Education of dentists in the treatment of patients with special needs

The dental education system has been suggested as the vital link in providing a workforce capable of improving oral health for people with special needs. Dental education institutions not only train dental professionals for their role in providing oral health services for people with special needs, they also provide a significant amount of services to this population in their clinical environments. However, there is no consensus about whether to concentrate the educational efforts on the preor postdoctoral level, or both. Furthermore, it is not clear if educational initiatives in the care of patients with special needs will translate into a larger oral health workforce willing to treat these patients. However, for the purposes of this paper, it will be assumed that more education and training in special care dentistry will lead to better-educated dentists and the desired result of better access to care for special needs patients. The authors will define special needs patients as those who have a chronic physical, developmental, behavioral, or emotional condition, and who also require health and related services of a type or amount beyond that the general population requires. This paper will describe accreditation issues and discuss the advantages and disadvantages of special care education in pre- and postdoctoral training and beyond.     

Collaboration between dental faculties and National Dental Associations (NDAs) within the World Dental Federation-European Regional Organization zone: an NDAs perspective

Although improvements in certain oral health measures have been achieved, many global oral health matters and challenges exist. Collaborations and partnerships among various institutions are crucial in solving such problems. The main aim of the present study was to analyse the nature and extent of the partnership between dental faculties and National Dental Associations (NDAs). A questionnaire was developed, focusing on the relationship between NDAs and dental faculties within the World Dental Federation-European Regional Organization (FDI-ERO) zone with regard to major professional activities, such as dental education (both undergraduate and continuing education), workforce issues, improvement of national oral health, and science and knowledge transfer. The questionnaire was sent to all member NDAs within the ERO zone. The response rate was 21/41 (53.65%). The major activities in which NDAs were found to be involved were improvement of national oral health (100%), followed by continuing education activities (90%), whereas the activity which received least involvement was the development of an undergraduate dental curriculum (52%). The NDAs perceived their relationship with dental faculties to be quite satisfactory in the fields of continuing education, science and knowledge transfer, and the implementation of new technologies into daily dental practice. However, it was suggested that their relationship needed significant improvement with regard to the development of an undergraduate dental education curriculum, dental workforce issues and negotiations with the authorities regarding professional matters/issues. As the two important elements of organised dentistry, NDAs and dental faculties have a significant role to play in the improvement of oral health and in finding solutions to global oral health challenges; therefore, their collaboration and partnership are crucial for this purpose. On the basis of the perceptions of NDAs regarding their relationship with dental faculties, it can be concluded that their partnership can and should be further improved.     

A comprehensive approach to teaching management in a degree-completion dental hygiene program

Changes in society have dictated changes in the future of the dental hygiene profession and in the curriculum used to prepare students. Dental hygiene students should be prepared to assume a variety of new roles in the oral health and health care fields, including administrator/manager, researcher, educator, clinician, patient advocate, and change agent. The role of the administrator/manager had been identified as an important one for dental hygienists. In order to develop the skills necessary to obtain a position in management or administration, dental hygiene students should have educational preparation in these areas. This paper describes the development of an enhanced business curriculum in a degree-completion program. The curriculum provides a basic foundation for the development of effective management skills and includes courses in business, human resources management, and marketing, along with elective course offerings and an externship program. An integrated approach to management is employed, with emphasis on application to oral health and health care delivery systems.     

The Malmö model: a problem-based learning curriculum in undergraduate dental education

A new undergraduate dental curriculum was introduced in Malmö in 1990 which is based on problem-based learning (PBL). The principles of PBL are strongly influenced by evidence from cognitive psychology and they form the educational strategy throughout the whole curriculum. Two further essential principles underpin the curriculum: a holistic attitude to patient care, and the promotion of oral health. Basic sciences and clinical dentistry are integrated within a structure based on oral conditions prevalent in the community. Students are encouraged to build their new knowledge, understanding and skills into the context of what they have already learned. This approach is facilitated by the presentation of conceptual models, one of which, The Oral Ecosystem is described in detail. The educational programme also gives students opportunities to learn in the clinical context from an early stage, and we endeavour to promote a scientific attitude from the very beginning of the programme. This paper describes the curriculum at three organisational levels (whole curriculum, single course, individual week).     

Turning Australia into a ‘flat-land’: What are the implications for workforce supply of addressing the disparity in rural–city dentist distribution?

