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[Fundamentals of dentistry for geriatric rehabilitation--an introduction to geriatric dentistry].

The percentage of aged and very old people in the total population is increasing rapidly in industrialized countries. This is an important change which, in particular, affects the areas of dentistry and oral medicine. The problems that this older population group face need to be given more attention and need to be brought more into the forefront of dental and oral medicine. The percentage of the dentate population has increased in Germany, due to the high standard of the dental care. The percentage of the edentulous population has therefore decreased. It has become necessary for those who care for the elderly to adjust to caring for the dentate patient, as opposed to edentulous patient. It is important for all professions involved in the treatment and care of geriatric patients to have an awareness of the basic fundamentals of geriatric dentistry within general rehabilitation. Doctors in particular need to be given training in the detection of caries, peridontal diseases, and denture problems. They should feel confident working with the dentist and his team as partners in the rehabilitation treatment. It is especially important that geriatric hospitals have experience in dentistry and oral hygiene, so that damage to life-long well cared for teeth can be prevented, and so that poor oral hygiene during a hospital stay does not result in dental problems. Dentists and their teams will have to adjust to the treatment of aged and multimorbidic patients. More discussion is also necessary between dentists involved in all areas of geriatric medicine, geriatric dentistry, and geriatric dental public health.

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[Specialties in dentistry. 4. Post-academic specialization in geriatric dentistry].

In recent years, a specialization in geriatric dentistry has been established and along with it an educational programme. A specialist in geriatric dentistry is a dentist general practitioner with special knowledge and skills for delivering oral care to frail elderly people. The educational programme aims at an increase in dentists serving in geriatric care who are well prepared for delivering care. In the programme attention is paid to the special aspects of care delivery and the special somatic, mental, and social characteristics of frail elderly people. The goal is to formulate an individual oral care programme for every frail elderly person. An individual oral care programme may contain 5 different oral care activities: continuing care, prevention, support, treatments, and evaluation. These activities define the scope of specialists in geriatric dentistry. This scope in turn defines the profile of required knowledge and skills, and the profile is the foundation of the educational objectives of the educational programme. The educational programme contains 7 modules: affinity; somatic and mental disabilities; communicative skills and coping with behavioural disturbances; emergency medical care; history taking, assessment, prevention, treatments and evaluation; organization and legislation; scientific training.

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Trends in predoctoral education in geriatric dentistry.

Historically, education in geriatric dentistry has been limited in both quantity and quality. More recently, a number of educational initiatives have been developed in response to the growing number of older adults and their changing oral health status and dental treatment needs. A survey of U.S. and Canadian dental schools examined curriculum trends and assessed the effectiveness of educational initiatives and the value of AADS/AoA geriatric dental curricular materials. All schools responded. Compared to previous reports, more schools had geriatric didactic course(s), clinical rotations, and faculty with geriatric dental training. Fifty-eight percent of dental schools support geriatric dentistry in their budgets. The primary barriers to program expansion continue to be the lack of trained faculty members, a crowded curriculum, and fiscal concerns.

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[Geriatric dentistry in dental education].

Geriatric patients have both special medical problems (problems with aging and general health problems) and specific dental problems. This requires special skills of dentists who are treating these patients. The medical problems require a dentist with a wide medical education and a friendly attitude towards his patients. The dental problems require a dentist who is more problem orientated on his way of treatment. Both aspects are present in the theoretical teaching in most of the dental schools. For treatment of institutionalized geriatric patients it is advocated to train specialists in geriatric dentistry taking into account the need for a multidisciplinary and specific approach.

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Dental student attitudes towards the elderly and training in geriatric dentistry.

From analysis of the relationships between geriatrics, gerontology, dental education and dental practice three major questions arise about barriers to the creation of a strong subdiscipline of geriatric dentistry (1) Why is the dental care utilization of the elderly comparatively low despite their high objective needs for dental care? (2) Why has the dental profession failed to move into the potential market created by the elderly thereby leaving geriatric dentistry comparatively underdeveloped? (3) Why do training programmes in geriatric dentistry fail to change significantly the attitudes of dental students towards the elderly? Answers to these questions indicate the need for specific structural and attitudinal changes if the barriers are to be eliminated.

