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Dental Education Goes Gray
The new color for dentists isn’t white; it’s gray. By 2030, the number of American adults 65 or older will double to nearly 70 million, according to the American Geriatric Society. Understanding the delivery of dental services and maintenance of care of geriatric patients is essential to preparing predoctoral dental students to respond to this unique population, according to Ronald L. Rupp, DMD, senior manager of professional relations for GlaxoSmithKline (GSK), and Marsha A. Pyle, DDS, MEd, associate dean of the Case School of Dental Medicine.
In collaboration with the American Dental Education Association (ADEA), GSK has taken the lead in preparing the next generation of dentists to adapt to the shifting patient demographic. On November 5th, at the 48th Annual ADEA Dean’s Conference in La Jolla, California, Drs. Rupp and Pyle unveiled the ADEA/GSK Elder Care Model Curriculum Project—a curriculum resource guide to assist faculty in educating dental students about the underserved area of geriatric dentistry.
The guide, entitled “Oral Health for Independent Older Adults,” presents the program in six different themes, a series of illustrative case reports, and a discussion of several innovative models of geriatric dental care. Each theme includes a goal, learning objectives, and suggested resources to “complement and enhance instruction already underway.”
THEME 1: DEMOGRAPHIC ASPECTS OF AGING
The first section focuses on the demographic development of the United States and characteristics of the aging population. Students will learn about developmental growth trends that affect the current and future health, social, and financial status of the older adult population.
Learning objectives include: the ways oral health contributes to quality of life in aging patients; population demographic information in practicing and planning care; and the difference between dental service in older and younger adults.
THEME 2: AGING PROCESS AND COMMON SYSTEMIC CONDITIONS
The impact of physiologic and anatomic changes associated with age, as well as conditions common in older adults, are addressed in this section. “Disease can present differently in the elderly, sometimes silently,” noted the authors.
Learning objectives include: the medical history taking of older adults, including informed consent and approval, and the role of caretakers; the implications of concurrent medical conditions on older patients compared to younger adults; discussing the age-related changes in body composition, including skin tears, bruising, and bone and muscle changes; and common adverse drug reactions in older adults.
THEME 3: NORMAL AGING OF THE ORAL COMPLEX
The normal aging patterns of the oral complex, the results of these changes, and the ability to distinguish between normal aging and pathology are important parts of this section. An increasing number of older patients actively preserve and maintain their oral health and dental care. The new elderly have more of their own teeth, visit a dentist regularly and demand more sophisticated care.
Learning objectives include: the anatomic and functional changes in bone modeling, the gingiva, and the periodontal ligament, among others; the functional characteristics of saliva and concerns regarding changes as a result of alteration in secretion or composition in the older adult; the age-related changes in each of the structures of the teeth; and risk factors for diseases, including attrition, caries, and pulp disease.
THEME 4: COMMON ORAL CONDITIONS OF OLDER ADULTS
Oral disease in an aging population has different consequences of disease treatment, as well as environmental and habitual behaviors that are unique. Students learn to consider risk and characteristics of diseases as primary information and tools to manage oral disease in the elderly.
Learning objectives include: the impact of medical disease and its effect on dental care; the causes of dentin hypersensitivity in older adults; and the risk, signs, and symptoms of periodontal disease in older patients.
THEME 5: SOCIAL ASPECTS OF CARE IN OLDER ADULTS
Social, behavioral, economic, and organizational factors can all affect treatment planning and clinical decision making in the oral health care of elders. Knowledge of the medical and systemic health of the patient is necessary for treatment; however, a clinician must also be aware of these social determinants of health.
Learning objectives include: the economic conditions of the older population, including the impact of a fixed income, and the effect of competing priorities on oral health care; and options available for financing dental care to people over 65.
THEME 6: DELIVERY AND MAINTENANCE OF CARE FOR OLDER ADULTS
The planning, provision, and maintenance of dental care services to the elderly have special practical concerns that can affect treatment.
Learning objectives include: considerations of assessing the elderly, including the accuracy of self-report, language and translation issues, caretakers’ roles, and informed consent issues; characteristic signs of elder abuse and the requirements, legal liability, and mechanism for reporting suspected cases; and the benefits of consulting with and referring an elderly patient to a dental specialist when managing the patient’s dental needs.
INNOVATIVE MODELS IN GERIATRIC DENTAL EDUCATION
The ADEA/GSK initiative focused on five standout programs that are “examples of excellence” in the pursuit of geriatric dental education and care. The Marquette University School of Dentistry boasts two of these: a comprehensive interdisciplinary geriatric dentistry curriculum and an interdisciplinary geriatric oral health Web site.
Developed during the 2003-2004 school year, the curriculum provides clinical experience with older adults during all four years of instruction, and emphasizes principles of preventive dentistry, public health, and ethics. Early clinical and community-based training are emphasized, allowing students to care for older patients as a member of an interdisciplinary team.
The Web site was developed to provide an electronic learning environment for practicing health professionals and students nationwide. The Web site was initiated in 2002 and is produced in collaboration with the Wisconsin Geriatric Education Center. Three dental schools, two graduate programs, and two interdisciplinary training programs have used the Web site for courses, workshops, and seminars.
- At the University of Colorado School of Dentistry, students participate in Total Longterm Care (TLC), a program for the elderly established by the Program of All-Inclusive Care for the Elderly (PACE). Dental students operate two clinics while on 5-week rotations. They work closely with geriatric health care professionals. Each student typically treats 20 geriatric patients per week.
- The Geriatric and Special Needs Program is one of the oldest programs at the University of Iowa College of Dentistry. A motorhome is used to transport dental equipment to a nursing home, where it remains for several weeks. Using this equipment, four dental students and supervising faculty provide dental care to the residents of the home. Additionally, this program provides emergency care at its Special Care Clinic for patients with special dental needs, including those with medical conditions, and physical and intellectual disabilities.
- A certificate in Geriatric Dentistry is offered at the University of Pittsburgh School of Dental Medicine. The program was designed to serve professionals who wish to acquire specialized knowledge about gerontology and geriatrics as it applies to the dental field. Providing direct care to an older adult is required by two courses. To date, three students have enrolled in the program, with the first expected to graduate in 2007.
The recent influx of innovative geriatric programs shows that dental education is adjusting to meet the needs of its patients. The ADEA/GSK Elder Care Model Curriculum Project offers these examples as models, as well as a guide to make older adult care an integral part of dental education. For more information, please visit the ADEA Web site at www.ADEA.org.
Information for this article was gathered from "Oral Health for Independent Older Adults," an ADEA/GSK predoctoral curriculum resource guide.