Dentistry in Australia has faced, and continues to face, significant workforce issues, in particular, a grossly distorted workforce distribution. In this study, an analysis of the consequences for the workforce that would occur under a series of reduced maldistribution scenarios is examined and reported. Three different scenarios were tested based on existing dental practice to population data at a national level. This study clearly highlights the very significant maldistribution of practices in Australia. However, more importantly, it highlights that to address this maldistribution requires something in the order of a tenfold increase in dental practice numbers (and the commensurate increase in workforce), which is not possible (or reasonable). As a nation, Australia has to look to other methods of achieving equity in access to good oral health. The application of modes of care delivery including, but not limited to visiting services needs to be examined and extended. Clearly, these new methodologies are going to rely on non‐dental health professionals taking a far more significant role in leading oral health‐care models as well as the expanded application of technology to bring unique skill bases to areas where these skilled individuals do not (and will not) reside.     

Access to dental care among older adults in the United States

Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners.     

Dental hygiene and direct access to care: Past and present

The American Dental Hygienists' Association (ADHA) defines direct access as the ability of a dental hygienist to initiate treatment based on their assessment of patient's needs without the specific authorization of a dentist, treat the patient without the physical presence of a dentist and maintain a provider–patient relationship. In 2000, there were nine direct access states; currently, there are 42 states that have authorized some form of direct access. The ADHA has been instrumental in these legislative initiatives through strong advocacy efforts. While research and data support the benefits of direct preventive/therapeutic care provided by dental hygienists, many barriers remain. This paper chronicles key partnerships that have influenced and advocated for direct access and the recognition of dental hygienists as primary healthcare providers. The National Governors Association released a report in 2014 suggesting that dental hygienists be ‘deployed’ outside of dental offices as one strategy to increase access to oral health care along with reducing restrictive dental practice acts and increasing the scope of practice for dental hygienists. The December 2021 release of the National Institutes of Health report, Oral Health in America, further supports greater access to dental hygiene preventive/therapeutic care. This paper also reflects on opportunities and barriers as they relate to workforce policy, provides examples of effective state policies and illustrates an educational curriculum specifically created to prepare dental hygienists to provide oral health services in settings outside of the dental office. Dental hygiene education must ensure that graduates are future-ready as essential healthcare providers, prepared to deliver direct access to dental hygiene care.     

Addressing disparities in children's oral health: a dental-medical partnership to train family practice residents

Providing oral health care to rural populations in the United States is a major challenge. Lack of community water fluoridation, dental workforce shortages, and geographical barriers all aggravate oral health and access problems in the largely rural Northwest. Children from low-income and minority families and children with special needs are at particular risk. Family-centered disease prevention strategies are needed to reduce oral health disparities in children. Oral health promotion can take place in a primary care practitioner's office, but medical providers often lack relevant training. In this project, dental, medical, and educational faculty at a large academic health center partnered to provide evidence-based, culturally competent pediatric oral health training to family medicine residents in five community-based training programs. The curriculum targets children birth to five years and covers dental development, the caries process, dental emergencies, and oral health in children with special needs. Outcome measures include changes in knowledge, attitudes, and self-efficacy; preliminary results are presented. The program also partnered with local dentists to ensure a referral network for children with identified disease at the family medicine training sites. Pediatric dentistry residents assisted in didactic and hands-on training of family medicine residents. Future topics for oral health training of family physicians are suggested.     

Progressing the action plan in Scotland--an educational perspective

In March 2005 the Scottish Executive Health Department published the 'Action plan for improving oral health and modernising NHS dental services in Scotland'. Six areas required major new educational input: pre-qualification education, workforce supply, career development, dental practice and team development, clinical effectiveness/quality improvement and support for the oral health strategy. Targets from the action plan that have been fully achieved include: 1) undergraduate student numbers have reached the target output of 135 per year; 2) vocational training numbers match graduate numbers; 3) a vocational training scheme for dental therapists has been developed and numbers of VT places will match the number of qualifying therapists; 4) a new strategy to support dental nurse training will allow an additional 200 dental nurse training places by 2007; and 5) a clinical effectiveness programme has developed a rolling programme of guidelines, the first one of which, on conscious sedation, was released in May. The dental action plan has provided Scotland with the best opportunity for modernising dental services since the NHS was established. This paper describes some of the educational developments that will ensure NHS dental services in Scotland are 'fit for the future' and 'delivering for health'.     