Adult↗

The teaching of geriatric dentistry in Canada.

Very little is known about the current status of geriatric training programs at Canadian universities because of the scarcity of information published on the subject. A study of the geriatric dentistry training programs offered by Canada's 10 dental schools has been completed. Its intent was to determine what type of educational activities in geriatric dentistry have either been offered in the past, are being offered now, will be offered in the next academic year, or are planned for the next five years. The results indicate that the 10 schools are doing very little in this regard. To keep pace with the level of geriatric dentistry training currently being offered in the United States, the dental profession must convince Canadian faculty members that the teaching of geriatric dentistry is crucial to both the undergraduate student and the graduate dentist. Continuing education in geriatric dentistry could be used to meet the oral health needs of our frail and dependent senior citizens. Geriatric dentistry must be taught at all levels of the profession so that this special clientele can receive the necessary treatment either within or outside of the dental office.

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Geriatric dentistry education in European dental schools.

As the numbers of elderly adults continue to grow within European populations, the need for dental students to be trained in the management of geriatric patients becomes increasingly important. Many dental schools have developed training programmes in geriatric dentistry in response to the changing oral health needs of older adults. The purpose of this on-line survey was to identify the current status of geriatric dentistry education in European dental schools. A questionnaire relating to the teaching of geriatric dentistry was posted on the Internet, and 194 dental schools in 34 European countries were invited to participate. Data from completed questionnaires were submitted to the investigators via email from 82 schools in 27 countries (42% response rate). Thirty-six percent of schools offered a specific geriatric dentistry course that included didactic teaching or seminar groups, 21% taught geriatric dentistry by means of organised presentations in the curriculum, and 36% taught the subject by occasional lectures. 7% of schools did not teach geriatric dentistry at all. A clinical component to the geriatric dentistry curriculum was reported by 61% of schools and 18% reported operating a specific geriatric dentistry clinic within the school. Of those providing clinical geriatric dentistry training, it was provided within the school in 45% of cases, with a further 29% of schools providing training both within the school and at a remote location. Seven percent of schools operated a mobile dental clinic for treating geriatric patients. Twenty-eight percent of schools had a geriatric programme director or a chairman of a geriatric section and 39% indicated that they plan to extend the teaching of geriatric dentistry in the future. Geriatric dental education has clearly established itself in the curricula of European dental schools although the format of teaching the subject varies widely. It is of concern that geriatric dentistry was not taught at all in 7% of schools. No data are available concerning whether or not geriatric dentistry is taught in the 58% non-responding schools.

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Standardized patients for teaching geriatric dentistry.

Effectively managing geriatric dental patients requires behavioral, communication, and assessment skills which are not easily taught or evaluated by traditional methods. Standardized patients (SPs) are persons trained to simulate real patients. The advantages of using SPs instead of real patients are that student experiences can be realistic, yet predetermined and controlled. In a program at the University of Illinois College of Dentistry, SPs are used to provide practice and to evaluate dental students regarding their performance in managing specific geriatric dental patients. In the past three years, over 1500 student-SP interactions specific to geriatric dentistry have been conducted with a wide variety of cases, including examination, diagnosis, and treatment planning. Additionally, program outcomes are discussed.

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Geriatric dentistry in Brazilian universities.

OBJECTIVE: The purpose of this study was to investigate the teaching of geriatric dentistry in Brazilian universities. MATERIALS AND METHODS: This study consisted of questionaires regarding the training in geriatric dentistry in 104 dental schools included in the National Institute of Education Research (INEP) in 2001. In order to calculate the sample (a random stratified one), the confidence interval was set at 99% and a maximum permitted error of 3% was adopted. Pearson's chi-square test was used in the inferential analysis. RESULTS: From the 64 dental courses which were studied, only 25 included geriatric dentistry in the curriculum. From 1857 students who were involved in the study, 41% sought knowledge outside the dental school and 98% considered that it was important that this subject should be included in the curriculum. There was statistical significance between geriatric dentistry teaching and the students' preference as well as the prospect of working with this group of the population. Geriatric dentistry as an individual subject was absent from the curriculum in two-thirds of the dental courses investigated. Knowledge was often transmitted as part of dental prosthetics and most of the students stated that they would want to be able to treat elderly people. It was relevant to note that senior students expected to work in this field. CONCLUSION: Dental students in Brazil do not have adequate training in geriatric dentistry.

