Geriatric dentistry in Brazilian universities

The World Health Organization has predicted an increase in the population of elderly people. 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.     

Geriatric dentistry: a new specialty in Brazil

Objective: To present the current status of geriatric dentistry in Brazil. Background: In 2001, the Brazilian Dental Council established a new specialty: geriatric dentistry. This decision was based on the increase in both the elderly population and the demand for dental treatment of this cohort. Materials and methods: Data were obtained through online searches of the Brazilian Dental Council and the Brazilian Institute of Geography and Statistics. Results: Brazil has 170 dental schools offering around 14 000 undergraduate vacancies every year. At the postgraduate level, there are 19 recognised dental specialties, one of which is geriatric dentistry, comprising 18 certificate programmes, with the potential to produce 216 new specialists every 18 months. The dentist/habitant ratio was 1:870, higher than that recommended by the Word Health Organization. The Brazilian population consists of around 14.5 million elderly people (8.6%). There were 124 specialists in geriatric dentistry distributed irregularly throughout the country. The specialist/elderly population rate was 1:117 249. At the undergraduate level, this new specialty is not included in the curricula of most dental schools in Brazil. Conclusions: Geriatric dentistry should be included in the undergraduate curricula of dental schools in Brazil. Postgraduate degree courses should be developed to produce more clinical academics and researchers in this field.     

A 30-year review of a geriatric dentistry teaching programme

doi: 10.1111/j.1741‐2358.2011.00471.x A 30‐year review of a geriatric dentistry teaching programme Objective: To review the development of the Geriatric Dental and Special Needs Education programme at the University of Iowa over the last 30 years. Background: The programme at Iowa evolved from a didactic elective programme taught by a single faculty person to a required didactic and clinical programme, which includes a Special Care Clinic in the dental school and a mobile unit with portable dental equipment which serves ten area nursing homes with comprehensive care. Materials and methods: Changes have been made in the programme over time based on formal and informal feedback from students and graduates, and we have also looked at the impact of the programme on dental services to our target population. Results: The factors influencing the curriculum development are identified and discussed. Conclusion: As no dental schools are the same, some general applications are suggested from the Iowa experience.     

Perceptions of family medicine and career choice among first year medical students: a cross-sectional survey in a Turkish medical school

Public attitudes to family medicine in Turkey have lagged behind its rapid academic development. The effect of undergraduate training in primary care on medical students' attitudes to family medicine has not been assessed. Objectives of this study were to assess the attitudes of first year medical students at Uludag University School of Medicine in Bursa, Turkey to family medicine and to determine their career aspirations. The study was a survey of the first year medical class in 2003-2004. The response rate was 95% (248/261 students). Students were positive about their choice of medicine as a career but had negative opinions of general practice. Female students were more positive in this respect. Initial preference was for specialization in fields other than general practice with little knowledge of the academic specialty of family medicine. Greater undergraduate exposure to family medicine is needed in order to increase knowledge of the field and influence student career choices.     

The road to Wisconsin

In this article Lynne Sears Williams of Calgary describes her family''s decision to leave for the US, where her husband, Dr. Jim Williams, will pursue his career in family medicine. The decision was not made easily, she writes, but eventually a love for Canada was outweighed by her husband''s desire to practise medicine without the financial and other constraints facing physicians in Canada.     

Do you have any regrets about entering medicine?

Do today''s students have any second thoughts about their decision to pursue a career in medicine? Gabriel Leung, who graduates in June from the University of Western Ontario, considers the problems and dilemmas that have confronted him and his classmates during their short careers and muses on the uncertain future today''s physicians face.     

Need for gerodontology education in India

Objectives: To evaluate the status and need for education in Geriatric Dentistry in India. Materials and methods: The status of dental education in India was studied. India has 185 dental schools producing 12 000 dental graduates every year. At postgraduate level, there are nine recognised specialities in Dentistry, and approximately 58 institutions offer 1160 places for postgraduate degree courses. Dental education is shaped and administered by the Dental Council of India. Results: So far, Geriatric dentistry has not developed as a separate, independent speciality at postgraduate level. The undergraduate curriculum does not have any significant component of geriatric dentistry. The lack of training results in poor understanding of special needs of older adults in young graduates. Without adequate training and personal experience of growing old, young graduates may not be able to understand the physical, socio‐economic and psychological problems of the elderly and the complexities involved in treatment planning for patients with multiple chronic diseases and medication. Conclusions: It is emphasized that geriatric dentistry should be included in each of the pre‐clinical, para‐clinical and clinical subjects at the undergraduate level. Graduate students should be encouraged to treat elderly patients in clinics under supervision using a multi‐disciplinary approach. Also, postgraduate diploma and degree courses in geriatric dentistry should be developed to address the needs of the vast elderly population in India.     