Non-working dental therapists: opportunities to ameliorate workforce shortages

BACKGROUND: Workforce development is acritical factor allowing delivery on government health priorities. Against a backdrop of increasingdemand for dental therapists being significantly higher than the levels of recruitment, it is widely acknowledged that rural and remote areas (having greater recruitment and retention issues) will face significant shortfall in therapist numbers as the workforce shortages take hold in dentistry. This study analysed the reasons for dental therapists leaving the profession, and factors that would promote the recruitment and retention of dental therapists, especially in rural and remote areas. METHODS: A postal survey was undertaken amongst all registered dental therapists in Western Australia between the years 1999-2003. RESULTS: Of all respondents, 28 per cent indicated that they do not work as dental therapists anymore. A number of reasons for leaving the profession were highlighted, including family reasons, careerchange, poor salaries, relocation, illness and injury, and stress. To increase retention and recruitment of dental therapists to rural areas, a number of opportunities were highlighted by respondents, including increased salaries, living support, travel assistance, access to continuing education, recruitment of more rural students and more flexibility (including job sharing). CONCLUSION: This survey has highlighted various opportunities to recruit and retain dental therapists in their profession and to increase the numbers of rural dental therapists. A broad integrated rural retention strategy is necessary to address these issues among the dental therapy workforce.     

Professional education to meet the oral health needs of older adults and persons with disabilities

A well‐prepared dental workforce is critical to improving the oral health of special needs patients. This paper, originally presented at the National Coalition Consensus Conference: Oral Health of Vulnerable Older Adults and Persons with Disabilities, reviews and suggests opportunities to enhance the professional education of the dental workforce, including enhanced faculty training in gerontology, geriatrics and special patient care, and opportunities for improved curricula and team training both within the dental team and among the diverse group of health professional that often collaborate in the care of special needs patients. Other considerations include the creation of a specialty of Special Care Dentistry, and the effective use of dental team members in the care of special needs patients.     

A new curriculum framework for clinical prevention and population health, with a review of clinical caries prevention teaching in U.S. and Canadian dental schools

To fulfill the Healthy People 2010 Objective 1.7, "Increase the proportion of . . . health professional training schools whose basic curriculum for health care providers includes the core competencies in health promotion and disease prevention," the Healthy People Curriculum Task Force has developed a curriculum framework for clinical prevention and population health for all the health professions. This framework has four components: 1) evidence base for practice; 2) clinical preventive services, including health promotion; 3) health systems and health policy; and 4) community aspects of practice. Within these four common components are nineteen domains, for which each health profession is identifying its own educational objectives. An inventory of knowledge and skills is being developed. A prerequisite to promoting change in the teaching of dental prevention and population oral health is to better understand the current status. Sixty-six of sixty-eight U.S. and Canadian dental schools provided input on the teaching of one important aspect of this wider topic--dental caries prevention--before a December 2002 Clinical Preventive Dentistry Leadership Conference in Cincinnati, OH. In clinical teaching, 68 percent of dental schools included caries risk assessment and also reevaluated preventive outcomes, but while 65 percent included remineralization procedures, only 38 percent specifically reevaluated this outcome. Faculty members have commonalities in attitudes about the advantages and problems in improving teaching in clinical prevention, yet dental schools act individually in curricular design and implementation. The conference introduced a method of conceptualizing change, so that dental schools might address organizational barriers in clinical curriculum development. Even with the new common curriculum framework, other barriers to improved dental prevention and population oral health exist: these include organizational change in dental schools, dental practices, and dental clinics; reimbursement issues and incentives; and lack of accepted and explicit standards in dental care.     

A new dental curriculum for chinese research universities

The current dental curriculum in China was developed from the system in the Soviet Union in the 1950s. This curriculum is outdated and must be reformed to keep pace with the developments of modern dental education. The new dental educational system should be customized to China's needs: care for a large population with poor overall oral health, operating within a government-owned, centralized health care delivery system. Chinese research universities have a mission to produce competent dentists who will also be educators and researchers. To efficiently train academic dentists who can also meet the clinical needs of today's Chinese population, a new dental curriculum was developed at the Institute and Hospital of Dentistry, Nanjing University Medical School. This curriculum has four main features: 1) a two-year general higher education plus five-year dental education ("2+5") model; 2) improved integration of didactic and practical learning; 3) improved integration of dental education with research training; and 4) improved overall sequencing of the entire curriculum. This article describes the details of this new dental curriculum.     

