Reformation in Dental Education

Reformation in Dental Education is Needed

By Mathew Podolin

Buffalo, N.Y.

            Modifying the dental curriculum to meet with the needs of the dental student requires a complete rearrangement of the basic sciences.

If the general practitioner is to be accorded the  privilege of performing surgery in and about the mouth he should have a fair knowledge of the bony hard marks and their mutual relation to the soft tissues, the blood supply, the location of the important nerve trunks and salivary ducts that are in his field of operation.

Dental Phases Should be Stressed

Gross anatomy should of course be taught, but the entire text should be modified so as to place more emphasis on the parts that are directly associated with dental operations.

The student should study the osteology of the head and neck with special emphasis on the maxillae, palates, malar bone, nasal bone and mandible. The maxillae is a bone of major importance, it takes part in forming the walls of the orbit, the nose and the mouth. The construction of the alveolar arch must be studied in relation to the upper teeth. The roots of the upper bicuspids and molars in relation to the antrums.

A full appreciation of the construction of the zygomatic arch is necessary for the proper treatment of a deformity in the temporal region. Fractures here cause great deformity, which is easily overcome by elevating the broken bone so as to reconstruct the normal curve of the arch.

The palate should be studied with particular reference to the foramina for the passage of nerves and blood vessels. The nasal bone is of no special importance. The nasal spine below for the attachment of the columella is of some surgical importance in the repair of a cleft lip. Its communication with the pharynx should be well understood as the dentist may have occasion to prescribe nasopharyngeal feeding to his patients.

If the dentist is to continue treating maxillary sinuses, he must learn to enter the antrum through the dose for irrigation purposes. Making an opening below the inferior turbinate bone a root may be removed by flushing the sinus from the nose through the socket. One of the most important bones of the face is the mandible; it gives form to the lower part of the face and to a certain extent part of the cheek. It has an exceedingly great direct and indirect influence upon the appearance of the individual.

Because of its inefficient blood supply osteomyelitis and other destructive diseases attack the mandible more frequently than the other bones in the ratio of 8 to 1. The groove of the facial artery at the lower border of the mandible in front of the attachment of the masseter muscle, is a landmark of great importance.

When reducing a fracture of the lower jaw various muscles must be taken into consideration, and a knowledge of the origin, insertion and action of these muscles greatly facilitates the making of a appliance for the purpose of holding the parts in their normal position, and at rest, while nature repairs the fracture.

For the same reason the understanding of the hyoid bone becomes important to the dentist. The hyoid bone is the point of fixation for the muscles of deglutition and for the muscles which open the mouth. During the process of deglutition the larynx is elevated by the contraction of the hyoid muscles. These muscles are attached to the styloid process of the lower jaw and tongue and fixed in position by the muscles attached to the sternum and clavicle.

Knowledge of Muscular Reactions, Essential

Asphyxia during a general anesthesia may be avoided by exerting pressure under the jaw pressing it forward. This brings the structures of the floor of the mouth and tongue forward giving the necessary breathing space that may save the patient’s life.

The skull, the frontal and temporal regions of the cranium deserve special attention from the dental student. The foramina for the exit of the terminal branches of the three divisions of the trifacial nerve have passing through them the corresponding arteries and veins.

The facial nerve, which is the motor nerve of the muscles of expression, makes its exit from the stylo mystoid foramen, passes through the parotid gland and breaks up into branches which radiate toward the temple, the eye, the cheek and the lower jaw, its existence in this region should not be forgotten, because improper surgery may cause permanent disfiguring and paralysis of the face.

Some Text Books Fall Short

It is difficult to understand why some of our excellent text books on oral surgery fail to describe the base of the skull. Its study and understanding is important to the dental student. Its boundaries are structures to which the dentist is devoted to. The many foramins transmit nerves and arteries which are directly associated with the dental field of operation.

There are twelve pairs of cranial nerves, all of which arising from the encephalon make their exit through openings in the base of the skull. In function some of these nerves are sensory, some are motor, still others are of special sense, while a few have branches with different functions. All these nerves with the exception, perhaps, of the olfactory and optic have branches of communication with neighboring cranial, spinal and sympathetic nerves.

Those whose function is common sensation have ganglia similar to the sensory of posterior roots of spinal nerves. The fifth nerve has small motor root without a ganglion, and a large sensory root which is divided in the intracranial operation for convulsive neuralgia of the face called Tie douloureux. All this is important if we wish to understand the actions of referred pain.

A knowledge of referred pain is of unestimable diagnostic value to the dentist. Because of trifacial nerve reflexes the dentist has considerable difficulty in locating the seat of pain. Frequently pain in remote parts of the body may be referred to the periphery of the trifacial. The so-called toothache is due to a stimulation of the sensory fibers of the trifacial nerve. A careful study of the optic ganglion which lies on the medial surface of the mandibular nerve will explain the frequency with which caraches are associated with preoperative or postoperative dental pain.

