J Dent Educ. 70(11_suppl): 19-21 2006
© 2006 American Dental Education Association
Global Issues in Oral Health |
New Perspectives for Education
Lisa A. Tedesco, Ph.D.
Being asked to prepare visionary remarks on a global theme is a doubly daunting task. While my remarks are directed toward education, the connections to research and science transfer are clear, practical, and intellectually accessible.
The immediate "world" we know, our day-to-day world, is increasingly complex and requires increasingly mindful reflection on experience and integration of information to meet our professional responsibilities in teaching, research, and clinical and community service. A number of findings and developments form complex (not simple or singular) interdisciplinary areas for education and practice. As I prepared my remarks for this conference, I tried to think through common orienting questions: education for what, for whom, and how? I will describe elements that could help us create a vision for education in terms of content and context, and I will talk about research developments in need of educational exposure regarding health disparities; what they mean for teaching institutions; and the importance of the behavioral and social sciences for any future vision.
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New Vision, New Content
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The oral health-systemic health connection and the relationship between dentistry and medicine have been at the top of the list for change in educational focus and curriculum revision for a number of years. The 1995 Institute of Medicine report on the future of dental education placed the importance of addressing these areas front and center.1 Today, there is growing scientific evidence on the relationship of oral health to systemic health.2 Areas of oral health-systemic health inquiry and significant findings worthy of curricular placement, and in some cases clinical training, include diabetes, respiratory conditions, cardiovascular conditions, pregnancy risk factors, and osteoporosis. Additionally, oral infection and pain are highly treatable and are immediately linked to quality of life issues. Chronic infection in any part of the body is physically and psychologically debilitating. In each case, for systemic disease connections and for treatment of immediate oral infections, our system of education and its content and clinical approach need to reflect the necessary interdisciplinarity—the crucial connection between medicine and dentistry—that is lacking in many places. We cannot expect to advance as academic and clinical institutions if we do not, with vigor, correct our lenses, revise our vision, and reorient our content and systems in dental education to address the oral health-systemic health connection.
The New York Times published an article in April 2005 on the work of David Wong at UCLA.3 The Wong laboratory and the laboratories of several other researchers around the world are investigating areas with molecular genetic techniques to understand the content of saliva to develop diagnostic tests for disease, not only oral but systemic. Salivary diagnostics, for example, hold promise in detecting head and neck cancers.4 The basis of scientific inquiry here is molecular genetics with connections to physiology and function, bioengineering, and proteomics. Other examples from a number of colleagues in oral health research and life sciences persuasively argue for change—sooner rather than later—in this area of research and education as it applies to present and future clinical practice.5,6
The oral-systemic connection and the role of new diagnostics are transformative. These highly interdisciplinary areas bring our educational framework to a critical boundary—the boundary that defines its present limits. The practical use of this science is upon us, and we must build our educational systems to incorporate it and collaborate across clinical practice divides. If it is not taught and integrated into our settings and clinics, what is the hope of it getting into everyday useful practice?
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Health Disparities, Local and Global
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Health disparities in the United States are pervasive and complex. Academic dentistry is only beginning to understand its role and responsibilities to address health disparities. The U.S. surgeon general’s report7 and a recent Institute of Medicine report8 are powerful in their analyses, recommendations, and call to action.
On the local front, as members of health professions schools in universities, we are committed through our mission and professional definition to contribute to the public good. Each institution must examine itself carefully and thoroughly and decide how it wishes to address health disparities in the context of its teaching and clinical programs. Partnerships for community-based clinical education and partnerships for community-based participatory research are two avenues of commitment. Local responsiveness calls us to do much work preparing ourselves and our institutions. For example, we must engage in approaches that ensure we admit a diverse student body; revise teaching programs to include health disparities, social epidemiology, and behavioral sciences for culturally sensitive care; and place the curriculum in a multicultural pedagogy to maximize the benefits of different points of view represented by our student diversity. Without these commitments, we will alienate our students, frustrate our faculty, and fail in meeting our responsibility to contribute to the public good.
