The Influence of “New Science” on Dental Education: Current Concepts, Trends, and Models for the Future

Advances in all aspects of science and discovery continue to occur at an exponential rate, leading to a wealth of new knowledge and technologies that have the potential to transform dental practice. This “new science” within the areas of cell/ molecular biology, genetics, tissue engineering, nanotechnology, and informatics has been available for several years; however, the assimilation of this information into the dental curriculum has been slow. For the profession and the patients it serves to benefit fully from modern science, new knowledge and technologies must be incorporated into the mainstream of dental education. The continued evolution of the dental curriculum presents a major challenge to faculty, administrators, and external constituencies because of the high cost, overcrowded schedule, unique demands of clinical training, changing nature of teaching/assessment methods, and large scope of new material impacting all areas of the educational program. Additionally, there is a lack of personnel with adequate training/experience in both foundational and clinical sciences to support the effective application and/or integration of new science information into curriculum planning, implementation, and assessment processes. Nonetheless, the speed of this evolution must be increased if dentistry is to maintain its standing as a respected health care profession. The influence of new science on dental education and the dental curriculum is already evident in some dental schools. For example, the Marquette University School of Dentistry has developed a comprehensive model of curriculum revision that integrates foundational and clinical sciences and also provides a dedicated research/scholarly track and faculty development programming to support such a curriculum. Educational reforms at other dental schools are based on addition of new curricular elements and include innovative approaches that introduce concepts regarding new advances in science, evidence-based foundations, and translational research. To illustrate these reforms, the Marquette curriculum and initiatives at the University of Connecticut and the University of Texas Health Science Center at San Antonio dental schools are described in this article, with recognition that other dental schools may also be developing strategies to infuse new science and evidence-based critical appraisal skills into their students’ educational experiences. Discussion of the rationale, goals/objectives, and outcomes within the context of dissemination of these models should help other dental schools to design approaches for integrating this new material that are appropriate to their particular circumstances and mission. For the profession to advance, every dental school must play a role in establishing a culture that attaches value to research/discovery, evidence-based practice, and the application of new knowledge/technologies to patient care.

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During the twentieth century, the practice of dentistry remained relatively static. New products and technologies were introduced at a rate that allowed dentists to provide effective and efficient patient care using the procedures acquired in dental school, and they were able to complete their practice careers incorporating few if any new products, materials, techniques, and/or office equipment. The arrival of the twenty-first century has suddenly forced on dentistry a new paradigm regarding expected standards for state-of-the-art patient care. Traditional methods and procedures that have served the profession well are being questioned within the context of evidence-based rationales and emerging information/technologies. Although there are no specific data or studies to support the notion that dental graduates and established practitioners are resistant to change and incorporation of new technologies, it is generally accepted that most new practitioners use the products and technologies they were exposed to and worked with in their dental training and postgraduate residencies. For many established practitioners, any new technology that could be perceived as disrupting or interfering with customary office routines is likely to be disregarded. In a busy office, especially a solo practice, any interference with traditional patient treatment schedules is assumed to be economically unacceptable. Thus, it is likely that practitioners believe they cannot stop treating patients to adopt new technologies or learn new procedures. The problem with this mind-set is that it precludes the use of new products and technologies that would allow dentists to treat larger numbers of patients more efficiently, and perhaps more effectively, despite the time required to learn and incorporate these innovations into their practices.

New science and technologies are already making their way into all aspects of dental practice and have changed traditional approaches to diagnostics, risk assessment, prevention, and many procedures in clinical dentistry. These new science advances are primarily directed toward connective tissue biophysics/ mechanics, tissue engineering, and the large areas of biotechnology (gene therapy, drug delivery, transport dynamics), molecular engineering (macromolecular structure, protein structure, and molecular therapies), informatics (patient management/record systems, data mining/management applications, and simulation/computer-assisted learning environments), and biomaterials (biocompatibility, bioengineering applications of polymers, biomimetics, implant materials, and nanotechnology of dental materials).

For example, there are now commercially available kits related to diagnosis, risk assessment, and prognosis for caries/periodontal disease based on genetic polymorphisms, biomarkers, and principles of cell biology.^1,2 In fact, the recent development of saliva as a diagnostic medium has placed dentistry at the forefront of monitoring systemic health and disease.³ The application of genomics/proteomics to diagnostic tests and preventive measures requires that students and practitioners receive the necessary knowledge related to microbial/human genetics and the current principles of molecular medicine.⁴ Given the current lack of genetics instruction in dental education, this will require significant restructuring of dental curricula and faculty development programs.⁵ Within the field of restorative dentistry, the tremendous advances in biomaterials research have led to the current availability of esthetic posterior adhesive restorations, ushering the profession into the “postamalgam era.”⁶ It has been clearly established that this new biomimetic approach to restorative dentistry is possible through the use of composite resins/porcelains and the generation of a hard tissue bond. The development of these nanomaterials has moved nanotechnology from its theoretical foundations into mainstream practice, and there are now many examples of commercially available products demonstrating the scope of further applications of such technology.⁷