The importance of studying the salivary glands can not be overemphasized. The glands and the relative positions must be remembered by every dentist. The submaxillary gland lies under the lower jaw is embedded in it. The duct called Wharton’s duct opens alongside of the frenum of the tongue. The submaxillary region or triangle as it is sometimes called is the seat of Ludwig’s angina. The inflammation involves the cellular tissues beneath the tongue and jaw around the submaxillary gland and the upper protion of the neck.

It is a dangerous disease and often causes death either by sepsis of edema of the larynx. The infection posses form the inside of the mouth to the submaxillary region outside by following the connective tissue around the submaxillary glands as it winds around the posterior edge of the mylohyoid muscle through the opening existing between the muscle in front and the anterior portion of the middle constrictor of the pharynx behind.

The smallest of the salivary glands is the sublingual located under the mucous membrane of the floor of the mouth, close to the inside of the symphysis of the jaw. The ducts 10 to 20 in number are called duets of rivinus, some of which open separately alongside of the freuum, while others join together with the duet of the submaxillary gland.

The parotid region is very important because of the parotid gland, which lies on the check behind the jaw and below the ear. The external and carotid artery as it ascends is surrounded by it and the facial nerve passes through it transversely, making it a dangerous field of operation even for the expert surgeon.

The parotid duet sometimes called Stenson’s duet leaves the gland about a centimeter below the zygoma and runs on a line joining the lower edge of the cartilaginous portion of the ear with the middle of the upper lip. Its opening is in a papilla on the inside of the cheek opposite the second upper molar tooth. In operating on the cheek one must avoid the lines of the duct or a salivary fistula may result.

A fine probe inserted from the mouth into the parotid nodes receive the lymph vessels from the scalp, the outer part of the eyelids, the eye, the cheeks, the nasal fossa, the nasopharynx, the external auditory meatus, and the region of the tempero-mandibular articulation.

Knowledge of Anatomy Aids in Treatment

Infection in these regions may cause parotid suppuration. In addition we may have a simple parotitis or so-called mumps. Suppurative parotitis that may be of metastatic origin or arising in the sense of eruptive fevers. Tumors of the parotid are liable to be mixed in character with a sarcomatous element.

The neck is liable to many affections. Its subcutaneous tissue becomes the seat of inflammation and cellulitis. The numerous lymph nodes are subject to tubecular and carcimomatous inflammation. These nodes may break may breaks down causing wide spread dangerous  abscesses which are guided in their course by the facias, hence one should make a special effort to understand the deep facias of the neck.

Blind Treatment

The dentist is constantly engaged in treating caries yet he knows neither of its etiology nor how to prevent its formation. He treats diseases of the gums, but known little or nothing about the ravaging and most prevalent of all diseases, periodontoclasia.

Scaling teeth is part of his daily task, yet he knows nothing about the formation of calculus, why some patients are subject to frequent accumulation while others have but little or nothing at all. He is confronted with erosion and recession but is comparatively ignorant of its origin and is doubtful in his treatments. He extracts teeth by the thousands and performs other minor and major surgery about the mouth with perfect impunity, yet now and then a fulminating phlegmon will result from a comparatively minor operation. Why?

He knows about the balance between the resisting host and the invading organisms, but when he operates on physical wrecks that make uneventful recoveries, while an apparent specimen of physical health develops a severe infection following a simple extraction, he begins to wonder what constitutes immunity? How can resistance be measured? These and many other problems of greater or lesser importance are confronting the dental practitioner daily.

Research is the crying need of the hour for the dental profession. We must admit that whatever progress dentistry may claim has been made chiefly in the mechanical end of its service. The technical skill of the dentist has been constantly perfect to the mutual advantage of both patient and operator. The dental curriculum with its emphasis on mechanical skill is to be credited with this accomplishment.

The time has come when dentistry must choose between independence of become engulfed by the medical profession. If dentistry wishes to maintenance its entity as a profession, it must assume the responsibility for its part in maintaining and preserving the health of the individual.

Research Aids

To be sure private and unorganized research has been carried on to some extent by the more serious minded men of the profession and their efforts here been crowned with considerable success.

Organized dentistry too is making an honest offer to foster dental research, being limited, however, by insufficient funds. Money and equipment, however, essential as it may be, is not our chief drawback. What the dental profession needs is more research workers.

Planting the seeds for future dental research workers should begin in the dental schools. Dental education must, therefore, be reformed with the intent purpose of stimulating the desire for research. The student’s mind must become impregnated with an enthusiasm for solving the many problems the profession is confronted with. Then and only then will dentistry be entitled to its independence as a profession.

560 Delaware Ave.,

Buffalo, N.Y.