the importance of a course in preventive dentistry in the dental school curriculum

6 .

DZ-9 I ST?iY IN DXITAL

Joseph C, Iluhler, D.D.S., Ph.D.,

FIaynmd K. Kine, D .D. S, , N.S. Tarry C-. Day, Disc. and **

I n any profession o r business it i s well f o r i t s members t o nause occasion- ally to examine tlleir y o g r e s s i n retrosFect and, i n a l i k e manner, their future. This is e q e c i a l l y true today i n dent i s t ry , f o r 4uring the past decad.e the nrofession hrs made p e a t s t r ides i n teaching and research. In &most a l l instances i n which noteirorthy progress is recorded i n the annals o f Cental his tory, i t has been achieved through the imagihation and investigative fervor o f relc?tively fev inc!!ivid.iials. Year a f t e r year, &ore and nore sTecial3.y trained vorlcers ttre enterin;: the f i e l d of 6.ental teaching, thus effect ing a new apnroach t o the older and- nore generally acce?ted routine dentel nrocedures. Such is the Timesent etatus o f ?re-re;itive dent is t r y i n the dental school curriculum.

The members of the _nrofe$sion who vere educ?,ted with the now routine technical nrocedures m y find i t d i f f i c u l t t o accept and encourage new sugges- tions. Consider one instance concerning dental caries. Ifany dental au tho r i t i e s have s ta ted that even i r i t l i the extensive research anG eclucation in Trsogress, a hicher percentx;e of -3eoFle a re i n need of dental a t t en t ion tlmn at any previous time. t he i r den t i s t s , but car r ies the connotation that there are more a c t d denta l defects tod-ay than there were years ago. who has studied the c!ecay pat tern of fre&%n students at a midvest univers i ty since 1929 states:

This does not mem that more neople a re , at the ?resent time, sseing

As an i l l u s t r a t i o n o f th i s , one author

IlThough ( t h i s Trepan) s t a r t ed only 20 ?'ears ace, these decennial reviews of the dental conrlition of univers i ty freslmen r ea l ly cover a >erioc? o f approxi- ne,tthy dental hea l th than anir other nei-iod. i n the vorltll s history. Xutrition, par t ic- ularly among the Arerican Teople, has greatly in:voveh. become an almost u n i v e r s d Tract ice , a t l e a s t by the majority o f persons i n the 1iic;her socioecononic leve ls to rihich the univers i ty students belong. Dental heal th education has bcen carr ied on at a constantly accelerating r a t e eince 1910, and i t s ernThasis has bcen increasingly on tlie des i raPi l i ty o f early and frequent dental care t o nrevent the deter iorat ion and loss or' teeth. Despite a l l the care and atteii t ion t h a t has been and. is being riven t o the teeth of ( these) university StUdeiltS, these tee th a re aotr d-ecaying t o a greater degree th,w they were 10 y e w s a?y and a stil.1 Greater degree than they were 20 gears ago.. . ,I'oreover, the l indings o f these three successive studies should serve as a challenge t o botn deiital research workers and Fract ic ing dentists. teeth a r e ivor th savinc, i t nust be these groups that w i l l f ind and annly the means o f savins then," 1

years. Tke meriod since that time has :?roc?uced. more benefit$ f o r

Dent81 hyziene has

I f

* Fieprinted by Yei-mission from the Journa l o f Dental Zducntion, Bovember 1952. **ZesI3ectively--Assistmt Profgssor , De?astment of Chmiatry, Vni?rei*sitp of

Indiana; Ckairnan, 9e:>artnent o f Chemistry, University of Indiana; Dean, School, of Dentistry, Uilivgrsity o f Indiana.

IBrekhus, Peter J.: The Deterioration of Runan Teeth, J . A . Y . A . , 42, 424; 1951.