Medicine or Science—A Study of Career Decisions

A study of the career decisions of all students in a single matriculation cohort was undertaken in 1965 at the University of British Columbia. Studied were 64 premedical students, 112 ex-premedical students and 87 science students who had completed at least their second year. It was found by means of a questionnaire that medicine remained the career of high prestige for the three groups of students. In general the values and needs of the ex-premedical student were more similar to those of the science student than the premedical student. The loyalists to medicine were found to be more committed, self-assured, and orientated towards people and service. In addition, the premedical student was more concerned about his academic achievement but was also more confident of his progress. He emerged at the end of his training as the committed student who had chosen medicine at an early age and had remained loyal to his chosen career goal.     

Dental utilisation for older Americans aged 55–75

Objectives: The purpose of this study was to analyze a comprehensive nationally representative data set to determine the effect of economic and non economic determinants on the decision to seek care and the decision to select a specific number of dental visits. Design: The conduct of this study involved the examination and analyses of secondary data available from the National Health Interview Survey. A two-pan choice logistic regression model was utilized to first describe the decision to seek care and second to describe factors associated with the decision to select a specific number of dental visits as a function of income, education, family size, age, marital status, presence of teeth, employment status, health status, gender, race, insurance status, and reason for dental visit. Subjects: Data analysis focused on 5.327 non-institutional older adults between the ages of 55 and 75 who were not eligible for Medicaid. Results: Results provide supporting evidence that income, presence of dental insurance, presence of teeth, gender, family size, education race and age are associated with the decision to seek dental care and that income, presence of dental insurance, gender, family size, education, and race are associated with the number of dental visits among users even when the effects of other variables are controlled for. Discussion : Analyses suggest that employment may have a surprisingly limited effect on dental utilisation and that among explanatory variables there are differences in significance and magnitude between the decision to seek care and the decision to select a specific number of dental visits. In addition, in contrast with some prior studies, health status does not appear to be associated with the decision to seek care or associated with the number of dental visits among respondents.     

Biomedical waste management practice in dentistry

Biomedical Waste Management practice in Dentistry is an important issue. Therefore, it is of interest to document awareness on such issues among clinical practitioners, academicians and students. A survey was completed using a questionnaire from 355 dentists consisting of 201 students, 39 academicians and 115 clinicians in India. Analysis of the survey data shows that majority of students, practitioners, and academicians are aware of laws binding with such issues. However, the Biomedical Waste Management practice among them is not satisfactory. Therefore, education on such issues among clinical practitioners, academicians and students is critical in this part of the globe.     

Use of polymethylmethacrylate as permanent filling agent in the jaw, mouth and face regions--implications for dental practice

doi: 10.1111/j.1741‐2358.2011.00479.x
Use of polymethylmethacrylate as permanent filling agent in the jaw, mouth and face regions – implications for dental practice Objectives: This article is a review of PMMA focusing on its properties, indications, contra‐indications and adverse effects. Background: The search to remain young is a constant attitude among Brazilians. The low cost of filling agents have stimulated its indiscriminate use, especially the bioplasty (non‐incisional method). Polymethylmethacrylate (PMMA) is the cosmetic filling agent of choice, because of its low cost, easy access and simple application technique. The impact on dentistry and orofacial medicine needs further awareness. Conclusion: The article aims to draw the attention of odontology and medical professionals to the product's applicability and its possible complications.     

Who Will Manage American Patients With Diabetes? Residents’ Career Preferences and Perceptions of Diabetes Care

ObjectiveTo identify the factors that encourage or discourage internal medicine and pediatric residents regarding specializing in endocrinology with a focus on diabetes.MethodsWe conducted an electronic survey of internal medicine and pediatric residents using a $10 participation incentive. A total of 653 residents responded to the survey (estimated response rate of 9.2%)—626 from residency programs that were contacted for our survey and 27 from referrals.ResultsAmong internal medicine and pediatric residents surveyed, 39 respondents (6.0%) planned to specialize in endocrinology, and 27 of these (4.1% of total respondents) planned to focus on diabetes. “Intellectual satisfaction, ” “emotional satisfaction, ” and “work-life balance” were identified by respondents as the most important factors in their choice of a specialty, with ratings of 5.5, 5.4, and 5.3 on a 6-point Likert scale. Among these factors identified as most important to a medical career, endocrinology with a focus on diabetes scored poorly with regard to intellectual and emotional satisfaction but received high ranking with regard to lifestyle. With regard to other factors, endocrinology was rated negatively on “compensation, ” “number of procedures, ” and “patient adherence to prescribed treatment.” Exposure to diabetes during training had no major influence on the decision to enter endocrinology.ConclusionEndocrinology with a focus on diabetes care is not an attractive specialty for most internal medicine and pediatric residents. Therefore, new strategies to attract residents to the field of diabetes care are needed. (Endocr Pract. 2011;17:235-239)     

Do adolescents' bioethical decisions differ from those of experts?

