| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Perspectives |
Key words: oral pathology curriculum
Submitted for publication 12/16/05; accepted 01/10/06
 |
Abstract |
|---|
 Top Abstract MethodsDiscussionConclusionReferences |
|---|
On behalf of the American Association of Dental Schools (AADS; now American Dental Education Association, ADEA), Zunt chaired a committee that included oral pathologists representing one Canadian and seven American dental schools to review and develop curriculum guidelines for predoctoral oral pathology course content.1 These guidelines, which were a revision of those published in the Journal of Dental Education in 1985,2 were approved by AADS and published in 1992.1 The committee recommended a core curriculum outline for oral pathology that consisted of eighteen topics:
Each of these categories was further subdivided, and in many instances, each subdivision included a number of unlisted specific entities. For example, in topic area #6 in the preceding list, "Infections and Infectious-Like Conditions of the Oral Regions," the committee listed "Viral" as a subcategory that contained many specific entities including infections by various herpes viruses, various human papilloma viruses, and human immunodeficiency virus. Consequently, the AADS recommendations are extremely comprehensive. Some subcategories included entities, such as "Myesthenias," that the practicing dentist or dental specialist is very unlikely to encounter. Other categories in the 1992 curriculum guidelines, such as "Healing of Oral Wounds," may be argued to be in the realm of physiology rather than oral pathology.
Although the thoroughness of the committee is to be commended, the list of oral pathology topics arguably may be better suited for a graduate program in oral pathology than for undergraduate dental students destined to become general dentists. Further, the only apparent rationale for this large topic base encompassing hundreds of entities is that these conditions occur in, or may affect, the oral cavity.
There is not universal acceptance of the 1992 oral pathology curriculum guidelines among oral pathologists in U.S. dental schools. In his editorial, Allen alluded to a discussion on the Bulletin Board of Oral Pathology in which different opinions about what should be taught in undergraduate oral pathology were expressed.3 Allen noted that a "laundry list of every possible lesion" does not allow the dental student to discriminate between common and uncommon diseases—conditions likely to be encountered and not likely to be encountered in a general dental practice. Allen and his colleagues at The Ohio State University College of Dentistry emphasize the "50 or so" most common conditions that the student is likely to encounter in a dental career. The dentist encountering any other, less common lesion is taught to refer the patient to an oral and maxillofacial pathologist. Lingen4 agreed with Allen, suggesting that the memorization of long lists of lesions, many of which would never be encountered by the dentist, was unproductive. However, Summerlin5 disagreed. He pointed out that teachers of oral pathology are ultimately responsible to the patient, who has the right to expect dentists to have a broad knowledge base that extends beyond the most common oral lesions or conditions.
Odell et al.6 also suggested that the AADS recommendations were too extensive and incompatible with modern concepts of dental education in the United Kingdom. They recommended a minimum curriculum with six major topic areas: general topics, disorders of the teeth, disorders of the tooth supporting structures, disorders of the oral mucosa, disorders of and within facial and jaw bones, and salivary gland disease. Each of these was divided and, often, further subdivided into specific topics similar to, but less comprehensive, than the AADS guidelines.
In an attempt to resolve the disagreement among oral pathology educators, we propose a model that may offer some degree of objectivity in determining what to teach in oral pathology. Since some subjectivity is inevitable, we believe that the model allows flexibility yet consistency in a logical approach to topic selection.
|
Methods |
|---|
|
TopAbstractMethodsDiscussionConclusionReferences |
|---|
Odell et al. recognized that the significance for health of a disease or condition was also an important criterion.6 We agree that dental students should learn conditions that affect the oral cavity with significant consequences with respect to acute or chronic patient morbidity or potential patient mortality. For example, students must learn about melanoma because it may present orally and may be life-threatening to the patient, although it is neither common nor unique to the oral cavity.
We suggest a third criterion—uniqueness of the condition or disease—because it occurs in the oral cavity and may not be well known by other health care providers. For example, diseases of the teeth and tumors and cysts of the odontogenic apparatus are largely in the knowledge base of the dental profession and are consequently our responsibility, but are not well understood by patients and are not in the spectrum of training for other health professionals. A general dentist may be sought by patients and other health care professionals for information or consultation concerning these conditions.
Circles in a Venn diagram can represent domains, one for each of the three criteria, and a fourth domain that represents an area of overlap (Figure 1
). The diameter of each circle may vary according to the number of entities it contains. Generally, most topics that fall within one of the four zones of intersection should be taught in the oral pathology curriculum. However, the selection of topics may be refined further by assigning a relevance score.
|
Domain 1: Commonness
Score 0— never or rarely occurs in the oral and maxillofacial area (omfa)
1— uncommonly occurs in the omfa
2— sometimes occurs in the omfa
3— commonly occurs in the omfa
Domain 2: Significance
Score 0— trivial, of no clinical significance
1— may cause mild to moderate morbidity
2— causes significant morbidity
3— potentially fatal
Domain 3: Uniqueness
Score 0— a condition or lesion that is not seen and does not affect the omfa
1— when a lesion or condition occurs, it uncommonly affects the omfa
2— when a lesion or condition occurs, it is usually in the omfa
3— exclusively an oral condition or lesion
The relevance score is the sum of scores of the three domains (range 0 to 9). Table 1 lists a number of entities to which we have assigned a relevance score appropriate to our patient population.
|
|
Discussion |
|---|
|
TopAbstractMethodsDiscussionConclusionReferences |
|---|
, we suggest a critical score of 4 for the general dentist. Any score of 4 or above is considered relevant to the practice of general dentistry and should be included in the topic selection. Significantly, all of the diseases listed in Table 2 fall into the overlap zones illustrated in the Venn diagram, since a highest score of 3 in any one domain is insufficient for inclusion. Excluded are such commonly taught entities as congenital lip pits, branchial cleft cysts, impetigo, various fungal infections, Behcet’s syndrome, angioedema, Spitz nevus, a number of unusual neoplasms, osteogenesis imperfecta, and the oral manifestations of many systemic diseases.
|
lists our recommended critical relevance scores for dental specialties and, with reference to Table 1, indicates the topics that we would select for each specialty. We recognize that there is still a significant amount of subjectivity in the process of assignment of topic scores in each of the domains. However, this model offers an objective framework designed to reduce the influence of subjectivity and allow the educator to more easily draw final conclusions about topic selection. Furthermore, some degree of subjectivity is encouraged since there is geographic variation in disease incidence and availability of medical care/specialists. Consequently, individuals in different parts of the world would assign different scores based on local data/conditions, resulting in courses that are more customized.
|
Conclusion |
|---|
|
TopAbstractMethodsDiscussionConclusionReferences |
|---|
|
Footnotes |
|---|
|
REFERENCES |
|---|
|
TopAbstractMethodsDiscussionConclusionReferences |
|---|
This article has been cited by other articles:
|
|
 |
|
  N. R. Chumbler, D. M. Cohen, I. Bhattacharyya, J. Sweitzer, and T. A. Dolan University of Florida College of Dentistry's "Case of the Month": Evaluating a Web-Based Continuing Dental Education Course for Clinical Oral Pathology J Dent Educ., February 1, 2007; 71(2): 260 - 268. [Abstract] [Full Text] [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
