Undergraduate Dental Education in Gerodontology in Germany between 2004 and 2019-A case for compulsory teaching?

INTRODUCTION

The study surveys the present state of undergraduate dental education in gerodontology in Germany and highlights changes between 2004 and 2019.

MATERIALS AND METHODS

In 2019, questionnaires were emailed to the department heads of all German dental schools. Data were analysed descriptively and compared to existing data from 2004, 2009 and 2014.

RESULTS

Thirty-nine (86.7%) out of forty-five responding department heads stated to teach aspects of gerodontology in traditional core subject lecture series. Overall, 15 (55.6%) out of 27 responding dental university schools are offering special education in gerodontology (dedicated lecture series and/or practical training). A stronger focus on non-dental topics has been observed over the years.

DISCUSSION

The 15-year observation period in Germany shows that teaching gerodontology should be mandatory. There is a lack of specialists in gerodontology at the dental schools, although specialisation has been possible for many years in the German professional association. Students should be sure that, as in other subjects, they are well trained for the very heterogeneous patient group of seniors. The financial and personnel prerequisites for the universities need to be established.

CONCLUSION

Inclusion of gerodontology in the national syllabus is a decisive factor for the integration of the subject into undergraduate courses. The recommendations of the European College of Gerodontology (2009) and of the German Association of Gerodontology (DGAZ) regarding didactical and practical teaching should be implemented in the respective compulsory syllabus to prepare current undergraduate dental students for the demographic challenges of tomorrow.

Student Perceptions of Age and Ageing-An Evaluation of Swiss Dental Students Receiving Education in Gerodontology

Society is ageing and the higher number of senior citizens in the total population is a challenge for society and often perceived as a burden. Negative images of old age can lead to ageism and poorer healthcare for older people. The younger generation will have to master these demographic challenges. Therefore, their attitude towards and their perception of the older generation has to be monitored. The aim of this study is to present the images of ageing held by dental students who received education in gerodontology and to assess possible changes between different generations of students over time and separated by gender. An annual, anonymous questionnaire survey was conducted among dental students at the end of the 10th semester each year between 2008 and 2021. The questionnaire surveyed personal attitudes towards ageing, the assessment of seniors, and personal experience with seniors (images of ageing, “Aging Semantic Differential”). In addition to confirming Friedan’s phenomenon regarding the assessment of age limits, the present study was able to demonstrate a positive image of ageing in dental students, which has remained almost constant over the years. An education in gerodontology might positively influence student perceptions of age and aging.

Influence of cognitive impairment and dementia on oral health and the utilization of dental services : Findings of the Oral Health, Bite force and Dementia Study (OrBiD)

BACKGROUND

The aim of this study was to show the influence of cognitive impairment and dementia on oral health and on the utilization of dental services.

METHODS

A cross-sectional analyzation of data of the OrBiD (Oral Health, Bite Force and Dementia) pilot study was conducted. 137 subjects were stratified into five dementia groups on the basis of the Mini Mental State Examination (MMSE) (1-no dementia (MMSE 28-30), 2-mild cognitive impairment (MMSE 25-27), 3-mild dementia (MMSE 18-24), 4-moderate dementia (MMSE 10-17), and 5-severe dementia (MMSE < 10)). Information on the utilization of dental services and oral health parameters (DMFT index, degree of restoration, Periodontal Screening Index, Bleeding on Probing, Oral Hygiene Index, Denture Hygiene Index) were collected.

RESULTS

An increase in dementia resulted in significant reduction in utilization. Moreover, with increasing cognitive impairment/dementia there was a significant difference in the number of teeth that were decayed, but not in the number of filled or missing teeth or the DMF/T index itself. With increasing dementia, the degree of restoration decreased and oral/denture hygiene deteriorated significantly. Nevertheless, periodontal therapy was required for all subjects independent of their degree of dementia while bleeding on probing was increasing with increasing dementia.

CONCLUSIONS

An influence of cognitive impairment and dementia on oral health and on the utilization of dental services was shown. However, no conclusions about the influence of the utilization behavior of people with dementia on oral health parameters can be drawn. Further longitudinal studies are needed. Trial registration ClinicalTrials.gov NCT03775772. Registered 14th December 2018, https://clinicaltrials.gov/ct2/show/NCT03775772 .

Gerodontology in the dental school curriculum: A scoping review

OBJECTIVE

To explore the current status of gerodontology in the undergraduate dental curriculum.

BACKGROUND

Internationally, there is recognition for the need to include gerodontology in dental education due to accelerating numbers of older dentate people. There is wide variation in the content and method of delivery of gerodontology in undergraduate curricula of dental schools.

METHODS

A scoping review framework was chosen to identify existing gaps and key concepts in the research on current undergraduate gerodontology education. Arksey and O'Malley's framework was used with the qualitative data analysis software NVivo to identify comparable information on geriatric dental education.

