OPINION
Does cosmetic dentistry
belong in dental schools?
James R. Dunn
 |
| James Dunn, SD’69, is associate professor of restorative dentistry at Loma Linda University. |
Some lecturing
and practicing dentists suggest that dental schools need to move into
the 21st century and teach dental students relevant dentistry! This message
usually means that dental students need to know more about tooth colored
dentistry and practice management, and less about metal (silver amalgam,
gold) dentistry.
A frequent response by dental faculty is: Because state boards require
amalgams and gold crowns as part of licensing examinations, and students
must pass state boards to practice, schools have an obligation to prepare
the student to practice, i.e., pass state boards. This argument is based
on fact, but the reality of dental education is much more complex.
Dentistry is an ever-expanding profession. Just as we know
that no one dentist can know everything in all areas of dental treatment,
we must also realize that dental schools cannot teach everything about
dentistry to students during the four years of predoctoral education.
Medicine long ago learned this lesson by requiring a internship year after
graduation, passing part three of national board exams, and only then,
is a medical school graduate eligible for a state license. Few, if any,
in medicine do not then complete a three-to five year residency before
beginning practice, and almost none practice alone.
| Dental schools cannot
do more than introduce the student to basic principles of treatment
of dental disease. |
Dental schools cannot do more than introduce the student
to basic principles of treatment of dental disease. It may be time to
consider the need for an additional internship year, or realize that it
is the responsibility of the dental graduate to continue their education
beyond the basics taught in dental school.
All accredited dental schools share a similar, basic curriculum.
Periodic accreditation reviews require each dental school to reevaluate
its current curriculum compared to overall dental knowledge, the time
available for training, and the relevancy of the curriculum to contemporary
dental practice. As new knowledge and technologies are introduced, the
curriculum must be revised within the limited hours available.
Every dental school department struggles with this problem
and the result often is a fight over who “owns” the curriculum
time.
The question about cosmetic dentistry is: How can this topic
be included in the curriculum? Some schools offer it as an elective, while
others include aspects of cosmetic dentistry in existing courses, resulting
in a reduction of some aspects of traditional procedures.
The goal of a dental school is to prepare its graduates
for practice. The message that established practitioners send to the schools
is that they want potential associates to have knowledge about cosmetic
dentistry. The dilemma for the schools is that dental education is traditionally
based on validated clinical procedures, and cosmetic dentistry is moving
too fast for evidence-based information to be included in the curriculum.
Fortunately, many schools—including Loma Linda University School
of Dentistry—are actively involved in research providing scientific
information that can be trusted.
Cosmetic dentistry procedures are being introduced into
dental school curriculums and eventually will become as traditional as
current metal treatments are now. No matter how much is included, there
will always be a need for continuing education to keep up with the knowledge
explosion in dentistry.
What is happening at LLUSD with regard to the teaching of cosmetic dentistry?
I am happy to report that here we are making a serious attempt at providing
important opportunities for our students to prepare for their future.
Freshman have both lectures and laboratory exercises in esthetic materials,
and anterior and posterior direct composites as part of the preclinical
restorative dentistry course. Anterior composites include Class 3, 5,
4, diastema, and veneer procedures. Posterior Class 1 and 2 composites
are taught prior to, but in the same sequence with, amalgam restorations.
| Cosmetic dentistry needs to be categorized and then one can decide which procedures can be included in the curriculum. |
A comprehensive lecture and laboratory series during the
junior year includes introduction to the psychology of human and dental
beauty, tooth whitening, dental photography, anterior and posterior direct
composites using the new “natural shaded” materials, ceramic
veneers, posterior indirect composites and ceramics. During the second
and third years, students treat patients with anterior direct composites
and tooth whitening.
An increasing number of dental school clinic patients are
requesting cosmetic procedures ranging from simple tooth whitening, to
veneers and posterior tooth colored restorations. After the junior class
in esthetic treatments, many students find adequate numbers of patients
wanting such treatment, giving them experience in a variety of cosmetic
procedures.
Fifteen senior students can apply to join the elective
monthly Aesthetic Dentistry Study Club, a continuing education course.
The 15 seniors join 35 practicing dentists one Friday a month for lecture,
laboratory, and an afternoon clinic. Seniors who fully participate in
the study club can treat patients with simple and complex cosmetic procedures.
Although all cosmetic procedures count toward graduation
requirements, only Class 3 and 5 direct composites are included in competency
examinations. This year, for the first time, the California dental board
will include a Class 3 composite; therefore the Class 3 composite will
be part of mock board examinations.
Class 2 direct composites still are not part of minimum
required procedures for graduation. Patients are, however, requesting
posterior composites, both for amalgam replacement and initial treatment.
This presents a problem for students: A minimum number of amalgams are
required and they need to practice for both the mock and the licensure
examination boards. Since cosmetic procedures are not required, students
must make a choice -- either prepare for the boards or get experience
that will help them in their future practice.
Let me suggest a possible solution to this problem: Because
schools cannot possibly teach all areas of cosmetic dentistry, nor can
they teach to competency in more than a few areas, maybe dental school
should contract with dental students on the amount and depth of information
that will be available during their undergraduate training, then provide
the additional information in continuing education or postgraduate programs.
Cosmetic restorative dentistry needs to be categorized and
then one can decide which procedures can be included in the curriculum.
The procedures which can not be included and procedures which need more
in-depth instruction, should be included in a post graduate, or continuing
education curriculum. Dental students would then know how much instruction
in cosmetic dental treatments they could expect while in dental school,
and how much they will have to learn after graduation.
Although this process will not meet all criticisms on the
role of cosmetic dentistry in dental schools, it will allow the student
to know how much information and experience can be expected. This process
would also allow observation of changes in dentistry and allow continuing
evaluation of technologies that may need to be included in the dental
school curriculum.
I am happy to tell you that we have started this process at Loma Linda, and will experiment with the concept. I invite your comments on this important issue.
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