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Behavioral and Social Science Education
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Within North America and in many other countries, there is increased immigration; and all of the issues above, in terms of disparities, diversity, and culturally sensitive care, remain at the center for us to address. The behavioral sciences can lead to vital solutions that converge globally. A brief look at the World Health Organization strategic directions for its oral health program provides an architecture for structuring general and specific convergence that the behavioral and social sciences offer. Listed among global concerns are threats of noncommunicable diseases with oral health components that are related to common and preventable risk factors represented in unhealthy diet and tobacco use. In established communities and emerging new communities, the World Health Organization describes higher risk for oral diseases as related to sociocultural determinants such as poor living conditions; low education; lack of traditions, beliefs, and culture in support of oral health. We can also see the cascade of problems related to inadequate water supply, lack of fluoride, and poor distribution of or lack of available services.
If we are serious about the side of dentistry that serves the public and seeks solutions to world problems shoulder to shoulder with others in the health professions, then we must be serious about elevating the role and responsibilities of social scientists in our academic institutions. Behavioral and social scientists have a role in designing educational approaches, delivering programs, managing partnerships, supervising students, and teaching other faculty, and this role is crucial to mounting solutions and ensuring institutional dispositions to help address some of the more intractable problems of poverty, locally and globally.
In sum, we are educationally at a highly consequential crossroads—one that connects science and service and health service to individuals and communities. Behavioral and social sciences have a crucial role in bringing the vision forward to program realities.
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Closing Observation
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At the conference we had the opportunity to see the National Institute of Dental and Craniofacial Research’s international video, "Science Knows No Country." Seeing it was special and poignant on many levels, and it was a privilege to have our distinguished colleague, mentor, and guide, Dr. Lois Cohen, talk with us about the film. The phrase "science knows no country" is from a quote by Louis Pasteur (French biologist and bacteriologist, 1822–95): "Science knows no country, because knowledge belongs to humanity, and is the torch which illuminates the world. Science is the highest personification of the nation because that nation will remain the first which carries the furthest the works of thought and intelligence."
I understand this to mean that we must carry the work of science forward to solve problems and improve the lives of communities and individuals. Pasteur would want us to teach the newest material and hasten the application of scientific findings in the basic, clinical, and behavioral-social sciences. It is a worthy educational standard.
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Footnotes
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Dr. Tedesco is Dean of the Graduate School and Vice Provost for Academic Affairs, Graduate Studies at Emory University. Direct correspondence to her at Emory University, 201 Dowman Drive, Mailstop 1580-002-2AA, Atlanta, GA 30322; 404-727-2669 phone; 404-727-4990 fax; lisa.tedesco{at}emory.edu.
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REFERENCES
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- Institute of Medicine. The future of dental education. J Am Coll Dent 1995; 62(1):6–8.[Medline]
- Two websites that provide useful information are www.nidcr.nih.gov/HealthInformation/DiseasesAndConditions/default.htm and www.altcorp.com/AffinityLaboratory/diseases.htm. Accessed: August 2005.
- Dreifus C. A conversation with David Wong: a bloodless revolution—spit will tell what ails you. The New York Times, April 19, 2005.
- Jiang WW, Masayesva B, Zahurak M, Carvalho AL, Rosenbaum E, Mambo E, et al. Increased mitochondrial DNA content in saliva associated with head and neck cancer. Clin Cancer Res 2005;11(7):2486–91. At: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=15814624&dopt=Abstract. Accessed: August 2005.[Abstract/Free Full Text]
- Collins F, Tabak L. A call for increased education in genetics for dental health professionals. J Dent Educ 2004; 68(8):807–8.[Free Full Text]
- Dudlicek LL, Gettig EA, Etzel KR, Hart TC. Status of genetics education in U.S. dental schools. J Dent Educ 2004; 68(8):809–16.[Abstract/Free Full Text]
- Oral health in America: a report of the surgeon general. Rockville, MD: U.S. Department of Health and Human Services, National Institute of Dental and Craniofacial Research, 2000.
- Institute of Medicine, Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, Nelson AR, eds. Unequal treatment: confronting racial and ethnic disparities in health care. Washington, DC: National Academy Press, 2003.
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New vision, new content
Health disparities, local and...