RESULTS

Five themes were highlighted in the studies including (1) gerodontology curriculum content, (2) attitudes, skills and knowledge of undergraduate dental students, (3) didactic teaching, (4) elective and compulsory teaching, and (5) extra-mural learning. The review found large variations in methodologies, presentation of data and findings. All studies emphasised a need for greater inclusion of gerodontology content in the undergraduate dental curriculum.

CONCLUSION

The review found limited research reporting on the educational outcomes of gerodontology in dental curricula with a lack of comprehensive information to inform gerodontology content in dental schools. This review has highlighted the need for national and international guidelines to ensure mandatory inclusion of sufficient and specific gerodontology training to prepare graduates for a growing dentate frail and care-dependent population.

Teaching undergraduate geriatric dentistry in five South America countries

OBJECTIVE

This study aimed to qualitatively analyse undergraduate geriatric dentistry (GD) teaching characteristics identified by geriatric dentistry teachers and senior students in five South American countries.

BACKGROUND

GD involves the knowledge and skills required to provide oral health care for older people.

METHODS

Exploratory-descriptive research with a qualitative approach developed in the undergraduate context of public universities in Chile, Argentina, Brazil, Colombia and Peru. Nine dental schools were intentionally selected. The participants were GD module teachers (20) and their senior students (30). Data were collected through open interviews via Skype^® conducted between May and August 2015 and were analysed using a content analysis technique with ATLAS.ti^® software, resulting in four categories.

RESULTS

GD modules are theoretical or a theoretical-practical mix. Most teachers are prosthodontists without specific training in GD. Their motivations to teach GD are related to personal, family, professional and social reasons. Humanity, sensitivity and knowledge of older people are considered fundamental characteristics of a GD teacher.

CONCLUSIONS

Students' first contact with an older person usually occurs during clinical activities. The participants mentioned insufficient hours for GD modules in the curricula and exclusively theoretical modules that do not allow students to learn typical specificities of older people. In the context of this study, the undergraduate GD teaching-learning process presented some weaknesses regarding educational methods, professor training and the interaction between older people and students. Diversification of learning scenarios and GD professor training are highly recommended.

A call to greater inclusion of gerodontology in the dental curriculum: A narrative review

AIM

This literature review explores the need for greater prominence of gerodontology in the undergraduate dental curriculum, focusing on the significance of gerodontology for dental students on clinical placements.

BACKGROUND

As Australia's population ages the number of dentate older people is increasing. An assessment of the dental profession's preparedness, including that of future providers, is needed to ensure that this public health issue is addressed.

METHODS

A database search was performed in MEDLINE (Ovid), CINAHL and JCU OneSearch. Of the 41 articles identified, 31 were selected for review using a narrative approach.

DISCUSSION

Of the 31 articles reviewed, 12 were Australian, 9 North American and 5 European. Five overarching themes were identified, including preparedness for residential aged care facilities; barriers to oral health services provision; attitudes to aged care; gerodontology as part of a dental school curriculum and service-based learning.

CONCLUSION

There are differences in the gerodontology curricula of dental schools, with a wide variation of clinical exposure to older patients. There is evidence that exposure to gerodontology curriculum prior to treating older people may help dental students feel more prepared for managing patients in aged care. The current marginal status of gerodontology in dental school curricula is in need of review.

Development of undergraduate gerodontology courses in Austria, Germany and Switzerland 2004-2014

PURPOSE/OBJECTIVES

In view of the demographic shift, undergraduate dental students should be prepared for growing numbers of older people and their specific needs. The study examines changes in undergraduate dental teaching in Austria, Germany and Switzerland between 2004 and 2014.

METHODS

Questionnaires were mailed in 2004, 2009 and 2014 to all deans and all department heads of Austrian (n = 4), German (n = 30) and Swiss (n = 4) dental schools.

RESULTS

Response rates were 51% for deans and 47% for heads of department. Gerodontology was taught in 5 German universities, all 3 Swiss and 1 Austrian dental school. Aspects of gerodontology were included in traditional core subjects; however, in a large number of German (88%) and Austrian (50%) universities, dedicated lecture series and seminars are lacking. Changes over time indicate firmly established teaching in Switzerland, minor fluctuations in Austria and reduced dedicated teaching activities in Germany.

CONCLUSIONS

Inclusion of gerodontology in the national syllabus is a decisive factor for the integration of the subject into undergraduate courses. The recommendations of the European College of Gerodontology (2009) regarding didactical and practical teaching should be implemented in the respective compulsory syllabus to prepare current undergraduate dental students for the challenges of tomorrow.

The Graduating European Dentist-Domain III: Patient-Centred Care

This position paper outlines the areas of competence and learning outcomes of "The Graduating European Dentist" that specifically relate to patient-centred care. This approach is becoming increasingly prominent within the literature and within policy documents. Whilst working to an evidence base is critical, dentists must also be aware of the scientific basis that underpins the treatment they provide. The evaluation process, which supports treatment planning, also requires dentists to be able to listen, collate, and record pertinent information effectively. In addition, the ability to account for a patient's social, cultural and linguistic needs (cultural competence) will result in a practitioner who is able to treatment plan for patient-centred care.

