Human Disease/Clinical Medical Sciences in Dentistry: Current state and future directions of undergraduate teaching in the UK and Ireland.

In March 2017, a group of teachers of human disease/clinical medical science (HD/CMSD) representing the majority of schools from around the UK and Republic of Ireland met to discuss the current state of teaching of human disease and also to discuss how the delivery of this theme might evolve to inform improved healthcare. This study outlines how the original teaching in medicine and surgery to dental undergraduate students has developed into the theme of HD/CMSD reflecting changing needs as well as guidance from the regulators, and how different dental schools have developed their approaches to reach their current state. Each school was also asked to share a strengths, weakness, opportunities and threats (SWOT) analysis of their programme and to outline how they thought their HD/CMSD programme may develop. The school representatives who coordinate the delivery and assessment of HD/CMSD in the undergraduate curriculum have extensive insight in this area and are well-placed to shape the HD/CMSD development for the future.

Putting the mouth back in the head: HEENT to HEENOT.

Improving oral health is a leading population health goal; however, curricula preparing health professionals have a dearth of oral health content and clinical experiences. We detail an educational and clinical innovation transitioning the traditional head, ears, eyes, nose, and throat (HEENT) examination to the addition of the teeth, gums, mucosa, tongue, and palate examination (HEENOT) for assessment, diagnosis, and treatment of oral-systemic health. Many New York University nursing, dental, and medical faculty and students have been exposed to interprofessional oral health HEENOT classroom, simulation, and clinical experiences. This was associated with increased dental-primary care referrals. This innovation has potential to build interprofessional oral health workforce capacity that addresses a significant public health issue, increases oral health care access, and improves oral-systemic health across the lifespan.

Academic dentistry in the 21st century: professional dental education or development of a trade guild.

Over the last decade, 10 new dental schools have been established and several more are on the drawing board for the near future. The overlying philosophy for this new generation of dental school is driven by a combination of societal and financial issues. As with many profound changes in educational philosophy, sooner or later there are always the unintended consequences that must be confronted. This article addresses several of the potential consequences.

Ten-year survey of program directors: trends, challenges, and mentoring in prosthodontics. Part 1.

PURPOSE: This study consisted of two parts. Part 1 was a survey of US program directors, and Part 2 reports on the survey findings distributed to the deans of US dental schools. Both surveys evaluated observations of trends in prosthodontic education. The first survey (2005) of program directors and deans was published in 2007. This second survey was conducted in 2009. The 2009 survey provided 10-year data on trends in prosthodontics as reported by program directors. MATERIALS AND METHODS: A national e-mail survey of 46 program directors was used to collect enrollment data for years 1 to 3 of prosthodontics training for US and international dental school graduates, the total number of applicants and applications considered, and the trends over time of applicants to prosthodontics for US dental school graduates and for international graduates. In addition, the program directors were asked to rank 13 key factors that may have contributed to any changes in the prosthodontic applicant pool. Program directors were also asked for information on student financial incentives and whether their programs were state or federally funded, and whether their sponsoring institution was a dental school. RESULTS: Of the 46 program directors, 40 responded, for an 87% response rate. Respondents reported that 66% of their enrollees were graduates of US dental schools. Between 2000 and 2009 the applicant pool in prosthodontics nearly doubled, with 50% of the program directors reporting an increase in US-trained applicants, 42.5% reporting no change, and only 7.5% reporting a decrease. Using the Spearman correlation for the 10-year survey, there was a positive, statistically significant correlation that society's demand for a higher level of training and credentialing and interest in prosthodontics among dental students contributed to an increase in the number of US dental graduates applying to prosthodontic programs. Only four programs offered no financial packages to offset tuition. The remaining 36 respondents reported some financial package. Among the respondents, there were 23 state-sponsored programs and 6 sponsored by private universities; the remaining 9 were sponsored by hospitals or federal agencies. CONCLUSIONS: A nearly doubled applicant pool and more US-trained applicants to prosthodontics ensure a much more competitive applicant pool for our specialty. In the 2009 survey, program directors reported that factors such as society's demand for a higher level of training and credentialing, interest in prosthodontics among US dental students, advances in implant, esthetic, and reconstructive dentistry, literature pertaining to the need of prosthodontists for the future, marketing of prosthodontics as a career, and the dollar value of prosthodontic training have all had some impact on increasing the mentored applicant pool to prosthodontic training in the United States.

Conscious sedation in Spanish dental schools: Current situation.