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A controlled evaluation of computer assisted training simulations in geriatric dentistry.

The increasing number of geriatric dental patients and the development of treatment plans that require consideration of complex psychosocial, socioeconomic, and medical/medication factors necessitates a change in the traditional teaching of treatment planning. A computer-assisted instructional program was developed to simulate the dentist-geriatric patient interaction and to train students in clinical decision making for the geriatric patient. This study compared the effects of this program with a more traditional approach based on readings from the geriatric dentistry literature. Twenty third-year dental students were matched on grade point average and randomly assigned to the computer or literature-based groups. They were pretested using a clinical analogue of a geriatric patient and then instructed to use either the computer or literature-based educational units. The students were then post-tested on a second clinical analogue. Students performed similarly at pretest. At post-test, both the computer and literature-based subjects were found to have acquired significantly greater evaluation points, to make fewer errors, and to design more involved treatment plans than at pretest. Comparison of computer and literature-based subjects' performance revealed no significant main or interaction effects regarding type of educational unit used. Consistent nonsignificant trends were noted with the computer-based subjects out-performing literature-based subjects on each outcome variable. In addition, the computer-based subjects had more positive feelings about the educational unit than the literature-based subjects at a statistically significant level. These findings suggest that the computer program is an effective alternative method for developing clinical decision skills in students treating geriatric patients.(ABSTRACT TRUNCATED AT 250 WORDS)

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Training for the future: issues in geriatric dentistry.

The following report was presented during the October regional meeting of the American Society for Geriatric Dentistry in Washington, DC. The needs for dentists who specialize in geriatric dentistry and dental curriculum in geriatrics are discussed, together with issues that face dental educators in geriatric dentistry.

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[Teaching of geriatric dentistry; training of "mobile dental service" dentists].

Quebec presently has 650,000 people over 65 years of age and as many as 900,000 will be alive at the beginning of the 21st century. Quebec epidemiological studies have shown that this group's dental condition is very poor. They feel no need to see a dentist, but 96% of them need treatment and the time elapsed since their last dental visit averages 13 years. It is forecasted that the dental needs of this group will rise, not only because of their increase in number but also because they will retain more teeth. Training in geriatric dentistry is presently deficient in the United States, Canada and particularly Quebec. Researchers have concluded, after studying the U.S. dental schools' current status of geriatric dentistry educational activities, that unless dental students receive training in geriatrics while at dental school, it is likely that they will not treat a lot of seniors in their practice. The teaching of geriatric dentistry is in full swing in the U.S. but knows a difficult birth in Quebec. There is no formal, extensive training program in geriatric dentistry given by the three dental schools in the province. Practicing geriatric dentistry requires special knowledge and skills. If treatment is to be successful, the practitioner must adopt a humanitarian approach and develop close relations and a better understanding of the feelings and attitudes of the elderly. The dentist must know and understand the special dental problems that makes them different from other groups.

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Current status of Geriatric Dentistry Educational Activities in U.S. dental schools.

The current status of Geriatric Dentistry Educational Activities (GDEA) in U.S. dental schools is reported in this survey. Data were collected regarding faculty involvement in geriatric programs, didactic and clinical academic curricula, and other aspects of the ongoing activities in schools. Data were reported by 50 (88 percent) of the nation's 57 dental schools in continuing operation. Forty-two schools reported discrete GDEA at the time of the study. Seven of these schools had a formal division or department of geriatric dentistry. The survey indicated that educational qualification of GDEA coordinators had risen significantly in recent years. The mean number of didactic hours (29) of instruction in geriatric education available to students has also risen. Curriculum time and financial considerations were the primary obstacles to expansion of clinical geriatric activities. With the current economic constraints in dental education, present GDEA levels are unlikely to expand in the foreseeable future, unless governmental or private agencies recognize the importance of developing GDEA and increase their support.

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