many parallels with other recent reports but also suggested some developments.

CONCLUSION

The survey provided an accurate snapshot of staff views on the quality of undergraduate clinical training in restorative dentistry. Despite experiencing difficulties in many areas of their work resulting in poor morale, staff considered teaching rewarding although undervalued by others. A number of recommendations are made for the development of undergraduate teaching.

E-learning used in a training course on atraumatic restorative treatment (ART) for Brazilian dentists

The purpose of this study was to assess the benefits of using e-learning resources in a dental training course on Atraumatic Restorative Treatment (ART). This e-course was given in a DVD format, which presented the ART technique and philosophy. The participants were twenty-four dentists from the Brazilian public health system. Prior to receiving the DVD, the dentists answered a questionnaire regarding their personal data, previous knowledge about ART, and general interest in training courses. The dentists also participated in an assessment process consisting of a test applied before and after the course. A single researcher corrected the tests, and intraexaminer reproducibility was calculated (kappa=0.89). Paired t-tests were carried out to compare the means between the assessments, showing a significant improvement in the performance of the subjects on the test taken after the course (p<0.05). A linear regression model was used with the difference between the means as the outcome. A greater improvement on the test results was observed among female dentists (p=0.034), dentists working for a shorter period of time in the public health system (p=0.042), and dentists who used the ART technique only for urgent and/or temporary treatment (p=0.010). In conclusion, e-learning has the potential of improving the knowledge that dentists working in the public health system have about ART, especially those with less clinical experience and less knowledge about the subject.

Learn-a-prep II as a predictor of psychomotor performance in a restorative dentistry course

This investigation assessed whether early student performance with a dental handpiece on a didactic training aid known as the Learn-A-Prep II (LAP II) was predictive of performance on subsequent practical examinations in a preclinical restorative dentistry course. Eighty-one first-year students were given initial handpiece training and formative feedback using the LAP II and were then instructed to independently prepare four LAP II patterns within the pattern lines and at a specified depth. Performance on the LAP II was compared with the summative assessment on two subsequent amalgam preparation practical examinations given at the middle (Class II) and end (Complex) of the course. Pattern preparation within the lines did not significantly improve the likelihood of receiving an A or B on the Class II practical (p=0.53) or on the Complex practical (p=0.37). Students who had an acceptable depth on the LAP II were 3.73 times more likely to receive an A or B on the Class II practical than those students who did not have acceptable depth (p=0.03). Performance at an acceptable depth did not significantly improve the likelihood of receiving an A or B on the Complex practical (p=0.15). The LAP II may aid in identification of students who would benefit from early intervention with additional focused instruction.

Computer-assisted dental simulation as a predictor of preclinical operative dentistry performance

We tested whether a computerized dental simulator (CDS) pre-test could predict preclinical operative dentistry examination scores. Thirty-eight first-year students completed cavity preparations during a single four-hour CDS pre-test prior to the operative dentistry course and during subsequent practical examinations. Masked, calibrated faculty members scored the preparations in both settings. Pass rates for the CDS pre-test, Exam 1, and Exam 2 were 50 percent, 66 percent, and 86 percent, respectively. Students who passed the CDS pre-test were more likely to pass Exam 1 (95 percent vs. 37 percent, p=0.0004) but not Exam 2 (89 percent vs. 83 percent, p=0.66) and had better mean scores on Exam 1 (73.4 vs. 68.3, p<0.0001), but not Exam 2 (76.2 vs. 74.7, p=0.35). As a diagnostic, success on the CDS pre-test predicted success on Exam 1 with 72 percent sensitivity and 92 percent specificity (positive predictive value 95 percent, negative predictive value 63 percent). As a diagnostic for Exam 2 performance, the CDS pre-test was a weaker predictor and not statistically significant. These findings suggest that a pre-course CDS test may help to identify students in need of early instructional intervention. Future studies are warranted to further define and implement the use of simulation technology in the assessment of students' psychomotor learning potential.

Teaching clinically relevant dental anatomy in the dental curriculum: description and assessment of an innovative module

The primary objective of the preclinical dental anatomy course in the predoctoral dental curriculum is to introduce students to cognitive and psychomotor skills related to the morphology and spatial and functional relationships of human dentition. Traditionally, didactic content for the subject is found in textbooks and course manuals and summarized by the faculty in lectures to the entire class. Psychomotor skills associated with recognition and reproduction of tooth morphology are traditionally learned by examining preserved tooth specimens and their cross-sections, combined with producing two-dimensional line drawings and carving teeth from wax blocks. These activities have little direct clinical application. In most cases, students are passive in the learning process, and assessment of student performance is unilateral and subjective. A recently revised dental anatomy module at the University of Illinois at Chicago College of Dentistry integrates independent class preparation with active small-group discussion and patient scenario-based wax-up exercises to replace missing tooth structure on manikin teeth. The goal of the revision is to shift emphasis away from decontextualized technical learning toward more active and clinically applicable learning that improves conceptual understanding while contributing to early acquisition of psychomotor skills. This article describes the rationale, components, and advantages of the revised module and presents a pre-post comparison of student learning outcomes for three class cohorts (N=203).