If our students are to become well-informed decision makers then they need to be aware of the practical applications of current developments in biotechnology, and appreciate the social and bioethical implications of this relatively new and controversial science. In this study, Year 10 (14 – 15 year old) science students in two schools were taught biotechnology courses that introduced them to bioethics. At the conclusion of the course, students completed a survey in which they made a decision about three bioethical dilemmas, and gave reasons to support their decision. The students' responses and reasons were compared with those of three experts. Although there was variation amongst students, the results of the survey suggested that the majority of students tended to resolve and justify their decisions in a way that was naive, idealistic, and rights based. Compared to the experts, the students seemed to give undue emphasis to the bioethical principle of autonomy. In addition, the reasons supplied by many of the students to support their decisions suggested that they did not consider long term consequences. These findings have ramifications for teachers who wish to include bioethical dilemmas in their teaching.     

It's a Wonderful Life: A Career as an Academic Scientist

Many years of training are required to obtain a job as an academic scientist. Is this investment of time and effort worthwhile? My answer is a resounding “yes.” Academic scientists enjoy tremendous freedom in choosing their research and career path, experience unusual camaraderie in their lab, school, and international community, and can contribute to and enjoy being part of this historical era of biological discovery. In this essay, I further elaborate by listing my top ten reasons why an academic job is a desirable career for young people who are interested in the life sciences.Students are attracted to careers in academic science because of their interest in the subject rather than for financial reward. But then they hear messages that make them think twice about this career choice. It is difficult to find a job: “Hear about Joe? Three publications as a postdoc and still no job offers.” The NIH pay line is low: “Poor Patricia, she is now on her third submission of her first NIH grant.” Publishing is painful: “Felix''s grad school thesis work has been rejected by three journals!” Academic jobs are demanding: “Cathy has spent her last three weekends writing grants rather than being with her family.”Such scenarios do take place, but if you think that this is what a career in academic science is about, then you need to hear the other side of the story. And this is the purpose of this article—a chance to reflect on the many good things about the academic profession. In the classic movie It''s a Wonderful Life, George Bailey is at the point of despair but regains his confidence through the wisdom and perspective of a guardian angel, Clarence. Doubt and setbacks also are bound to happen in science (as is true of other careers), but pessimism should not rule the day. It is a great profession and there are many happy endings. I would like to share my top ten reasons of why being an academic professor is a “wonderful life,” one that bright and motivated young people should continue to aspire to pursue.     

Geriatric dentistry--meet the need

Geriatric dentistry or gerodontics is the delivery of dental care to older adults involving the diagnosis, prevention, and treatment of problems associated with normal ageing and age-related diseases as part of an inter-disciplinary team with other health care professionals. Geriatric health is an ignored and under-explored area worldwide. Oral health reflects overall well being for the elderly population. Conversely, elderly patients are more predisposed to oral conditions due to age-related systemic diseases and functional changes. The major barriers to practising geriatric dentistry are the lack of trained faculty members, a crowded curriculum and monetary concerns. For successful treatment, the practitioner must adopt a humanitarian approach and develop a better understanding of the feelings and attitudes of the elderly. Prevention and early intervention strategies must be formulated to reduce the risk of oral diseases in this population. In future, dental professionals must have a proper understanding of the magnitude of the services to be provided to the elderly. This could only be realised through an education programme in geriatric dentistry, which should be started without further delay. This article hence sets out the objectives, needs, present scenario, strategies and types of dental treatment required by the elderly population.     

Discussions on oral health care among elderly Chinese immigrants in Melbourne and Vancouver

doi: 10.1111/j.1741‐2358.2011.00568.x Discussions on oral health care among elderly Chinese immigrants in Melbourne and Vancouver Background: This study explored how elderly Chinese immigrants value and relate to how acculturation influences oral health and subsequent service use. Methods: Elders who had immigrated to Melbourne and Vancouver within the previous 15 years were recruited from local community centres and assigned to focus groups of 5–7 participants in Vancouver (4 groups) or Melbourne (5 groups). Results: Following an iterative process of thematic analysis, the discussions revealed that immigrants care about the comfort and appearance of their teeth, and they value Western dentistry as a supplement to traditional remedies, but they have difficulty getting culturally sensitive information about oral health care. Accessing dentistry, they explained, is distressing because of language problems and financial costs that impose on their children. Consequently, many immigrants obtain dental treatment in China when they return for occasional visits. They felt that separation of dentistry from national health care programmes in Canada and Australia disregards natural links between oral health and general health. Conclusions: The similarity of concerns in both cities suggests that dissemination of information and availability of services are the important themes influencing oral health, and that, beliefs developed over a lifetime play an important role in interpreting oral health in the host country.     

