Dental Education

Dental schools are located within or close to medical and hospital facilities. The traditional four-year program of studies corresponds to that of medicine and consists of two preclinical years of basic sciences and two years of clinical study. The basic sciences (anatomy, physiology, biochemistry, etc.) are taken by dental students in some schools together with medical students; in others, instruction is given exclusively in dental school. While most work consists of lecture and laboratory experiments, preclinical study also includes learning the basic techniques of dental restoration and treatment through practice on inanimate models.

The two clinical years are spent treating patients having a variety of oral diseases and disorders, while working under the supervision of clinical instructors. A variety of clinical procedures and dental care for special patients (for example, the old and infirm) are mastered during this period. Making use of dental auxiliary personnel is outlined.

Beginning in the 1960s, the traditional curriculum in dentistry underwent change; the nature of this change was two fold. First there was a new approach that involved integration of the basic and clinical sciences with emphasis on relevance, and thus students were introduced to the patient earlier. Also, greater emphasis was placed on preventive dentistry, public health dentistry, practice management, and hospital dentistry. The curricula of almost all dental schools have been updated to a greater or lesser extent along these lines.

A second major change that was attempted was the shortening of the curriculum to three years. This experiment, however, appears not to have been successful and, as of this time, all dental schools have a four-year program leading to the D.D.S. or D.M.D. degree except the University of the Pacific, which has a three-year program, and Harvard, which has a five-year program.

To provide an insight into the various dental school courses and the approximate amount of time devoted to each, a summary is presented in Table 22.1.

A sample breakdown of the major courses by year is shown in Table 22.2. Schools will allot varying amounts of time to the different courses and some courses may appear under different titles.

To clarify the nature of the major courses taken in dental school, a brief description of their content follows. (Courses are listed alphabetically.)

Biochemistry

The course covers the biochemical processes that occur at the cellular and subcellular levels, and with tissue and organ metabolism and function. Emphasis is placed on the molecular basis of oral and other human disease.

Complete Dentures

Both the theoretical and practical aspects related to the construction of complete dentures are considered during this second-year course. A complete denture is constructed for a mannequin.

Crown and Bridge (Fixed Prosthodontics)

This course extends over the last three years. In the second year the student is introduced to the principles and basic techniques of fixed prosthodontics. Included are such topics as articulation, tooth preparation, impressions, working cast construction, waxing, casting, soldering, and finishing. The third year focuses on the research aspects, evaluating comparative studies of materials and techniques used in prosthodontics. The fourth year is devoted to seminars on current problems in the field and to clinical procedures for more complex problems.

Dental Anatomy

This freshman course deals with the anatomical structure, individual characteristics, and the functional arrangement of teeth and their development.

Dental Materials

This first-year course serves to introduce the student to the basic principles and properties of materials used in dental treatment. Experience to gain and improve manipulative skills with selected materials is provided.

Endodontics

This subject is usually taught starting in the sophomore year. The differential diagnosis of dental pain is taught. Emphasis is placed on the technique used for preparing access cavities, preparing the root canal, obliterating the canal space, and utilizing endodontic instruments. The periodontal diseases and the use of surgical techniques in their treatment are discussed. The fourth year emphasizes clinical work such as surgical treatment of pathological disorders of tissues and all phases of root canal therapy.

Gross Anatomy

The goal of this course is to familiarize the student with the anatomical basis for the study of the basic sciences and the clinical practice of dentistry. Emphasis is placed on the functional significance of various organ systems and regions by means of integrating the lectures and laboratory sessions. The latter use predissected cadavers, skeletons, models, X-rays, and movies.

Histology

A study of the microscopic structure of tissues with special reference to the morphology of the oral cavity, particularly the teeth. Both light and electron microscopic levels of organization of tissues are analyzed.

Microbiology

The course introduces the student to bacteriology, virology, parasitology, immunology, and mycology as related to the oral cavity. The student learns the microbial diagnostic techniques and studies the bacteria of the nasopharynx and the processes of antibiotic resistance.

Operative Dentistry

In the second year, the basic concepts and procedures of tooth restoration are presented. Cavity preparation and restoration are taught in the laboratory. All types of cavities and the use of various restorative materials are covered. An anatomical mannequin is used to obtain experience. After a transition period from mannequin to patient, students are provided with an opportunity, over the last two years, to apply their theoretical knowledge in the clinic under supervision. Lectures, demonstrations, and seminars provide the opportunity to evaluate progress and receive individual guidance.

Oral Diagnosis

This course extends over the last two years. In the third year, students are taught how to take a history and carry out a clinical examination in light of the patient's complaint. The course serves to correlate the basic and clinical information by focusing on diseases and abnormalities of the oral cavity. Clinical work involving oral diagnosis is required. The fourth year consists of a seminar course devoted to diagnosis and treatment planning of specially selected cases that provide valuable learning experiences.

Oral Surgery

Having had courses in anesthesiology, radiology, and exodontics in the first through third years, the student is prepared for this fourth-year course in oral surgery. The course is devoted to the diagnosis and surgical treatment of diseases, injuries, and defects of the jaws and related structures.

Partial Dentures

The student is taught partial denture concepts and techniques. Technical experience is gained by fabricating dentures, using a mannequin as a patient.

Pathology

Taught during the second and third years, this course stresses the recognition and treatment of oral diseases based on their clinical characteristics and an understanding of the disease process.

Pharmacology

Taught in the second or third year, this course aims to acquaint students with drugs currently in use, and to prepare them for the rational application of the drugs in dental practice.

Physiology

Taught in the first year, the course deals first with cell physiology and then with the function of the organ system. The physiological basis of dentistry and its application to clinical practice are emphasized.

Pedodontics

This subject is taught from the second to the fourth years. In the second year, the emphasis is on the procedures used with children of primary and mixed dentition ages, related to child management, oral pathology, preventive orthodontics, and operative techniques. The laboratory deals with restorative dentistry in the primary dentition. In the third year, the lectures deal with the procedures utilized, etiology, prognosis, and treatment of the dental problems of children. Supervised clinical experience is provided to learn the art of teaching dental hygiene to children and to develop the skills to diagnose and treat them. The fourth year is a continuation of the third year course.

Periodontics

This subject is usually taught during the last two years. The course includes a study of periodontal diseases, incorporating clinical and histopathological findings, etiological factors, and methods of prevention. The techniques of periodontal therapy are taught and clinical experience is provided.