Reformation in Dental Education

Part I
By Mathew Podolin, D.D.S.
A second article by Dr. Podolin, discussing the important phases of the dental curriculum will appear in the next issue of Nutrition and Dental Health.
Much thought and effort has been devoted to the improvement of dental education, and to be sure a considerable progress has been made in the last quarter of a century. But if that same progress is to continue on and on, as it should, we must everlastingly change our teaching methods, our curriculum and equipment to conform with the latest development and discoveries in the scientific world.
Suggestions have been made that in addition to the dental schooling, a full medical course be added. This would mean ten to twelve years of college study, entirely too long, and would find very few desiring to spend so much time and money for the privilege to practice in such a limited field. For dentistry with all its branches is entirely too limited to demand such a sacrifice.
To confine this highly important training to a small group would defeat they very purpose and aims of advancement and progress in the dental profession. Furthermore we seriously question if the additional training as it is proposed or as practiced by some institutions today is accomplishing its desired results.
The so-called basic or fundamental sciences should, of course, be taught, but to assure successful assimilation, the relation of the subjects to dentistry must be emphasized whenever possible, and this can best be accomplished by one thoroughly trained in both branches of these sciences.
The object of some schools to produce a skilled technician rather than a scientifically trained diagnostician falls equally short of its goal. We cannot overestimate the important of diagnosis in the dental curriculum. Intelligent treatment without a proper diagnosis is impossible, but learning to diagnose oral diseases does not necessarily mean than every dentist be qualified to treat these cases, then why burden him with a complete medical course?
The present curriculum puts the student in touch with a lot of information while not entirely useless from an educational point of view, still is a considerable waste of time from a practical standpoint.
At the present the dentist is trained in the same manner as is the physician during the first two years. After that, the medical student is learning to interpret diseased processes by actual observation and practical application of his acquired knowledge. While the dental student stops right there and becomes engrossed entirely in the mechanical end of dentistry, and it is because of this profound difference that the medical sciences in the dental curriculum must be modified to suit the dental student.
We admit that in most schools the dental student is receiving excellent instruction in the basic sciences and an earnest effort is being made to teach the student in a manner that he may be able to interpret diseases of the mouth in its relation to general health.
But the lack of practical application to diseased processes and the fact that mechanics and mechanical efficiency becomes the dominant activity of the dental student, the basic sciences so diligently studied soon become mere subjects for the qualification to a dental degree.
To be justly classified as a member of the healing arts the dentist doest not necessarily have to be physician, but if the dentist is to continue to treat diseases of the mouth and its contiguous parts, if he is to extract teeth and perform other minor surgery he must have a thorough knowledge of the sciences directly related to the field in which he operates, and a general knowledge of medicine so that he can correlate diseases of the mouth to systemic disturbances.
The Curriculum
A modified dental curriculum should curtail subjects that are quite unimportant for the practice of dentistry and intensify the efforts in subjects directly related to the dental problem. Gross anatomy and pathology of the entire body should, of course, be taught the dental student, but in a limited degree, while anatomy of the head and neck and pathology of the mouth and its contiguous tissues should be greatly emphasized, and should become the dominant subjects in preference to mechanical efficiency.
For the student inevitably has greater opportunities to perfect his mechanical ability when out of school. There is a definite lack of correlation of subjects. The teachings of anatomy of the upper and lower jaws might well be coincidental with the study of the act of deglutition and mastication. The function of the muscles of mastication could well be illustrated in relation to the segments in case of a fractured jaw.
The teaching of anatomy and pathology should never cease during the entire curriculum, and the hospital clinics and laboratories should be available for research at all times. The studies of biochemistry should synchronize with the studies of pathology, nutrition and pharmacology. While histology and physiology may be studied as separate subjects it would be far more impressive upon the student’s mind if they were presented in direct relationship to disease.