In the area of dental informatics, the application of computer and information sciences to improve dental research, education, and practice has been particularly noteworthy. Many dental schools have developed sophisticated simulation laboratories that take advantage of virtual reality technologies to teach preclinical skills, and the use of electronic teaching tools and learning environments (CD-ROM or web-based) has increased dramatically.^8,9 Although today’s dental students are entering the educational program with unprecedented computer literacy, many dental faculty require significant training in order to take full advantage of current computer-aided simulation and instruction capabilities.^10,11 Most dental schools have already implemented some form of electronic paperless records, patient management systems, and digital imaging techniques. Although this technology has the ability to revolutionize patient care through rapid and efficient management of large amounts of clinical information, for it to be useful, the technology must be understood by the end users (students, faculty, and practicing clinicians). At the present time, many practitioners do not exhibit a high degree of computer literacy and are not using currently available informatics technologies to their full potential.¹²

The use of computer and imaging technology is rapidly changing the practice of orthodontics through computer-assisted appliances for tooth movement (Invisalign^TM computer-generated therapy).¹³ Newly available digital imaging methods that reveal minute details and enhance discrimination have added a sophisticated level of reliability/predictability to implant procedures.^14,15 Recent improvements in computer-aided design (CAD) and computer-aided manufacturing (CAM) for indirect restorations now provide for replication and digitization of the complex topography of tooth structure.¹⁶ Over the last several years, CAD-CAM techniques have transitioned from the domain of the unreliable to mainstream practice, providing better mechanical properties, improved marginal integrity, and enhanced esthetics compared to traditional indirect techniques. Today’s more reliable CAD-CAM techniques, some of which may reduce the number of patient visits, are available for the production of a wide range of ceramic restorations.

Scientific and technological advancements that generate new knowledge will continue to occur at unprecedented rates. Future advances will be made possible through emerging interdisciplinary collaborations and thought processes. Thus, significant curricular changes will be necessary to educate a new group of dental professionals who will effectively use interdisciplinary research findings to solve clinical problems and apply new technological advances to the oral health environment. In order to maintain its status as a respected scientifically based health profession, dentistry must appreciate and incorporate these advances within its education and patient care systems. The continued evolution of the dental profession will depend on the discipline’s ability to translate the new science into integrated interdisciplinary services in clinical settings.¹⁷ To ensure the continued viability of the profession, it is the responsibility of the dental education sector to facilitate the development of institutional infrastructures that are responsive to and supportive of scientific and technological advances. At the very least, faculty and students must become sophisticated consumers of research and utilize scholarly approaches to evidence-based paradigms in their clinical patient management.

Those outside of dental education may assume that such health professions education/training programs regularly transfer new knowledge and clinical applications of new technologies into their curricula; however, those within dental education realize that scientific advances usually experience a slow assimilation into the dental curriculum.^18,19 Dental education in the United States has traditionally been characterized by discipline-based, lecture-style teaching that emphasizes technical expertise,^20,21 with insufficient attention paid to the development of critical thinking/problem-solving skills and redesign of content/teaching approaches, thus resulting in a stagnant, overcrowded curriculum.^22,23 Furthermore, graduates do not have an appreciation for the application/importance of research and discovery to patient care activities and are not adequately prepared to embrace interdisciplinary technology-based education/training and informational resources critical to lifelong learning and professional growth.^24–26

There are a variety of opinions regarding the future role of new science and research/scholarship in dental education.^25–30 Some contend that current curricula and research/scholarly training experiences maintain an adequate number of research/scholarly enterprises to develop new knowledge, disseminate new advances/technologies, and translate that information into patient care. However, recent approaches have maintained narrowly focused definitions of the perceived importance of research/scholarly activity, the purpose of research, strategies for increasing the number of future dental researchers/educators, and methods for producing graduates who incorporate evidence-based philosophies into their practices.^26,30 Furthermore, most would admit that some potentially serious problems have developed including insufficient 1) numbers of current and future research/ scholarly dental faculty; 2) integration of dental research into the larger world of science; 3) application of new science to clinical practice settings; and 4) acceptance/ownership of research findings by the dental community.^25–30 To date, there are no data available to determine the degree to which the current educational system has contributed to these problems.

Historically, approaches to support new science and research/scholarship have favored accomplished investigators and established infrastructures within research-intensive institutions.^26,29,30 Dental schools designated as research non-intensive are usually associated with smaller universities, have institutional missions emphasizing teaching/service, often lack resources required for developing an infrastructure that supports elite research programs, and are unable to sustain a critical mass of experienced faculty actively engaged in research and scholarly pursuits. Within these cultures, faculty have limited time to pursue scholarly activities because a faculty-intensive teaching curriculum dominates the environment.³¹ As a result, research endeavors at these schools have been largely ignored, creating a large cadre of disenfranchised faculty and students with no ability or desire to contribute to the overall agenda related to the infusion of science and discovery into the dental curriculum and patient care activities.

The present paradigm of dental education severely limits the ability to restructure the process to support infusion of new science due to an overcrowded curriculum, lack of integration of biomedical/clinical sciences, and a clinical component that operates in an environment completely removed from research/scholarly enterprises.^26,30 Within this context, new advances/technologies and the overall activity of research/scholarship become an afterthought or an arena reserved for a cloistered group of designated academic faculty. This traditional model must experience a paradigm shift, not only to increase the number of participants in science/scholarship, but also to enhance access, acceptance, and applicability of the science/scholarship. For the profession to advance, every dental school must play a role in establishing a culture that attaches value to research/discovery, evidence-based practice, and the application of new knowledge/technologies to patient care.³²

DentalEDU.TV is designated as an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing dental education programs of this program provider are accepted by the AGD for Fellowship, Mastership and membership credit. Approval does not imply acceptance by the state or provincial board of dentistry. The current term of approval extends from February 1, 2009 to January 31, 2012
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