Dental patients with systemic diseases that require an accurate knowledge of pathogenesis have been increasing [8,9]. In order to diagnose and treat these patients correctly, dentists need to be familiar with cardiovascular, respiratory, immune, endocrine, metabolic diseases, etc. Iwamoto et al. reported previously that HbA1c levels were reduced significantly in periodontitis patients with diabetes after anti-microbial periodontal treatment . In addition, prosthetic treatment increases food intake, resulting in an improvement of nutritional status [11,12]. It is generally accepted that dental treatment can contribute to an improvement not only in oral conditions but also in feelings of happiness in dental patients [13,14]. The benefits of dental treatment must be communicated effectively to dental students. Therefore, we evaluated whether the undergraduate students at dental school understood the significance of periodontal and prosthetic treatment in the systemic health of patients.
First, we examined the educational effects of traditional lectures on the dental students’ understanding of the positive relationship between systemic health and dental treatment, such as periodontal and prosthetic treatment, using an awareness survey before clinical training. As a control, we surveyed medical students before clinical training, because the medical students had not received any lectures about dental treatment. The survey evaluated whether the students recognized the significance of dental treatment for the systemic health of patients after traditional lectures. As expected, most dental students recognized the effects of periodontal treatment on several systemic diseases compared with the medical students (Table 1), one of the most important topics in the field [1,2]. Traditional lectures before clinical training are useful to help students recognize the importance of periodontal treatment on systemic improvement. In addition, there were no significant differences between dental and medical students in the recognition of the effects of periodontal treatment on geriatric- and feelings-of-happiness-related factors. Unfortunately, the systemic effects of tooth loss due to the progression of periodontitis were not fully recognized, even in dental students after their lectures. Interestingly, no significant differences were observed between dental and medical students in the recognition of the positive effects of prosthetic treatment on systemic health. Both dental and medical students may feel that prosthetic treatment is only essential for the improvement of mastication while eating. Surprisingly, more medical students recognized that there is a positive effect of prosthetic treatment on the improvement of halitosis symptoms. Most medical students recognized that prosthetic treatment is same as full-denture wearing, and that halitosis may be improved by completely washing the dentures using a cleaner.
Next, to examine whether undergraduate clinical training deepens the students’ understanding about the clinical significance of dental treatment to systemic health, the same subjects were surveyed after completion of clinical training (Table 2). Although dental students before clinical training understood that periodontal treatment improves the outcomes of systemic diseases, such as diabetes mellitus and aspiration pneumonia, after clinical training the students had a deeper understanding of the topic. In addition, a significantly higher percentage of students recognized the positive effects of prosthetic treatment on aspiration pneumonia after clinical training, despite not understanding the effects before clinical training. These results indicate that the students learned the relationship between aspiration pneumonia and periodontitis in the lectures on periodontics, but not the lectures on prosthetics. Although aspiration pneumonia is a systemic disease, the disease is also considered a geriatric disease which may explain our findings.
Currently, Japan has an aging population . Our previous findings showed that the progression of oral frailty symptoms, such as an unclosed mouth, impaired tongue movements, and loss of posterior occlusion, is a significant risk factor associated with aspiration pneumonia in elderly patients, which decreases the quality of life . Loss of posterior occlusion is an unexpected consequence of periodontitis, therefore periodontal treatment must be performed in middle-aged people to prevent tooth loss so that the quality of life is not affected. The ultimate objective of periodontal treatment in middle-aged people is to improve their quality of life as they age. Geriatric conditions, such as tooth loss, may be improved by prosthetic treatment, e.g. denture wearing in elderly people. The importance of periodontal treatment should be emphasized in order to promote the health of elderly patients in the future and this should be taught in the periodontics curriculum. As shown in Table 2, dental students after clinical training fully recognized the improvement of several geriatric factors, even such factors as walking function or cognitive function, which are connected to not only prosthetic treatment but also periodontal treatment. Both periodontal and prosthetic treatment contribute to the prevention of geriatric impairment, resulting in an improvement of the patients’ quality of life. An effective curriculum should be designed to enable dental students to recognize the importance of dental treatment.
Finally, we considered the following question: “Which is superior, periodontal or prosthetic treatment, for the improvement of systemic health?” As expected, most dental students both before and after clinical training recognized that periodontal treatment has more positive effects than prosthetic treatment in the improvement of systemic diseases such as diabetes, arteriosclerosis, rheumatoid arthritis, and chronic kidney disease (Table 3). On the other hand, although most dental students before clinical training recognized that prosthetic treatment has more positive effects than periodontal treatment in the improvement of geriatric factors, such as swallowing function, nutritional condition, and walking function, there were no significant differences regarding the recognition of periodontal and prosthetic treatments in the improvement of all geriatric factors after the completion of clinical training. This recognition could be improved by undergraduate clinical training that includes explanations of how both periodontal and prosthetic treatment contribute to improving the condition of geriatric patients. Furthermore, we propose the necessity of collaboration with a dentist in geriatric field, although the recognition of students was not surveyed in this study. We expect necessity of the multi-disciplinary approach should be educated to the dental students at first, and the common understanding in dental field will expand to the medical field in the future.
There is a saying in the United Kingdom: "Experience without learning is better than learning without experience." We propose that a combination of experience gained by clinical training and evidence obtained from traditional lectures should underlie the experience- and evidence-based education (EEBE) model that is used in dentistry education. We believe that EEBE is the most important concept for creating the foundation of the dental educational program used at our school. The idea that the ultimate objective of both periodontal and prosthetic treatment is to improve the quality of life of patients as they age should be conveyed to all dental students.