Development and evaluation of an interactive dental video game to teach dentin bonding

Written and clinical tests compared the change in clinical knowledge and practical clinical skill of first-year dental students watching a clinical video recording of the three-step etch-and-rinse resin bonding system to those using an interactive dental video game teaching the same procedure. The research design was a randomized controlled trial with eighty first-year dental students enrolled in the preclinical operative dentistry course. Students' change in knowledge was measured through written examination using a pre-test and a post-test, as well as clinical tests in the form of a benchtop shear bond strength test. There was no statistically significant difference between teaching methods in regards to change in either knowledge or clinical skills, with one minor exception relating to the wetness of dentin following etching. Students expressed their preference for an interactive self-paced method of teaching.

Repair versus replacement of defective composite restorations in dental schools in Germany

The aim of this paper was to review the current teaching of repairs to direct composite restorations in dental schools in Germany, last surveyed ten years ago. Based on an 83% response rate, the findings indicate that most, but not all, dental schools included teaching of repair techniques; however marked variations were found to exist regarding clinical indications and repair techniques of the teaching. It is suggested that certain aspects of the existing teaching in some schools should be reviewed, specifically the lack of use of a bonding agent and the issue of flowable composites to complete repairs.

Can evaluation of a dental procedure at the outset of learning predict later performance at the preclinical level? A pilot study

The purpose of this study was to examine the effectiveness of conventional pre-clinical training in dentistry and to determine if evaluation of a dental procedure at the beginning of dental training can be a predictor for future performance. A group of second year dental students with no previous experience in operative dentistry were asked to prepare a conventional class I cavity on a lower first molar typodont. Their first preparation was carried out after an introductory lecture and a demonstration and their second at the end of conventional training. The prepared typodonts were coded and blindly scored for the traditional assessment criteria of outline form, retention form, smoothness, cavity depth and cavity margin angulation. Once the codes were broken, a paired t-test was used to compare the difference between the means of before and after scores (P<0.0001) and a Pearson's linear correlation to test the association (r=0.4). From the results of this study, we could conclude that conventional preclinical training results in a significant improvement in the manual skills of the dental students and that the dental procedure used had only a limited predictive value for later performance at the preclinical level.

Preliminary assessment of faculty and student perception of a haptic virtual reality simulator for training dental manual dexterity

Virtual reality force feedback simulators provide a haptic (sense of touch) feedback through the device being held by the user. The simulator's goal is to provide a learning experience resembling reality. A newly developed haptic simulator (IDEA Dental, Las Vegas, NV, USA) was assessed in this study. Our objectives were to assess the simulator's ability to serve as a tool for dental instruction, self-practice, and student evaluation, as well as to evaluate the sensation it provides. A total of thirty-three evaluators were divided into two groups. The first group consisted of twenty-one experienced dental educators; the second consisted of twelve fifth-year dental students. Each participant performed drilling tasks using the simulator and filled out a questionnaire regarding the simulator and potential ways of using it in dental education. The results show that experienced dental faculty members as well as advanced dental students found that the simulator could provide significant potential benefits in the teaching and self-learning of manual dental skills. Development of the simulator's tactile sensation is needed to attune it to genuine sensation. Further studies relating to aspects of the simulator's structure and its predictive validity, its scoring system, and the nature of the performed tasks should be conducted.

Relationship between perception of difficulty and clinical experience of approximal composite restorations in final-year undergraduate students at Tokyo Medical and Dental University

The aims of this study were to clarify which steps in approximal restorative procedure were difficult for the final-year undergraduate students at Tokyo Medical and Dental University, and to examine the relationship between perception of difficulty and clinical experience. At mid-term of the clinical education experience, a self-questionnaire was performed by final-year undergraduate students to clarify the difficulty of restorative procedures at the time. There were statistically significant differences in the number of clinical cases experienced at the time between students who designated the matrix application, shade selection and finishing as the easy steps and those who considered them as the difficult ones (Fisher exact test with Bonferroni correction, p < 0.05). There was a significant difference in the total number of procedures designated as difficult between students who had treated above 15 cases and those who had fewer than 15 cases (Wilcoxon rank-sum test, p< 0.05). In the final-year clinical education for operative dentistry, students might need to treat over 15 cases to gain confidence in performing approximal composite restorations independently.

Expanded functions for dental auxiliaries education in Tennessee

Access to care continues to be an overriding issue in dentistry. The development of new categories of dental auxiliaries, such as mid-level providers, is a matter of concern to many states and the dental profession. Tennessee has an EFDA educational program for dental auxiliaries taught by dental school educators who have trained more than 300 auxiliary personnel in restorative and prosthetic dentistry. Graduates of this educational program have helped keep Tennessee's dentists well ahead of any increased demand for dental care.