The current Spanish curricula for degrees in dentistry include conscious sedation (CS) as a basic training competency. However, is the CS training delivered by Spanish dental schools a consensus-based educational framework enabling students to use this anesthetic technique after graduation? To answer this research question, a study was designed aiming to identify the strategies used to teach this competency in Spanish dental schools and the characteristics of teaching. The authors reviewed legislation concerning officially established requirements for a degree in dentistry as well as curricula currently taught in Spain. Our analysis identified clear discrepancies among the schools of dentistry studied. The only overlap was observed in reference to the level of proficiency imparted, which prevents Spanish dentistry students from using this anesthetic technique after graduation. Specific features of the normative framework and of the Spanish legislative system underlying the design of the present curricula of degrees in dentistry would explain the discrepancies in CS competencies taught at our schools of dentistry. Almost 10 years since its implementation and in light of the new demands of the complex society in which we live, Spanish universities must unify their educational criteria regarding CS training to ensure the appropriate qualification of our new dentists in this technique.

The transition from amalgam to other restorative materials in the U.S. predoctoral pediatric dentistry clinics.

Increased concerns about the safety of amalgam restorations in children have resulted in many dental schools emphasizing the teaching of alternative dental materials. This study investigated the current teaching of different dental materials for use in posterior teeth in the United States predoctoral pediatric dentistry programs. In 2011, the authors invited the chairs of the predoctoral pediatric dentistry departments in all accredited dental schools at that time (N = 57) to participate in an internet-based survey. Descriptive statistics were calculated to describe the frequency of using different restorative materials. Regression models were developed to explore the factors related to the use of dental restorations in predoctoral pediatric clinics. Among the 44 dental schools that responded (77% response rate), 74% used amalgam, and 93% used composite in primary posterior teeth. Glass ionomer was used by 61% of the schools in primary posterior teeth. Placing amalgam in primary posterior teeth was associated with programs that treated more 3-5-year-old patients (ß = .302, p < .043), whereas the use of glass ionomer was associated with having students serving at off-site satellite dental clinics (ß = .015, p < .012). In general, having departments with chairs who had positive attitudes towards Minimal Invasive Dentistry (MID) used composite (ß = .091, p < .0001) and glass ionomer (ß = 103, p < .0001) more frequently and were less likely to use amalgam (ß = -.077, p < .005) in primary posterior teeth. Although teaching MID concepts in predoctoral pediatric clinics in dental schools is increasing, the use of amalgam in posterior primary and permanent teeth is still widely practiced.

Academic dentistry.

Since 1988, thirteen dental schools have provided dental undergraduate programmes within the United Kingdom (UK). In 2006, two new dental schools were created supporting dental education in the community. A further new dental school in Scotland will be accepting students in autumn 2008. In the past 25 years, extensive reorganisation of the NHS has resulted in long-term implications for the training of medical and dental academic staff. The number of academic clinicians is below the minimum viable level and external constraints, combined with a lack of suitable applicants, have led to a moratorium on academic recruitment within some Dental Schools. A detailed review of the historical and associated factors which have led to the problems presently besetting academic dentistry are discussed along with the initiatives introduced in the last 10 years to revitalise the speciality. Also, the present and future outlook for academic dentistry in other countries are discussed. Opinion is divided as to the appropriate setting for the training of undergraduate students between those who support community-based dental education and those who believe dental education should remain within research led dental establishments. External factors are moulding an unsatisfactory situation that is proving increasingly unattractive to the potential dental academic and the case for reform is obvious.

Evolution of dental school clinics as patient care delivery centers.

Dental school clinics, originally envisioned as closely similar to private practice, evolved instead as teaching clinics. In the former, graduate and licensed dentists perform the treatment while undergraduate dental students are assigned treatment within their capabilities. In the latter, dental students provide the treatment under faculty supervision. It is generally recognized that the care provided by the teaching clinics is inefficient. However, in the last quarter of the twentieth century, dental school clinics began to pay much more attention to how treatment is rendered. The comprehensive care movement and quality assurance systems are leading towards more efficient patient-centered care. Case studies at the University of Maryland, Columbia University, and University of Louisville describe activities to make their clinic programs more efficient and patient-friendly. This article explores whether the potential exists for faculty to take a direct patient care delivery role in dental clinics in order for those clinics to become efficient patient care delivery systems as originally envisioned in the early part of the twentieth century.

Teaching of posterior composites in dental schools in Japan - 30 years and beyond.