7. Figures vwy as t o the number of people who routinely v i s i t the den t i s t ,

but most s t a t i s t i c s indicate that aFproximately 25-35 ner cent o f the adul t p o p l a t i o n see the dent i s t i n a somewhat re,gularr fashion. chil3ren v i s i t i ng the dent i s t i s vithout d.oubt much l e s s than this. O f the adul t f igure, a considerable number a r e not receiving even adequate d.enta1 a t ten t ion , due nostly to the overwhelming backlog of people requiring tieatrnent. For e x a q l e , i n Incliana, whose population i s aqroximately four mill ion, there i s a d-entist-to-population ratio of about I. t o 2000. This figure i s aTFroximately the average of the United States. This means that the general p rac t i t ioner can' q e n d l e s s than one h o u r a year per nerson. Por the time available Fer na t ien t , then, t h i s mag amount t o l i t t l e more than a thorough prophylaxis once a year. I t almost goes without fur ther j u s t i f i ca t ion that if new ideas and present c03- cepts of correctin; the dental ills a re not forthcoming and a c c c t e d by the profession and l a i t y a l ike , i t w i l l be imFossible even t o keep abreast of the ex is t ing dental problens of the en t i r e population.

The percentage of

Many dental educators have recognized t h i s problem and a r e attempting t o f ind a sat isfactory solution, courses be in s t i t u t ed i n dental schools throughout the country, thereby at l e a s t eqos ing the dental student to the present-day f a c i l i t i e s avai lable f o r preventing dental diseases. This idea i s d- i f f icu l t t o i n s t i t u t e i n the dental. cw-riculum for man:' reasons. I n the majority of schools, the dental f a c u l t i e s a r e composed of mrsoiis whose nrimary in t e re s t 2nd t ra in ing a re i n res tor ing dental heal th after a f f l i c t i o n , which i s not conducive to prophylactic progress. Secondly, for :7ea.;s the dental schools vere forced t o choose their f acu l t i e s , f o r the most Tart, from general pract i t ioners , who as a r u l e had no s?ecific t ra in ing in the basic sciences other than that taught a s a part of t he i r dental sc:iool cur r icu lm. Thus, teaching tended t o be stereot,yped. aRv new i fea , t:-iere are alvmys those who attempt t o b e l i t t l e i t , rnaihly through ignorance, and contri'oute l i t t l e ' su-yvort i n i t s behalf. besides these coul6 be mentioned, but suff ice i t t o say that today almost every denta l school has some facul ty members well qual i f ied t o discuss nreventive den t i s t ry in te l l igent ly , both from a dental and. a basic science vitypoint, The ::ood intentions of the members o f the nrofession a r e best summarized i n a recent discussion o f the Advances i n Dental Science fron 1900-19j0, a port ion o f which was written summarizing Freventive dentistry.

Some a r e sug5esting that add i t iona l prophylactic

Thirdly, a8 v i t h

Other obvious f ac to r s

IIProgress i n the development of preventive nethods t r i l l be the index of the advancement and achievement in dentistry. devotion t o unveil new knowledze, w i l l continue t o serve t h i s noble intention,Il2

Dental research, with its a l t r u i s t i c

What is meant bg the term "preventive denti?try"? I n i t s broadest sense,

But i n this discussion, the term pre- preven'tive dent i s t ry obviously means the teachings and techniques used to prevent gl& clental i l l s from occurring, vention of denta l car ies only v i l l be consid.ered, B r l y textbooks of preventive dent i s t ry , such as that m i t t e n by Tones, actual ly enbodied the former concept, t he i r q e c i a l em+asis being placed on oral hygiene and the DrinciTles of dental prophylaxis, and Oral SeFeis, mizht well be referred to as the Fredecessor of a course i n preventive dent i s t ry as w i l l be outlined hereirith, for i t s general theme was a d.iscussion o f the current vrorlr of that t i ne vhich inquired into the methods of

P i c k e r e l l t s excellent textbook, The Prevent ion of De2Cal Caries

~ ~~~

'3aume, L. J. and Becks, H. : Advances in'Denta1 Science, Prewntive Dentistry, edited by E. S. C-. Robinson; J . A . D . A . 40, 666; 1950.

the preventive treatment of dental cariee. topics, which included the ’passive resistance o f the teeth together with factors ine-wing act ive natural yrotection, More recently, Bunting! s Text- book of Oral Fjgiene and Preventive Dentistry i s a combination o f these two general ideas. I t ?resents material , both from the standpoint o f oral prophy- laxis and chemical and bacter ia l procedures, which m i & t be used in preventing aental caries.