The effect of magnification loupes on the performance of preclinical dental students

OBJECTIVE

optical magnifying devices such as magnification loupes are increasingly used in clinical practice and educational settings. However, scientific evidence to validate their benefits is limited. This study assessed the effect of dental magnification loupes on psychomotor skill acquisition during a preclinical operative dentistry course.

METHOD AND MATERIALS

the performance of first-year dental students was assessed during an Advanced Simulation Course (AS) using virtual reality-based technology (VRBT) training. The test group consisted of 116 dental students using magnification loupes (+MAG), while students not using them (-MAG, n = 116) served as the control. The following parameters were evaluated: number of successfully passing preparation procedures per course rotation, amount of time per tooth preparation, number of times students needed computer assistance and evaluation, and amount of time spent in the computer assistance and evaluation mode per procedure. Data were collected on each student through VRBT during the preparation procedure and stored on a closed network server computer. Unpaired t tests were used to analyze mean differences between the groups. In addition, student acceptance of magnification loupes was measured and evaluated through survey interpretation.

RESULTS

+MAG students completed more preparations, worked faster per procedure, and used the computer-assisted evaluation less frequently and for shorter periods, therefore displaying greater overall performance. The survey revealed a high degree of student acceptance of using magnification.

CONCLUSION

dental magnification loupes significantly enhanced student performance during preclinical dental education and were considered an effective adjunct by the students who used them.

Review of outcomes from a change in faculty clinic management in a U.S. dental school

Dental schools use a variety of clinic management models with the goals of promoting patient care, student education, and fiscal responsibility. In 2004, the University of the Pacific Arthur A. Dugoni School of Dentistry transitioned to a more generalist model with these goals in mind. The purpose of this study was to evaluate the outcomes of this clinic model change relative to the quantity of specific procedures completed by students. The quantity of procedures completed by each student from the classes of 1995 through 2009 were compiled from our electronic clinic management system and analyzed. The post-transition group (2004-09) showed a greater number of completed oral diagnosis and treatment planning and root planing procedures per student compared to the pre-transition group (1995-2003), but fewer crowns, root canals, operative procedures, and dentures. Because the higher procedure numbers were for low-cost procedures, our transition to a generalist model did not necessarily enhance clinic income but may support student learning and enhanced patient care.

Clinical teaching in restorative dentistry and the variation between students' and supervisors' perceptions of its effectiveness

OBJECTIVES

To investigate if there was an agreement between the students and supervisors on the quality of clinical teaching in Restorative Dentistry in the Dublin Dental School and Hospital and to identify differences on how effective clinical teaching is perceived between three academic years. In addition it aimed to identify the existence of any similarities between students' and supervisors' perceptions of specific teaching behaviours that are most and least helpful in learning.

MATERIALS AND METHODS

An anonymous questionnaire based on the above objectives was distributed to three cohorts of undergraduate students and three cohorts of clinical supervisors. The response rate was 94% for the first, 94% for the second and 63% for the third student cohort. Twenty-one (21) out of the 36 supervisors returned the questionnaire. Basic analysis of the clinical questionnaire was carried out in order to find the distributions of the variables between the groups. These distributions were compared using a non-parametric analysis (Kruskal-Wallis). The degree of association was measured by the Pearson's chi-square values.

RESULTS

Students from all 3 years reported to be neither very satisfied nor very dissatisfied with their clinical teaching with a few statistically significant differences across the 3 years. The supervisors on the other hand, replied with a great deal of similarity across the 3 years. Furthermore, supervisors gave a high degree of straight line responses and generally felt very good about the level of clinical teaching. There was a high degree of variability in what the supervisors thought was important but also a high degree of similarity in what they thought was not helpful. It was exactly the opposite for the students.

CONCLUSIONS

There is a limited agreement between students and staff on the effectiveness of clinical teaching and the way effectiveness is perceived between students and clinical supervisors as well as between senior and more junior students. Overall though students and supervisors rated the clinical teaching favourably but indicated several areas of concern.

Impact of computerized dental simulation training on preclinical operative dentistry examination scores

Simulation training may be useful in the preclinical operative dentistry curriculum; however, the optimal timing and duration of training have not been defined. This study compared eight hours of adjunctive computerized dental simulator (CDS) training at two different time points to traditional teaching alone. First-year dental students (n=75) were randomized to CDS training (n=39) or traditional preclinical dental training alone (n=36). Of thirty-nine students in the CDS group, twenty-six were trained before exam 1 (pre-exam group) and thirteen after exam 1 (post-exam group). The primary outcome was performance on three practical examinations. The secondary outcome was the influence of timing on exam performance. CDS-trained students performed significantly better than controls on exams 1 and 2 and were higher but not significantly so on exam 3. There were no differences between CDS groups. These results suggest that eight hours of CDS training administered early in the preclinical operative dentistry may improve student performance.