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

Stakeholder perceptions of gerodontology education for final year Australian dental school curricula

AIM

The study explored the perceptions of final-year Australian dental students, directors of nursing, and consumer representatives toward geriatric education provided at Australian undergraduate dental schools. Findings will strengthen and inform future curricula design for dental schools.

METHODS

Semi-structured interviews and focus groups were conducted through videoconferencing and in-person interviews, and analyzed using thematic analysis.

RESULTS

Thematic analysis found the major themes to include relationships, curriculum variation, resources, and in-service learning experiences. The participants found gaps in the current delivery of undergraduate dental education. Solutions included greater resourcing through funding and time allocated to supervisors and a curriculum dedicated to gerodontology.

CONCLUSIONS

Healthcare professional curriculum design must consider the needs of the learners and stakeholders involved in the health of older people. The focus group participants found multiple barriers and gaps to achieving what is required to adequately prepare dental graduates for an older, frail, and care-dependent population. For curricula to be successful, policymakers and education providers must find solutions to ensure that the oral health needs of older Australians are addressed and managed appropriately.

Australian dental school academics' perceptions of gerodontology education in the undergraduate curriculum

INTRODUCTION

Australia's rapidly growing population of dentate, frail, care-dependent older people require graduates skilled in managing the health needs of this patient group. The perceptions of academics teaching gerodontology may inform future dental curricula recommendations. This study explored the perceptions of gerodontology education amongst Australian dental school academics.

MATERIALS AND METHODS

All nine Australian dental schools providing entry-to-practice dentistry programs were invited to participate in semi-structured interviews. Academics from six dentistry programs took part, and the data were analysed using a thematic approach.

RESULTS

The three main themes identified from interviews included 'clinical exposure', 'organisational levers', and 'sociological barriers'. The attitudes of students, as well as society and health professionals, were seen as strongly influential in preparing the workforce for managing the oral health of older people. The themes inter-linked with a knock-on effect where societal attitudes and organisational levers impact on the ability to successfully support students' preparation for gerodontology practice. Limited resources were barriers to achieving ideal learning and teaching and continued upon graduation as oral health care for older people was perceived as undervalued and under-resourced.

CONCLUSION

There has been a continued cycle of failure in healthcare schemes and advocacy for the improvement of oral health for older people which has contributed to the inadequate preparation of dental graduates for managing frail and care-dependent older people. Organisational, societal, and political change is needed to support the education of dental students in this area to ensure graduate dentists are competent to manage the oral care needs of this growing population.

DENTAL PATIENT-REPORTED OUTCOMES IN GERIATRIC DENTISTRY : A call for clinical translation

As the proportion of older adults in the world population increases, there is an increasing need to provide adequate dental care for this very heterogeneous group of individuals. The relationship between oral and systemic health, the impact of medication on oral health, and the influence of accessibility to dental care and other social and environmental factors shape the provision of dental care for older adults more than in children, younger, and middle-aged adults. However, while dental care for older adults is shaped by these factors and is often different from the care for other adults, what matters to older dental patients does not differ from what matters to dental patients in general. The four dimensions of oral health-related quality of life (OHRQoL)-Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact-capture dental patients' suffering from oral disorders. OHRQoL questionnaires can be used to assess this impact and to achieve results that are compatible with adults in general. More than in other age groups, cognitive impairments or dementia limit the usefulness of questionnaires or interviews for oral health impact assessment. In these situations, family members or caregivers can assess the patient's oral health impact, and oral health care providers need to rely more on physical oral health characteristics for clinical decision-making than in other dental patients. While the tools to measure oral health impact change, the targets for dental care stay the same. Prevention and reduction of functional, painful, aesthetical, and broader psychosocial impact related to oral disorders are the central tasks for geriatric dentistry as they are for dentistry in general. The aim of the manuscript is to highlight the importance of patient-reported outcome measures in geriatric dentistry, addressing challenges and opportunities for their application.