OBJECTIVES: The teaching of posterior composites has been a major part of the curriculum in Japanese dental education for several decades. The aim of this paper was to investigate the current trends in the teaching of posterior composites to undergraduate dental students in Japan by comparing the results of surveys conducted for over 30 years. METHODS: In late 2016-early 2017, a questionnaire seeking information on the teaching of posterior composites was distributed via e-mail to the persons responsible for teaching operative dentistry in 29 dental schools having undergraduate dental degree programs in Japan. The results obtained were compared to those from surveys conducted in 1986, 1997, and 2007. RESULTS: All 29 schools that were sent the questionnaire completed the responses (response rate = 100%). All 29 schools reported teaching the placement of composite in occlusal and two-surface occluso-proximal cavities in both premolars and molars. Four schools reported not teaching the placement of three-surface occluso-proximal composites in premolars and five schools reported not teaching it for molars. Twenty-seven (93%) schools taught composite first as a part of the preclinical curriculum, whereas 15 (65%) schools did so in the survey of 2007. Variations were noted between schools in the teaching of, cavity design. In contrast, greater consistency was observed in the teaching of techniques for protecting exposed dentin and light-curing technologies. CONCLUSIONS: It is hoped that measures intended to increase the clinical experience of restoring teeth with direct composite-resin for dental students in Japan will be effective, providing opportunity to bring dental education in Japan more into line with international norms.

Curriculum restructuring at a North American dental school: rationale for change.

The purpose of this article is to discuss how traditional dental school curricula are inconsistent with research in how learners learn. In the last ten years, there has been considerable discussion about the need for dental education reform, and innovative changes have occurred in the curricula of a number of U.S. dental schools. However, efforts in curriculum restructuring have been hindered by the lack of evidence that one specific curriculum design achieves outcomes superior to other designs. Moreover, there has been little discussion in the dental literature about how modern theories of learning can provide a sound rationale for change in dental education. Thus, it is important for those involved in curriculum reform to present the rationale for change based on the best available evidence. In this review, we summarize aspects of research on learning that seem applicable to dental education and outline ways in which curricula might be changed to become more consistent with the evidence.

Academic tenure and higher education in the United States: implications for the dental education workforce in the twenty-first century.

This article reviews the literature related to the evolution and implementation of academic tenure (AT) in U.S. higher education. It is intended to highlight AT implications for the recruitment, retention, and development of the dental education workforce in the twenty-first century and the need for this workforce to implement change in dental education. The dental education workforce is shrinking, and a further decrease is projected, yet the demand for dental education is increasing. AT is becoming increasingly controversial, and the proportion of tenured to nontenured (i.e., contingent) faculty is declining within an already shrinking faculty pool. Confusion regarding the definition of scholarship and its relationship to research and publishing further confounds discussions about AT. Whether the principles of academic freedom and due process require tenure for their preservation in a democratic society is open to question. In view of competing time demands and increasing pressure to publish and apply for grants, factors including the seven-year probationary period for tenure, the decreased availability of tenured positions, and the often perceived inequities between tenured and contingent (i.e., nontenured track) faculty may pose an obstacle to faculty recruitment and retention. These factors may severely limit the diversity and skill mix of the dental education workforce, resulting in a decrease in staffing flexibility that appears to be needed in the twenty-first century. Politics, increasing dependence on grant funding by some institutions, resistance to change, and insufficient mentoring are all stimulating discussions about the future of tenure and its implications for U.S. dental education.

Looking Back to Move Ahead: Interprofessional Education in Dental Education.

Interprofessional education (IPE) is a widely recognized and critical component of dental and health professions education and is included in two of the predoctoral education standards required by the Commission on Dental Accreditation (CODA). Following a review of the literature on the state of IPE education in U.S. dental education programs, this article revisits six institutions identified in previous research as exemplars successfully implementing IPE on their campuses. Interviews were conducted with leaders at the following programs: Columbia University, Medical University of South Carolina, University of Colorado Anschutz Medical Campus, University of Florida, University of Minnesota, and Western University of Health Sciences. Strengths and weakness of IPE in dental education are discussed, along with opportunities for the future including reducing barriers to scheduling, increasing intraprofessional education, and consistent outcomes assessment. The article concludes with lessons learned by administrators and suggestions for improving incorporation of these requirements into predoctoral dental education programs by emphasizing the importance of IPE and dentistry's role in overall health. This article was written as part of the project "Advancing Dental Education in the 21st Century."