Dental therapy in Western Australia: profile and perceptions of the workforce

BACKGROUND: In 2002, the Centre for Rural and Remote Oral Health (CRROH) completed a rural oral health workforce survey which indicated that a high number of therapists, although registered, were not working as therapists. The aim of the present study was to develop a profile of the dental therapy workforce and analyse the perceptions of therapists. METHODS: In 2004, a postal questionnaire survey was undertaken amongst all registered dental and school dental therapists for 1999, 2000, 2001, 2002 and 2003. RESULTS: Valid information was obtained from 253 therapists (55 per cent response rate). The therapy workforce are almost exclusively female, have an average age of 40 years, are working in urban areas, obtained their qualification on average 20 years ago, work for the School Dental Service and qualified in Western Australia. More than a quarter no longer worked as therapists. Perceptions regarding the advantages and disadvantages of dental therapy as a career were identified. CONCLUSIONS: When trying to promote dental therapy and school dental therapy as a career, retain therapists and recruit new graduates, the opportunities identified in this survey should be embraced. A clear focus on the issues will be required to facilitate meeting the workforce objectives as outlined in Australia's National Oral Health Plan.     

The effect of an HIV/AIDS educational program on the knowledge, attitudes, and behaviors of dental professionals

The Pacific AIDS Education and Training Center (PAETC) developed and tested over time a curriculum to meet the changed HIV/AIDS-related needs of dental health professionals. The objective of this study was to evaluate the HIV-related knowledge, attitudes/beliefs, and behaviors among the participants of a CE training course based on this curriculum, both before and six weeks after the completion of the course. The project recruited 106 participants who were dental health professionals over a ten and a half year period (1992-2003). The dental participants consisted of 79 percent dentists and 21 percent dental hygienists or dental assistants. The sample was 67 percent male, 33 percent female, 45 percent Caucasian, and 24 percent Asian. An adapted questionnaire was used before and after the training to assess the educational needs of the participants and evaluate the success of the program in meeting those needs. Approximately 81 percent of the participants completed both questionnaires. After the course, the participants significantly changed their knowledge, attitudes/beliefs, and behaviors (65 percent, 86 percent, 55 percent respectively, all at p=.0001). Overall, the educational program was successful in increasing and promoting the HIV/AIDS-related knowledge and attitudes/beliefs of the participants and enhancing their commitment to infection control and HIV risk screening behaviors.     

Oral health trends in the US

In the US, dental hygienists are an integral part of the health care workforce. Dental hygienists are prevention specialists who understand that recognising the association between oral and total health can prevent disease. In the US, they also consider it as a part of their job to detect the presence of systemic illnesses. Although they cannot make a medical diagnosis, they can explain their findings to the patients and urge them to see a physician. This report explains the educational requirements for a dental hygienist, barriers and access-to-care issues, some oral health preventive methods, among other things.     

Transcultural skills content in a dental curriculum: a comparative study

Background: Australia has the highest proportion of immigrants in the world (24% of the population is overseas‐born, compared to 22% in New Zealand, 19% in Canada and 12% in the USA). In this context, dental students have become increasingly diverse in a milieu where patients are derived from increasingly diverse backgrounds. Aim: The study aims to analyse the degree to which transcultural and communication skills content is currently embedded in the medical, physiotherapy and dental curricula at a major Australian university. Materials and methods: Undergraduate dental, medical and physiotherapy curricula were compared and critically assessed. Researchers considered the amount of transcultural and communication skills content, the number of formal contact hours for each course and the number of teaching staff involved. In addition, 21 interviews were conducted with staff at the three schools, who were involved in the curriculum development process. Results: The medical and physiotherapy curricula had an explicit focus on transcultural and communication skills as a major and continuing element, delivered by teaching staff from a wide variety of academic and professional backgrounds. In contrast, the dental course showed an under‐representation of transcultural and communication skills content which was taught by a limited number of staff from the School of Dental Science. Conclusions: In marked contrast to medical and physiotherapy curricula, transcultural and communication skills content had a low formal profile in the dental curriculum. A curriculum review process may be a positive step towards the development of a new training curriculum giving higher priority to transcultural and communication skills to support more effective workforce development.     