Determinants of choosing a career in family medicine

Background

Student choice is an important determinant of the distribution of specialties of practising physicians in many countries. Understanding characteristics at entry into medical school that are associated with the choice of residency in family medicine can assist medical schools in admitting an appropriate mix of students to serve the health care needs of their regions.

Methods

From 2002 to 2004, we collected data from students in 15 classes at 8 of 16 Canadian medical schools at entry. Surveys included questions on career choice, attitudes to practice and socio-demographic characteristics. We followed students prospectively with these data linked to their residency choice. We used multiple logistic regression analysis to identify entry characteristics that predicted a student’s ultimate career choice in family medicine.

Results

Of 1941 eligible students in the participating classes, 1542 (79.4%) contributed data to the final analyses. The following 11 entry variables predicted whether a student named family medicine as his or her top residency choice: being older, being engaged or in a long-term relationship, not having parents with postgraduate university education nor having family or close friends practicing medicine, having undertaken voluntary work in a developing nation, not volunteering with elderly people, desire for varied scope of practice, a societal orientation, a lower interest in research, desire for short postgraduate training, and lower preference for medical versus social problems.

Interpretation

Demographic and attitudinal characteristics at entry into medical school predicted whether students chose a career in family medicine.The number of physicians per capita in both Canada and the United States has declined, and this decline is expected to continue. Canada has already experienced a drop of 5.1% in the physician-to-population ratio from a peak in 2000, and in the United States a shortage of up to 200 000 physicians, or 20% of the needed workforce, is predicted to occur by 2025.^1,2 Combined with a growing elderly population and decreasing physician-hours,^3,4 this reduction in the physician-to-population ratio is expected to have implications for the health care systems of both countries. Therefore, health resource planners likely will be looking to expand the role of primary care, and of family medicine in particular.^5–8 To support such an expansion, a commensurate increase in the numbers of domestically trained family physicians will be required. But with as few as 25% (in 2003)⁹ of Canadian medical graduates choosing family medicine as their top career choice in the residency match, it is unlikely the health care system will be able to supply adequate numbers of primary care physicians.In most countries, the number and the distribution of specialties of physicians are determined by numerous factors, including government policies, training opportunities, immigration and emigration of providers, sex and age distribution of providers, and remuneration incentives and disincentives.^10–17 In many medical systems, the career interests of students also have a substantial steering effect on the distribution and number of available physicians.^18,19The purpose of this study was to follow a large cohort of Canadian medical students from school entry through exit to examine how their career aspirations changed over time and to identify, using multiple logistic regression analysis, the variables at entry into medical school that predict a career choice of family medicine at graduation.     

Dental Care for the Elderly

The geriatric population in many parts of the United States is underserved by dentistry. Socioeconomic problems, difficult access to dental facilities, and confusion about the need for dental care often prevent the elderly from seeking dental service. Because dental diseases are not life threatening or outwardly disabling, administrators of institutions for the elderly and health legislators place a low priority on dental care for the elderly. These factors working in concert with the insidious, progressive, and cummulative nature of denture diseases contribute to the poor dental health experienced by some segments of the geriatric population. Dentistry has the manpower and the technology to improve the oral health of the elderly, but society must be made aware of the importance of dental health in the total health of elderly persons in order that dentistry be given a chance to achieve that goal.     

Stem cells: Sources,and regenerative therapies in dental research and practice

Stem cells are considered to be among the principle scientific breakthroughs of the twentieth century for the future of medicine, and considered to be an important weapon to fight against diseases, particularly those that have resisted the efforts of science for a long time. Human dental tissues have limited potentials to regenerate but the discovery of dental stem cells have developed new and surprising scenario in regenerative dentistry. Stem cell treatments are one example of the possibility using adult cells sourced from patients’ own bodies’ means that it can be expected that in the near future such treatments may become routine at dental practices. The hope is that it will become possible to regenerate bone and dental tissues including the periodontal ligament, dental pulp and enamel, and that the creation of new teeth may also become feasible. In view of this possibility of achieving restoration with regenerative medicine, it can be considered that a new era of dentistry is beginning. Thus the aim of this review is to give dental professionals a brief overview of different stem cells sources and the latest findings and their implications for improving oral health and treating certain conditions of the human mouth and face.