The Graduating European Dentist: A New Undergraduate Curriculum Framework

With "The Graduating European Dentist", ADEE provides a new approach that reflects best academic practice for European undergraduate dental education. The new suite of documents sees increased emphasis on important curriculum components such as patient safety, working as a team and patient-centred care. There is also an increased emphasis on teaching excellence, student satisfaction and student preparedness and support. Guidance relating to methods of teaching and learning, and assessment (educational measurement), is also provided. It is anticipated that this new format will further increase accessibility and utility for educators, institutions, societies and regulators, across the sector.

Higher education in Gerodontology in European Universities

Background

The rapid aging of the European population and the subsequent increase in the oral care needs in older adults necessitates adequate training of dental professionals in Gerodontology (Geriatric Dentistry). This study was designed to investigate the current status of Gerodontology teaching amongst European dental schools at the undergraduate, postgraduate and continuing education levels.

Methods

An electronic questionnaire was developed by a panel of experts and emailed to the Deans or other contact persons of 216 dental schools across 39 European countries. The questionnaire recorded activity levels, contents and methodology of Gerodontology teaching as part of dental education programs. Repeated e-mail reminders and telephone calls were used to encourage non-responders to complete the questionnaire.

Results

A total of 123 responses from 29 countries were received (response rate: 56.9%). Gerodontology was taught in 86.2% of schools at the undergraduate level, in 30.9% at the postgraduate level and in 30.1% at the continuing education level. A total of 43.9% of the responding schools had a dedicated Gerodontology program director. Gerodontology was taught as an independent subject in 37.4% of the respondent schools. Medical problems in old age, salivary impairment and prosthodontic management were the most commonly covered topics in Gerodontology teaching. Clinical teaching took place in 64.2% of the respondent schools, with 26.8% offering clinical training in outreach facilities.

Conclusions

The vast majority of European dental schools currently teach Gerodontology at the undergraduate level. More training opportunities in oral care of frail elders should be offered, and more emphasis should be placed on interdisciplinary and interprofessional training, educational collaborations, and the use of modern technologies. Dedicated postgraduate Gerodontology courses need to be developed to create a significant number of specialized dentists and trained academics.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-017-0362-9) contains supplementary material, which is available to authorized users.

Engaging dental professionals in residential aged-care facilities: staff perspectives regarding access to oral care

The limited access to oral care for older people living in residential aged care facilities (RACFs) has been noted repeatedly in the literature. The aim of this study was to explore RACF staff perspectives on how to engage dental professionals in the provision of oral care for RACF residents. Semi-structured interviews were conducted with 30 staff from six purposively selected RACFs located in high socioeconomic areas to gain understanding of the multidimensional issues that influenced the engagement of dental professionals from a carer perspective. Analysis revealed that staff perceived tensions regarding affordability, availability, accessibility and flexibility of dental professionals as significant barriers to better oral care for their residents. Participants raised a series of options for how to better engage dental professionals and reduce these barriers. Their ideas included: the engagement of RACF staff in collaborative discussions with representatives of public and private dental services, dental associations, corporate partners and academics; the use of hygienists/oral health therapists to educate and motivate RACF staff; the promotion of oral health information for troubleshooting and advice on how to deal with residents’ dental pain while waiting for support; the encouragement of onsite training for dental professionals; and the importance of gerodontology (geriatric dentistry). Findings highlighted the need to explore alternative approaches to delivering oral care that transcend the model of private clinical practice to focus instead on the needs of RACFs and take into account quality of end-of-life oral care.

[Oral health in dementia: Results of a telephone helpline]

BACKGROUND

The complexity of dental care and oral hygiene for people with dementia increases with increasing numbers of residual teeth.

AIM

This study was carried out to determine whether the offer of a telephone helpline on oral health and dementia would be utilized.

MATERIAL AND METHODS

Over a period of 1 year contacts received by a telephone helpline manned by three oral healthcare staff were collected and analyzed.

RESULTS

From 01 June 2012 to 31 May 2013 a total of 355 callers (180 healthcare staff and 175 relatives) presented and discussed 2535 problems. The average duration of a call was 21 min. Almost one quarter of the callers were looking for mobile dental care services and 14.4 % were looking for a dentist specialized in caring for patients with dementia. Oral disease, oral care and conflicts between stakeholders on aspects of oral health were discussed. Of the healthcare staff three quarters asked about training to improve the oral health of people with dementia.

CONCLUSION

The demand on the specialists of the helpline showed a substantial knowledge deficit of healthcare staff and relatives. The study confirmed a wide range of oral health issues of people with dementia. Knowledge on oral and denture hygiene and on oral disease could be introduced into primary training and continued professional education. In addition to the lack of knowledge, deficits also exist in the oral healthcare system for people with dementia. Politicians and healthcare stakeholders are encouraged to incorporate oral healthcare for people with dementia into strategies and dementia networks.