Specific form of ageism in dental care: Convergent validity of the Ageism Scale for Dental Students and its implications for education

INTRODUCTION

The World Health Organisation considers ageism as an important barrier to age-appropriate care for older adults. An Ageism Scale for Dental Students (ASDS) has been validated in the United States, Brazil, Greece, Romania and in France. At present, the convergent validity of ASDS has never been evaluated. Moreover, a specialised and disciplinary tool as the ASDS may not overlap with more general ageism assessment which may highlight the need for specific courses during the education of the future health professionals.

MATERIALS AND METHODS

The survey was administered from December 2020 to January 2021. All the undergraduate students of the last 3 years of study at the dental school of Clermont-Ferrand were invited to complete both scales. Two hundred sixteen students were randomly divided into two equal groups. The first group answered first Aging Semantic Differential- ASD then ASDS, the second in reverse order. The convergent validity between ASDS and ASD was assessed by computing a Pearson correlation coefficient and discriminant analysis between each component of the two scales.

RESULTS

The response rate was of 53.7%. The correlation analysis conducted on the total scores of the ASDS and of the ASD shows a significant, yet weak relationship. The discriminant analysis indicates that only the first component of the ASDS is significantly associated with each dimension of the ASD, whereas the second component is totally independent from the ASD and the third component almost independent from the ASD, except for the integrity dimension.

CONCLUSIONS

This specialised questionnaire may assess a form of ageism that is not captured at all in more general scales. Such a scale may help to identify the different dimensions of ageism among dental students which is required to reduce ageism in medical care. This reduction should pass by adapted courses in gerodontology.

What influences dental students' attitudes regarding the treatment of older adults? A scoping review

PURPOSE

The aim of this study is to investigate the literature to evaluate dental students' attitudes regarding the treatment of older adults.

METHODS

A scoping review was performed following Preferred Reporting Items for Systematic Reviews and Meta-Analyses/PRISMA guidelines to identify articles from four electronic databases: MEDLINE via the PubMed interface, Embase, Cumulative Index to Nursing and Allied Health Literature, and AgeLine. Gray literature searches were also performed in Scopus, Web of Science, and ProQuest Dissertations and Theses-Health and Medicine.

RESULTS

Eleven articles were assessed. The majority (72, 72%) were published between 2011 and 2020, evidencing various contexts of dental students, such as different countries and cultures, and levels of education. The most commonly used tool/instrument to survey dental students' attitudes was the Aging Semantic Differential Scale. Student age, race, and marital status did not seem to interfere with dental students' attitudes regarding the treatment of older adults.

CONCLUSIONS

Dental students tend to have a positive attitude toward older people. In this context, female students, students who interact with older people, and clinical students have more positive attitudes than male and nonclinical students.

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.

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.

Elderly Patients' Perception of Previewing the Prosthetic Treatment Outcome

The demographic statistics indicate that, with the industrial development and the advances in the medical field, the average life of the population has started to increase significantly; consequently, the needs of treatments in geriatric dentistry are becoming more and more significant. The purpose of this study was to evaluate patients' perception of diverse techniques used to obtain previews for final fixed prosthetic restorations: digital smile design (DSD), wax-up, indirect mock-up, temporary restorations, Computer-Aided Design (CAD). A focus group that included 11 participants, all of them geriatric patients, was formed; patients were invited to respond to a set of seven questions before and after various previsualization methods were applied. The focus-group report indicated that the indirect mock-up and the temporary restorations were considered by the geriatric patients as the best methods for obtaining good prosthetic previews. Comparing to the other tested methods, the use of indirect mock-up increased the acceptance of the prosthetic treatment plan and offered the most influential visual impact for 72.7% of participants. In addition, all tested previews allowed excellent communication with patients, the best results being obtained with the temporary prosthetic restorations (for 54.5% of participants). This approach represented a tool for better decisions regarding final dental restoration and has had a positive influence on patients' acceptance of the treatment plan as well, making the final restoration more predictable.