If the curriculum could be altered so that the student be brought into contact with clinical material while he is studying these sciences, it would tend to leave a more lasting impression upon his mind, thus enabling him to become better equipped in the pursuits of this profession.
Hospital and Clinical Facilities
While most of the dental schools are awakening to the possibilities and importance of hospital clinics, they are as yet not sufficiently organized to function as they should for that purpose. With the exception of a few short classes, where some of the studies are demonstrated by clinical observation, the present hospital and clinical facilities are entirely inadequate.
The dental student must be given the opportunity to follow up cases following the extraction of teeth. He must observe infective processes from the onset to its unfortunate or successful conclusion. All the hospital and clinical work becomes a total failure, if it fails to develop, at least to a certain degree, surgical judgment and intelligent diagnostic qualities in the student’s mind.
The Dental Faculty
The teacher is just as important as the curriculum in the dental scheme of education. Dental colleges do not require any special preparation for teaching. Too many teachers attain their posts because of their financial success in their profession, even though they are not qualified to teach. To be sure, the more careful Dean selects his faculty from those who distinguish themselves professionally, but altogether too often this professional distinction is acquired through political office and not through exceptional ability, advanced study or scientific research.
Dentists who have had additional training and special preparation in a particular subject are far better teachers than medical men, who although excellent in their own field nevertheless fail to grasp the true spirit and to understand the needs of the dental practitioner.
There are, however, some medical teachers who through their many years of association with the dental schools are exceptionally well informed about the dental problems, and because of their medical training have become invaluable assets to dental education.
To be skillful and efficient in one’s own practice is not enough to qualify one for a teaching part. It should not be the aim of the faculty to produce skillful dentist, for skill will inevitably come with the practice and experience if the capacity to acquire such skill is there, but rather, the teacher must strive to develop in the student an attitude of mind without which the training is a total failure.
The objective should be to instill into the student’s mind an interest and desire for research, so that he may continue in his studies after graduation, thus maintaining the dignity and respect of his profession.
Of course, we fully appreciate that while hospital and clinical facilities may be recognized, curriculums changed or modified, to organize a qualified faculty is quite another problem.
True that there are not enough teachers with such special training that would qualify in all our dental colleges. But this deficiency in our dental educational system should be an incentive to rectify this condition, perhaps, not immediately but gradually and definitely, rather than an excuse for our present stagnation. We do not recommend a wholesale replacement of the present faculties, a good many are excellent educators and are indispensable to our dental education. What we do recommend is :
1st. That the schools establish a more definite policy to be followed in future appointments.
2nd. That members of the faculty be required to carry on additional study and research in the particular subject they teach.
3rd. That each member present at least one paper a year before the entire faculty, to any group of dentists, or have it published in a recognized dental journal.
4th. The teacher should be requested to prepare his lecture same as the student is expected to prepare his assignments. Too many valuable hours are waste by the “profs,? who enter their lecture rooms unprepared, ramble on, on unrelated subjects, then dismiss the class under the assumption that they put one over, but they didn’t. The intelligent student feels that he has been cheated and reacts accordingly, sometimes losing all respect for his tutor.
5th. The lecture hour should consist of forty-five minutes straight lecturing and fifteen minutes for open discussion. Following a lecture, the student’s mind is frequently perplexed, and unless some explanation is made right there and then, he is likely to underestimate the importance of the lecture, thus the hour of tutorage may be completely wasted.
6th. Whenever possible lectures should be supplemented by models, slides or other illustrations, for observation is sometimes keener and more perceptible, leaving a more lasting impression upon the student’s mind.
7th. A full time faculty is, or course, much more desirable than a part time staff. However, owing to the financial limitations under which our dental schools are operating this would hardly seem practical at this time.
In concluding this brief outline we are fully aware that the above program calls for nothing short of a complete reformation in our dental education, but if the standard of dentistry is to be raised, if the dentist is to become an important cog in the wheel of disease prevention our dental educational system must be reformed.
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