Analysis of the extent and efficiency of the partnership and collaboration between the dental faculties and National Dental Associations within the FDI–ERO zone: a dental faculties' perspective

Background and aim: As National Dental Associations and dental faculties can be considered as the two major institutions representing national organised dentistry, their further extended collaboration is crucial in responding to the many global oral health matters and issues. The main aim of the present study is to analyse the nature and extent of the partnership between the dental faculties and NDAs. Methods: A questionnaire was developed focusing on the relationship between National Dental Associations and the dental faculties within the World Dental Federation–European Regional Organisation zone regarding their major professional activities such as dental education, workforce issues, improvement of national oral health, science and knowledge transfer. The questionnaire was sent to 173 dental faculties within the countries in the European Regional Organisation zone. Results: Response rate was 62/173 (35.8%). Major activities of dental faculties were listed as implementation of new technologies into practice (72%), followed by improvement of national oral health (65%), while the least involved activity was dental workforce issues (42%). The dental faculties perceived their relationship with the National Dental Associations as quite satisfactory in the field of continuing education and science and knowledge transfer. However, their relationship was suggested to need significant improvement when dealing with undergraduate dental education curriculum, dental workforce issues and negotiations with the authorities regarding professional matters/issues. Discussion and conclusions: Despite the fact that there are differences between the perceived competences and responsibilities of the two bodies, the presence of so many potential areas of collaboration, the increasing expectations from the individual dentists/dental profession and the new challenges of the dental profession give this relationship significant importance. Communication, regular contacts, more joint activities and improved collaboration is needed between dental faculties and National Dental Associations to overcome such professional matters and issues.     

The GKT diploma in dental sedation--a judgement

AIMS AND OBJECTIVES: The use of sedation in the management of pain and anxiety for the provision of dental care is as vital to the dental profession as are windscreen wipers to a motor vehicle. Not for use on every patient or every occasion, but in times of need to wipe away the tears, and essential for effective work. Training in sedation techniques should be a part of the undergraduate curriculum, and postgraduate opportunities need to be developed to support this important aspect of care. This paper examines a particular training course provided within the Department of Sedation and Special Care Dentistry at GKT Dental Institute, King's College London, leading to the Diploma in Conscious Sedation for Dentistry (Dip.D.Sed). The aim of this study was to investigate what impact the course has had on the practice of sedation. Three objectives were defined: 1) Students' evaluation of the course; 2) Students' practice in sedation prior to and on completion of the course; 3) Students' involvement in sedation training of dentists or dental nurses following completion of the course. METHOD: Information was obtained by postal questionnaire from students who had attended the course since its inception in 1997 to 2000. RESULTS: 30 students completed and returned the questionnaire which represented a 100% response. There was an overall expression of satisfaction from students on the course content and the experience they had obtained. The range of experience was 70-100 treatment episodes over 40 clinical sessions. An increase in both the practice of sedation and the involvement in training (dental nurses and dentists) was also shown. The greatest clinical change was the increase in use of intravenous sedation by the students from the community dental service. CONCLUSION AND RECOMMENDATION: This study concluded that the objectives of the course had been achieved. The importance of providing training that enables the safe and effective provision of sedation within primary care as an operator sedationist was strengthened by this study. The value of an intermediate level between the two day section 63 course and the six month diploma course was suggested by students in this study. The development of a clinical attachment based on The Standard Course in Conscious Sedation was proposed as a possible option to fill the gap. The provision of postgraduate training in sedation is limited particularly in some areas of the UK. This problem should be addressed by increasing the opportunity for postgraduate training in sedation by dental schools and postgraduate deaneries. Work towards increasing the funding and opportunities for training in this important area of care needs to be undertaken.     

The Arizona model: a new paradigm for dental schools

The traditional method for the delivery of didactic instruction and patient care in dental schools has come under fire from a number of sources over the past several years. The American Dental Education Association and others have outlined numerous issues impeding the swift progression of student learning through the dental curriculum. Declining state revenues allotted to dental education, the increasing shortage of dental faculty, and the management of student learning in an already overcrowded dental school curriculum have led to the investigation of strategies that address solutions to these and other shortcomings in the current milieu of dental education. To address these deficiencies, strategies for change have been suggested. This article describes the development, implementation, and assessment of a new dental school that addresses these and other challenges to the education of today's dental student, thus creating the Arizona Model. Following seven years of operation, outcomes analysis at the Arizona School of Dentistry & Oral Health has shown positive trends in controlling educational costs, a shift to a modular curriculum, increasing student clinical experiences, and, consistent with the mission of the school, producing dentists who are well prepared for dental public health service.