2e considered many well chosen

Few dental schools have as a Tortion o f the i r curriculum a ckair o f ?re- ventive dent is t ry that is independent of a course i n oral hygiene, orthod-ontia, public health, o r periodontia, and that i s designed expl ic i t ly t o >resent recent material on the news o f preventing dental digeases. in the United S ta t e s vrkose recent catalogs were examined, only two l i s t in their bu l le t ins a special course en t i t l ed , “Preventive Dsnt istry,I1 and define i t as a course separate from periodontia, v i t h the aim of ?resenting recent chenicai and bacter ia l findings whereby dental diseases can be prevented, For example, one ins t i tu t ion ind-icates this i n their catalog:

Of’the 41 d.enta1 schools

1ICaries prevention. Intensive study of the problen of dental car ies , with Anatomical re la t ions , epidemiolom, special reference t o nethods of prevention.

diamosis and therapy, determining car ies suscept ibi l i ty and o f techniques of grevention.”

La5oratory study and demonstrations o f techniques f o r

Another universitzr refers t o their course as containing the fo l lowing topics:

Itpreventive Dentistry. The lecture course i s siven in the f i r s t and second semesters 05 the fourth year. io logy and dental caries. for the 8.ifferences observed i n the cpxies suscept ibi l i ty of various peoples, The material presented i n the course i s pertinent to planning and suyervising a successful preventive dental service. 11

Special emphasis i s placed on the epiaem- Consideration i s given t o the fe.ctors responsible

Thirty dental echools fail even to l i s t a course i n preventive dent is t ry of any nature, while nine indicate a course i n car ies control i s being taught.

A cowee i n preventive dent i s t ry 8 8 outlined hermrith might well be placed i n the junior o r senior years of our present-day curriculum. usually offers somewhat nore clsssroom hours, and has the advantage o f present- ing the material at szrch a time that the student has time t o correlate i t with h i s c l in i ca l observ2”tions. adequ&te. If the subject vere t o embody prevention 02 d-ental disease as a whole, although ent i re ly separated from the course i n periodontia and/or o r a l hygiene, it m i g h t v e l l require tvice this many classroom hours. as the former should include material along the following l ines: background of previous attempts to yeven t soft and hard t i ssue disease, and a review of t h e nature of the physical and chemical structures of the teeth 2nd s q p o r t i n g etructures, inclut-ing mineral metabolism. This latter topic should emphaaize the I1dyumicst1 of the teeth and bones with special emphasis upon recent Laovledce gained through the use of rad-io-tracer techniques employed in this f ie ld . The morphology o f the teeth, 8ex and age incidence, and races with natural immunity and susceptibi?ity and the various means of diagnosing caxies and soue epidenological stu6ies shoving car ies d i s t r ibu t ion

The junior year

A t o t a l of 16-20 didactic hours would yerhpFs be

Such a course An h i s to r i ca l

9.

should be includ-ed. The general importance o f adequate nut r i t ion upon the sof t and hard t i s sues s7iould be i l l u s t r a t e d and stressed, and specif ic nu t r ien ts and d ie ta ry esse:itials imyortant f o r an adequate dent i t ion should be reviewed. The ro l e that endocrine dyscrazies may play i n dental car ies should be outlined s t ress ing es?ecic.llp the e f fec t that the hormones night have uFon the sal iva and develoTing &entition. The'problem of resietance t o decay a f t e r erv?t ion of the tee th should'be e:n$asized, and infornation per ta ining t o pen ic i l l i n , urea, ammonim ion, chlorophyll, e tc . , should be included, as well as a thorou& dis- cussion of f luorines i n ca r i e s prevention. The :;enera1 problec. of carbohydrate metabolism and dent21 ca r i e s i s an important consideration i n A course such as th i s , Under t h i s zeneral toFic, nany of the t e s t s f o r car ies suscept ib i l i ty '

should be presented, as well as the general touic of dental plaques, T ina l ly , sone genoral aspects o f educational neasures tha t could be Ferforned by th general p r s c t i tioner should be pointed out and- discussed-,

A. course o f this nature i s geared t o ??resent infornation about ca r i e s prevention t o the advanced dental student, and i t i s honed that by such a presentation the student \ r i l l be bet ter equi9yed t o cope t r i t h the yoblems o f preventive dentistr;? rrhich a r i s e i n his cornunity a f t e r he begins !Trivzte pract ice; sunplies, and. the l i ke a r e evidence that ire ?,re d.1 avare o f a nroblem, but sa t i s fy ing progress w i l l not be achieved u n t i l t he r?ental schools r e a l l y begin t o think and teach prevention o f dental caries.

3 u c a t i o n a l nrosrams i n the schools, connunal f luoridizet ion o f iwteer