Dental education at a crossroads

Dentists have proven themselves time and time again to be dynamic innovators in the medical field. From Dr. Horace Wells, the pioneer of anesthesia, to Dr. William Rollins, who revolutionized radiation protection, there is a rich history of dentists on the cutting edge. The artisanship inherent in dentistry pushes modernization. All of this is driven by the ideal of comprehensive patient-centered care. However, in a field entrenched in tradition, new technologies can seem disruptive. Often we are slow to integrate them, especially in an educational setting. Though there are countless factors in the evolving face of dentistry, one consistent challenge remains. Dental educators need to keep pace with a rapidly changing field. The crux of the issue is how to educate dental students in the fundamentals while still encouraging them to be modern clinicians. While we recognize the issue, we certainly do not have the answer. We do, however, encourage the conversation about what is relevant and what is not.  As technological advancement outpaces clinic norms, how do we train today’s dental students in the technology of tomorrow instead of the practices of yesteryear?

As we toured dental schools only a couple of years ago during our application process, there was a bright-eyed sense of wonder at all of the technology at our fingertips. Each curriculum would challenge us to be innovators. But the practical application of integrating new technologies is another matter. We spend time training with materials and techniques that, despite their historical value, are functionally out-of-date. For example, the declining use of amalgam is well documented. It accounted for only about a third of the restorations placed in 2005, according to the ADA. This trend underscores the rapidly widening gap between dental education and “real world” dentistry.

The practice of teaching outdated materials is partially driven by cost-saving measures. State-of-the-art technology is cost-prohibitive for many schools, especially with increasing class sizes. A single CEREC unit, for example, costs over $100,000 plus costly software updates and maintenance. The technologies that have streamlined dentistry in private practice have become inaccessible to students due to their prices.

A compounding factor to the gap in training is shrinking funding for state dental schools. Despite increasing class sizes and much needed new technologies, ADEA explains that state and federal funding has shrunk in recent years, necessitating spending cuts.

All of these factors result in delayed adoption of new technology into standard care. Real world dentistry is a fast-paced, technology-based occupation. Yet the dentistry practiced in schools mirrors the dentistry of 30 years ago. This disconnect contributes to an often ungraceful transition into practice after graduation and the increasing need for students to pursue advanced programs in general dentistry to master essential skills.

According to an article in Dental Economics, new innovations take an average of 25 years to be incorporated into standard practice. This is especially true in dentistry because the private practice model, reinforced by laws that protect the dental “turf,” limits revenue streams and potential outside investment. These circumstances contributed to the rising proportion of Dental Service Organizations and other dental conglomerates owned by venture capital companies. As costly continuing education courses and equipment become a necessity of the profession, large corporations are better able to float the cost. They entice new graduates hoping to keep their heads above water while they establish themselves and pay off hefty student loans.

The first step to solving a problem is acknowledging it. As a profession, we must engage in rigorous self-reflection and an open, honest conversation to address this. These factors are not insurmountable. But they do continue to grow as we leave them undiscussed. We as students are the future on whom the obligation falls.

 

~ Abby Halpern and Dahlia Levine, Georgia ’18